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Birhane S, Beyene MG, Tadesse F, Baye AM. Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study. Thromb J 2024; 22:62. [PMID: 38997721 PMCID: PMC11241949 DOI: 10.1186/s12959-024-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and deep venous thrombosis (DVT) are the two most important manifestations of venous thromboembolism (VTE). DVT remains a significant condition since associated morbidity is significant and has elevated healthcare-related costs. METHODS A retrospective cohort study was conducted among DVT patients admitted to Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul's Hospital Millennium Medical College on follow-up from July 1, 2017, to July 01, 2020. Data on sociodemographic characteristics, types of DVT, laboratory findings, medications, risk factors of DVT, complications and outcomes of DVT were collected. The data were analyzed using SPSS version 25. Multivariate logistic regression analysis was conducted to determine predictors of DVT recurrence and major bleeding. A P value < 0.05 was considered to identify significant predictors. RESULTS The mean age of the participants was 45.2 years, with SD of 15.36. The major causes of DVT included immobilization (29.9%), previous surgery (27.5%) and cancer (21.1%). The DVT recurrence rate was 22.5%. Nine (2.2%) of the participants died, and 19.9% developed complications. Bilateral DVT (Adjusted odds ratio (AOR) = 2.8, 95% Confidence interval (CI) = 1.14, 6.66), obesity (AOR = 3.3, 95% CI = 1.15, 9.59), hypertension (AOR = 6.5, 95% CI = 2.90, 14.70) and retroviral infection (AOR = 6.3, 95% CI = 2.34, 16.94) were predictors of recurrent DVT. Nineteen (4.7%) patients had major bleeding, and patients with bilateral DVT, active cancer and terminal age had an increased risk of major bleeding. CONCLUSIONS The overall DVT recurrence rate was alarmingly high and further complicated by PE, post thrombotic syndrome and chronic vein insufficiency, resulting in a 2.2% death rate. Major bleeding after DVT and PE remained high. Close monitoring should be performed for patients with advanced age, active cancer, bilateral DVT, retroviral infection, obesity and hypertension to prevent the recurrence of DVT and major bleeding.
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Affiliation(s)
- Seble Birhane
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Melak Gedamu Beyene
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Fishatsion Tadesse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Mulu Baye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia.
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2
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Shenoy MT, Mondal S, Fernandez CJ, Pappachan JM. Management of male obesity-related secondary hypogonadism: A clinical update. World J Exp Med 2024; 14:93689. [PMID: 38948417 PMCID: PMC11212738 DOI: 10.5493/wjem.v14.i2.93689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 06/19/2024] Open
Abstract
The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism (MOSH) with emerging evidence on the role of testosterone therapy. We aim to provide an updated and practical approach towards its management. We did a comprehensive literature search across MEDLINE (via PubMed), Scopus, and Google Scholar databases using the keywords "MOSH" OR "Obesity-related hypogonadism" OR "Testosterone replacement therapy" OR "Selective estrogen receptor modulator" OR "SERM" OR "Guidelines on male hypogonadism" as well as a manual search of references within the articles. A narrative review based on available evidence, recommendations and their practical implications was done. Although weight loss is the ideal therapeutic strategy for patients with MOSH, achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice. Therefore, androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity. However, there is conflicting evidence for the appropriate use of testosterone replacement therapy (TRT), and it can also be associated with complications. This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH. Before starting testosterone replacement in functional hypogonadism of obesity, it would be desirable to initiate lifestyle modification to ensure weight reduction. TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients. Balancing the risks and benefits of TRT should be considered in every patient before and during long-term management.
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Affiliation(s)
- Mohan T Shenoy
- Department of Endocrinology, Sree Gokulam Medical College, and Research Foundation, Trivandrum 695607, Kerala, India
| | - Sunetra Mondal
- Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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3
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Meier B. Every Patent Foramen Ovale Should Be Closed. J Clin Med 2024; 13:3355. [PMID: 38893065 PMCID: PMC11172438 DOI: 10.3390/jcm13113355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The first respective case report in the medical literature dates back to the 19th century. It led to death. The fact that a PFO is present in roughly 25% of people underscores its overall potential to cause harm. Yet at the same time, the sheer number discourages the medical community from screening for it and from treating it. About 5% of the population have particularly dangerous forms of PFOs. Such PFOs portray a high enough risk for clinical events, the likes of death, stroke, myocardial infarction, or ocular, visceral, and peripheral embolism, to justify screening for them. Highly significant health incidents being at stake, it appears obvious that PFO closure should be used for primary prevention. This is supported by the fact that closing a PFO is the simplest intervention in cardiology, with presumably the highest clinical yield. Being mainly a preventive measure, PFO closure represents a mechanical vaccination. When closing PFOs for one of the rarer therapeutic indications (migraine, platypnea orthodeoxia, etc.), patients automatically profit from the collateral benefit of getting, at the same time, mechanically vaccinated for life against paradoxical embolism. Vice versa, closing a PFO for the prevention of paradoxical embolism betters or cures migraine or exercise dyspnea not infrequently, thereby improving quality of life as a collateral benefit.
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Affiliation(s)
- Bernhard Meier
- Department of Cardiology, University of Bern, 3012 Bern, Switzerland
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4
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Afassinou YM, Adani-Ifè AA, Sossou YI, Pessinaba S, Atta B, Pio M, Baragou S, Damorou F. Epidemiological, clinical, therapeutic and evolutionary specificities of the association between venous thromboembolic event and cancer in sub-Saharan Africa: Case of Togo. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:72-79. [PMID: 38697713 DOI: 10.1016/j.jdmv.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/22/2023] [Indexed: 05/05/2024]
Abstract
BACKGROUND Our study aimed to describe the clinical, paraclinical, therapeutic and outcomes of patients with venous thromboembolic event (VTE) associated with cancer in the context of limited resources. MATERIALS AND METHODS This was a descriptive cross-sectional study over a period of six years from March 1, 2016 to March 31, 2022, in the cardiology department and the oncology unit of the Sylvanus Olympio Teaching Hospital of Lome. Our study examined medical records of patients who were at least 18 years old and had venous thromboembolic disease and cancer that was histologically confirmed. This study did not include records that were incomplete or records from patients with coronavirus disease. RESULTS Our study included 87 patients with average age of 56.36±15.26 years. The discovery of VTE occurred incidentally in 28.74%. Venous thrombosis was isolated in 68.96% and proximal in 95%. Pulmonary embolism was bilateral in 77.77%. Gynaecological and urological cancers were found in 33.33% and 32.19% respectively. Adenocarcinoma was the histological type of cancer found in 47.13%. Cancers were at a very advanced stage in 74.71%. Treatment with antivitamin K was prescribed in 12.65%. In our study, there were 58 patients who passed away with a mortality rate of 66.66%. The cause of death was a complication of VTE in 22.42% and related to the course of cancer in 63.79% of cases. CONCLUSION VTE during cancer is particular with a fatal evolution due to the severity of VTE and the very advanced stage of cancer.
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Affiliation(s)
- Y M Afassinou
- Department of Cardiology, Sylvanus Olympio Teaching Hospital, 15BP 314 Lome, Togo.
| | - A A Adani-Ifè
- Department of Oncology, Sylvanus Olympio Teaching Hospital, Lome, Togo
| | - Y I Sossou
- Department of Cardiology, Sylvanus Olympio Teaching Hospital, 15BP 314 Lome, Togo
| | - S Pessinaba
- Department of Cardiology, Campus Teaching Hospital, Lome, Togo
| | - B Atta
- Department of Medicine, Sokode Regional Hospital, Sokode, Togo
| | - M Pio
- Cardiology Department, Kara Teaching Hospital, Kara, Togo
| | - S Baragou
- Department of Cardiology, Sylvanus Olympio Teaching Hospital, 15BP 314 Lome, Togo
| | - F Damorou
- Department of Cardiology, Campus Teaching Hospital, Lome, Togo
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5
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Khubdast S, Jalilian M, Rezaeian S, Abdi A, Khatony A. Prevalence and factors related with venous thromboembolism in patients admitted to the critical care units: A systematic review and meta-analysis. JOURNAL OF VASCULAR NURSING 2023; 41:186-194. [PMID: 38072571 DOI: 10.1016/j.jvn.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Venous thromboembolism is one of the most common cardiovascular disorders in the any intensive care units (ICUs), which annually leads to death and imposes great costs on patients and society worldwide. The present study was conducted with the aim of determining the prevalence and factors related to venous thromboembolism in the ICUs as a systematic review and meta-analysis. METHODS The current study was conducted in international databases, on all descriptive and analytical studies and clinical and semi-experimental trial studies, without time limit until November 2, 2021. The present study was designed and implemented based on PRISMA guideline. The quality of the studies was checked using STROBE checklist and meta-analysis was performed using CMA software. RESULTS Among the 3204 articles found, after the evaluations, 189 articles entered the full text review phase, and as a result, 38 articles were included in the study. The reported prevalence of thromboembolism was 1-45%. The prevalence of venous thromboembolism was 12% in overall. The chance of venous thromboembolism was higher in ICUs patients >57 years old and ICUs patients with a history of venous thromboembolism. CONCLUSION The results of this study showed that venous thromboembolism has a higher prevalence in ICUs patients in comparison to non-ICUs patients. It is recommended to nurses and healthcare staffs to provide accurate decision and care for prevention of venous thromboembolism and paying attention to the patient's warning signs, timely administration of anticoagulants, and monitor coagulation factors.
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Affiliation(s)
- Safura Khubdast
- Kermanshah School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Jalilian
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Centre, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Kermanshah School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Centre, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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6
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Han J, van Hylckama Vlieg A, Rosendaal FR. Genomic science of risk prediction for venous thromboembolic disease: convenient clarification or compounding complexity. J Thromb Haemost 2023; 21:3292-3303. [PMID: 37838557 DOI: 10.1016/j.jtha.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
Venous thromboembolism (VTE) refers to abnormal blood clots in veins occurring in 1 to 2 per 1000 individuals every year. While anticoagulant treatment can prevent VTE, it increases the risk of bleeding. This emphasizes the importance of identifying individuals with a high risk of VTE and providing prophylactic interventions to these individuals to reduce both VTE and bleeding risks. Current risk assessment of VTE is based on the combination of mainly clinical risk factors. With the identification of an increasing number of genetic variants associated with the risk of VTE, the addition of genetic findings to clinical prediction models can improve risk prediction for VTE. Especially for individuals in high-risk situations, the added value of genetic findings to clinical prediction models may have benefits such as better prophylaxis of VTE and the reduced side effects of bleeding from unnecessary treatment. Nevertheless, the question of whether these models will eventually have clinical utility remains to be proven. Here, we review the current state of knowledge on genetic risk factors for VTE, explore genetic prediction models for VTE, and discuss their clinical implications and challenges.
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Affiliation(s)
- Jihee Han
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Warren RB, Basey V, Lynam A, Curtis C, Ardern-Jones MR. The risk of venous thromboembolism in atopic dermatitis: a matched cohort analysis in UK primary care. Br J Dermatol 2023; 189:427-436. [PMID: 37418627 DOI: 10.1093/bjd/ljad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common chronic inflammatory skin condition. While other chronic inflammatory conditions are associated with increased risk of venous thromboembolism (VTE), associations between AD and VTE have not been established. OBJECTIVES We examined whether AD is associated with an increased risk of VTE in a population-based study. METHODS Electronic health records were extracted from UK general practices contributing to the Optimum Patient Care Research Database (1 January 2010 to 1 January 2020). All adults with AD were identified (n = 150 975) and age- and sex-matched with unaffected controls (n = 603 770). The risk of VTE, consisting of pulmonary embolism (PE) or deep-vein thrombosis (DVT), was compared in people with AD vs. controls using Cox proportional hazard models. PE and DVT were examined separately as secondary outcomes. RESULTS We identified 150 975 adults with active AD and matched them with 603 770 unaffected controls. During the study, 2576 of those with active AD and 7563 of the matched controls developed VTE. Individuals with AD had a higher risk of VTE than controls [adjusted hazard ratio (aHR) 1.17, 95% confidence interval (CI) 1.12-1.22]. When assessing VTE components, AD was associated with a higher risk of DVT (aHR 1.30, 95% CI 1.23-1.37) but not PE (aHR 0.94, 95% CI 0.87-1.02). The VTE risk was greater in older people with AD (≥ 65 years: aHR 1.22, 95% CI 1.15-1.29; 45-65 years: aHR 1.15, 95% CI 1.05-1.26; < 45 years: aHR 1.07, 95% CI 0.97-1.19) and those with obesity [body mass index (BMI) ≥ 30: aHR 1.25, 95% CI 1.12-1.39; BMI < 30: aHR 1.08, 95% CI 1.01-1.15). Risk was broadly consistent across mild, moderate or severe AD. CONCLUSIONS AD is associated with a small increase in risk of VTE and DVT, with no increase in risk of PE. The magnitude of this risk increase is modest in younger people, and those without obesity.
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Affiliation(s)
- Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal, Salford, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Victoria Basey
- Pfizer Ltd, Walton Oaks, Walton on the Hill, Tadworth, UK
| | | | | | - Michael R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Dermatology, University Hospitals Southampton NHS Trust, Southampton, UK
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8
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Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Risk of Venous Thromboembolism With Gout Flares. Arthritis Rheumatol 2023; 75:1638-1647. [PMID: 36808284 DOI: 10.1002/art.42480] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Previous studies demonstrated that the risk of venous thromboembolism (VTE) is increased in patients with gout, but not whether there was a temporal association between gout flare and VTE. This study was undertaken to evaluate potential temporal associations between gout flare and VTE. METHODS Data were obtained from electronic primary-care records from the UK's Clinical Practice Research Datalink, which links data from hospitalization and mortality registers. Using self-controlled case series analysis adjusted for season and age, we evaluated the temporal association between gout flare and VTE. The 90 days after primary-care consultation or hospitalization for gout flare was designated the exposed period. This was divided into three 30-day intervals. The baseline period was up to 2 years before the start of and up to 2 years after the end of the exposed period. The association between gout flare and VTE was measured using adjusted incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). RESULTS In total, 314 patients met the inclusion criteria (age ≥18 years, incident gout, no presence of VTE or use of a primary-care anticoagulant prescription before the start of the pre-exposure period). Among the 314 patients, VTE incidence was significantly higher in the exposed period than in the baseline period (adjusted IRR 1.83, 95% CI 1.30-2.59). The adjusted IRR of VTE during the first 30 days after gout flare was 2.31 (95% CI 1.39-3.82) relative to the baseline period. No increase in the adjusted IRRs was observed in days 31-60 (adjusted IRR 1.49, 95% CI 0.79-2.81) and days 61-90 (adjusted IRR 1.67, 95% CI 0.91-3.06) relative to baseline. Results were consistent across sensitivity analyses. CONCLUSION Among patients with gout, there was a transient increase in the rate of VTE within 30 days after primary-care consultation or hospitalization for gout flare.
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Affiliation(s)
- Edoardo Cipolletta
- Academic Rheumatology, University of Nottingham, Nottingham, UK, and Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | - Anthony J Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
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Gucsav MO, Tatar D. A Scoring System to Determine the Risk Factors Causing Recurrent Pulmonary Thromboembolism. ARCHIVES OF IRANIAN MEDICINE 2023; 26:374-380. [PMID: 38301096 PMCID: PMC10685820 DOI: 10.34172/aim.2023.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2024]
Abstract
BACKGROUND The risk of recurrence in pulmonary embolism is the highest in the first week after the acute event. Although it decreases over time, it may remain high for months depending on compliance with treatment and the nature of the underlying risk factor. Our study aimed to identify risk factors that lead to recurrence in pulmonary thromboembolism (PTE) patients and establish an easy-to-use scoring system that determines the risk of recurrence after the first embolism. METHODS We retrospectively evaluated 1452 patients who were diagnosed with acute PTE between 7/1/2014 and 7/1/2019. Demographic data, comorbidities and clinical data of the patients, and risk factors were recorded. The relationship of the examined parameters with recurrent PTE was evaluated. RESULTS Diabetes mellitus (DM), hypertension, obesity, and the presence of at least one hereditary risk factor were found to be associated with recurrence. The sensitivity of our score was 66.9%, the specificity was 63.2%, the positive predictive value was 19%, and the negative predictive value was 93.7%. The risk of recurrence in the patients identified as high-risk in the scoring system was 3.47 times higher than those identified as low-risk. CONCLUSION In terms of risk of recurrence, special attention should be paid to patients with diabetes, HT, obesity and any of the hereditary risk factors. Using scoring systems to determine the risk of recurrence will be valuable and interesting as it is easy-to-use, gives quick results and provides quantitative results.
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Affiliation(s)
- Mutlu Onur Gucsav
- Department of Chest Diseases, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Dursun Tatar
- Department of Chest Diseases, University of Health Sciences, Dr. Suat Seren Training and Research Hospital for Chest Diseases and Thoracic Surgery, Izmir, Turkey
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10
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Iglesias MJ, Sanchez-Rivera L, Ibrahim-Kosta M, Naudin C, Munsch G, Goumidi L, Farm M, Smith PM, Thibord F, Kral-Pointner JB, Hong MG, Suchon P, Germain M, Schrottmaier W, Dusart P, Boland A, Kotol D, Edfors F, Koprulu M, Pietzner M, Langenberg C, Damrauer SM, Johnson AD, Klarin DM, Smith NL, Smadja DM, Holmström M, Magnusson M, Silveira A, Uhlén M, Renné T, Martinez-Perez A, Emmerich J, Deleuze JF, Antovic J, Soria Fernandez JM, Assinger A, Schwenk JM, Souto Andres JC, Morange PE, Butler LM, Trégouët DA, Odeberg J. Elevated plasma complement factor H related 5 protein is associated with venous thromboembolism. Nat Commun 2023; 14:3280. [PMID: 37286573 PMCID: PMC10247781 DOI: 10.1038/s41467-023-38383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Venous thromboembolism (VTE) is a common, multi-causal disease with potentially serious short- and long-term complications. In clinical practice, there is a need for improved plasma biomarker-based tools for VTE diagnosis and risk prediction. Here we show, using proteomics profiling to screen plasma from patients with suspected acute VTE, and several case-control studies for VTE, how Complement Factor H Related 5 protein (CFHR5), a regulator of the alternative pathway of complement activation, is a VTE-associated plasma biomarker. In plasma, higher CFHR5 levels are associated with increased thrombin generation potential and recombinant CFHR5 enhanced platelet activation in vitro. GWAS analysis of ~52,000 participants identifies six loci associated with CFHR5 plasma levels, but Mendelian randomization do not demonstrate causality between CFHR5 and VTE. Our results indicate an important role for the regulation of the alternative pathway of complement activation in VTE and that CFHR5 represents a potential diagnostic and/or risk predictive plasma biomarker.
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Affiliation(s)
- Maria Jesus Iglesias
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
- Division of Internal Medicine, University Hospital of North Norway (UNN), PB100, 9038, Tromsø, Norway
- Translational Vascular Research, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019, Tromsø, Norway
| | - Laura Sanchez-Rivera
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Manal Ibrahim-Kosta
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Laboratory of Haematology, CRB Assistance Publique-Hôpitaux de Marseille, HemoVasc (CRB AP-HM HemoVasc), Marseille, France
| | - Clément Naudin
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
- Translational Vascular Research, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019, Tromsø, Norway
| | - Gaëlle Munsch
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, ELEANOR, Bordeaux, France
| | - Louisa Goumidi
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Laboratory of Haematology, CRB Assistance Publique-Hôpitaux de Marseille, HemoVasc (CRB AP-HM HemoVasc), Marseille, France
| | - Maria Farm
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Philip M Smith
- Department of Medicine Solna, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Theme of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Florian Thibord
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Framingham, MA, USA
- The Framingham Heart Study, Boston University, Framingham, MA, USA
| | - Julia Barbara Kral-Pointner
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Mun-Gwan Hong
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Pierre Suchon
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Laboratory of Haematology, CRB Assistance Publique-Hôpitaux de Marseille, HemoVasc (CRB AP-HM HemoVasc), Marseille, France
| | - Marine Germain
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, ELEANOR, Bordeaux, France
- Laboratory of Excellence GENMED (Medical Genomics), Bordeaux, France
| | - Waltraud Schrottmaier
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Philip Dusart
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
- Translational Vascular Research, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019, Tromsø, Norway
| | - Anne Boland
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
- Laboratory of Excellence GENMED (Medical Genomics), Evry, France
| | - David Kotol
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Fredrik Edfors
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Mine Koprulu
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Maik Pietzner
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Scott M Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Surgery and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew D Johnson
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Framingham, MA, USA
- The Framingham Heart Study, Boston University, Framingham, MA, USA
| | - Derek M Klarin
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA, USA
| | - David M Smadja
- Hematology Department and Biosurgical Research Lab (Carpentier Foundation), European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, 20 rue Leblanc, Paris, 75015, France
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, 4 avenue de l'Observatoire, Paris, 75270, France
| | - Margareta Holmström
- Coagulation Unit, Department of Haematology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Maria Magnusson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Coagulation Unit, Department of Haematology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Angela Silveira
- Department of Medicine Solna, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mathias Uhlén
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Thomas Renné
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Centre Hamburg-Eppendorf, D-20246, Hamburg, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, D-, 55131, Mainz, Germany
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | - Angel Martinez-Perez
- Genomics of Complex Diseases Group, Research Institute Hospital de la Santa Creu i Sant Pau. IIB Sant Pau, Barcelona, Spain
| | - Joseph Emmerich
- Department of vascular medicine, Paris Saint-Joseph Hospital Group, INSERM 1153-CRESS, University of Paris Cité, 185 rue Raymond Losserand, Paris, 75674, France
| | - Jean-Francois Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
- Laboratory of Excellence GENMED (Medical Genomics), Evry, France
- Centre D'Etude du Polymorphisme Humain, Fondation Jean Dausset, Paris, France
| | - Jovan Antovic
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Jose Manuel Soria Fernandez
- Genomics of Complex Diseases Group, Research Institute Hospital de la Santa Creu i Sant Pau. IIB Sant Pau, Barcelona, Spain
| | - Alice Assinger
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Jochen M Schwenk
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
| | - Joan Carles Souto Andres
- Unitat d'Hemostàsia i Trombosi. Hospital de la Santa Creu i Sant Pau and IIB-Sant Pau, Barcelona, Spain
| | - Pierre-Emmanuel Morange
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Laboratory of Haematology, CRB Assistance Publique-Hôpitaux de Marseille, HemoVasc (CRB AP-HM HemoVasc), Marseille, France
| | - Lynn Marie Butler
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden
- Translational Vascular Research, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019, Tromsø, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - David-Alexandre Trégouët
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, ELEANOR, Bordeaux, France.
- Laboratory of Excellence GENMED (Medical Genomics), Bordeaux, France.
| | - Jacob Odeberg
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, SE-171 21, Stockholm, Sweden.
- Division of Internal Medicine, University Hospital of North Norway (UNN), PB100, 9038, Tromsø, Norway.
- Translational Vascular Research, Department of Clinical Medicine, UiT The Arctic University of Norway, 9019, Tromsø, Norway.
- Department of Medicine Solna, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
- Coagulation Unit, Department of Haematology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
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A Comprehensive Review of Risk Factors for Venous Thromboembolism: From Epidemiology to Pathophysiology. Int J Mol Sci 2023; 24:ijms24043169. [PMID: 36834580 PMCID: PMC9964264 DOI: 10.3390/ijms24043169] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Venous thromboembolism (VTE) is the third most common cause of death worldwide. The incidence of VTE varies according to different countries, ranging from 1-2 per 1000 person-years in Western Countries, while it is lower in Eastern Countries (<1 per 1000 person-years). Many risk factors have been identified in patients developing VTE, but the relative contribution of each risk factor to thrombotic risk, as well as pathogenetic mechanisms, have not been fully described. Herewith, we provide a comprehensive review of the most common risk factors for VTE, including male sex, diabetes, obesity, smoking, Factor V Leiden, Prothrombin G20210A Gene Mutation, Plasminogen Activator Inhibitor-1, oral contraceptives and hormonal replacement, long-haul flight, residual venous thrombosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, trauma and fractures, pregnancy, immobilization, antiphospholipid syndrome, surgery and cancer. Regarding the latter, the incidence of VTE seems highest in pancreatic, liver and non-small cells lung cancer (>70 per 1000 person-years) and lowest in breast, melanoma and prostate cancer (<20 per 1000 person-years). In this comprehensive review, we summarized the prevalence of different risk factors for VTE and the potential molecular mechanisms/pathogenetic mediators leading to VTE.
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12
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Huang Z, Xu X, Xu D, Zhao P, Zou M. Efficacy of 11 anticoagulants for the prevention of venous thromboembolism after total hip or knee arthroplasty: A systematic review and network meta-analysis. Medicine (Baltimore) 2023; 102:e32635. [PMID: 36637921 PMCID: PMC9839234 DOI: 10.1097/md.0000000000032635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the efficacy of 11 anticoagulants in the treatment of venous thromboembolism (VTE) after total hip or knee arthroplasty. METHODS PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine databases were electronically searched for studies assessing the efficacy of different anticoagulants for the prevention of VTE after total hip or knee arthroplasty from January 1, 2010, to January 27, 2022. Two reviewers independently screened the literature, extracted data, and graded the evidence using Confidence in Network Meta-Analysis. The network meta-analysis was then performed using Stata 16.0 software and R 4.1.0 software. RESULTS A total of 61 articles were included. The results of network meta-analysis showed that apixaban, edoxaban, fondaparinux, rivaroxaban, and darexaban were the most effective anticoagulants for the prevention of deep vein thrombosis in patients undergoing total hip or knee arthroplasty (P < .05), while there was no difference in the efficacy among the anticoagulants for the prevention of pulmonary embolism (P > .05). CONCLUSION Apixaban, edoxaban, fondaparinux, rivaroxaban, and darexaban have the best efficacy for the prevention of VTE after total hip or knee arthroplasty.
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Affiliation(s)
- Zhihao Huang
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Xinru Xu
- College of Food Science, Northeast Agricultural University, Harbin, China
| | - Dan Xu
- Obstetrical department, Lijin County Central Hospital, Dongying, China
| | - Pengfei Zhao
- Department of Clinical Pharmacy, Weifang People’s Hospital, Weifang, China
- * Correspondence: Pengfei Zhao, Department of Clinical Pharmacy, Weifang People’s Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang 261041, China (e-mail: )
| | - Miao Zou
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
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de Alencar Martins AR, Rodrigues Junior LF, de Oliveira JR. Benefits of early mobilization in patients with deep venous thrombosis: a scope review. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: Deep venous thrombosis (DVT) is a blood flow obstruction caused by the formation of a thrombus in deep system veins, with higher prevalence in lower limbs. Bed restriction has been indicated in patients with DVT in order to avoid pulmonary embolism caused by displacement of the thrombus. However, immobility has recently been considered a risk factor for DVT, not only due to blood flow stasis, but also by secondary complications as muscle atrophy and weakness. Objective was to review the possible benefits of early mobilization in patients with DVT in the intensive care unit.
Methods: A scope review of literature was conducted. The following keywords were used: deep venous thrombosis, early mobilization and physical therapy. The search was made on Pubmed and Scielo databases. Results: 20 studies were found and 7 articles were included in the review using the exclusion criteria.
Conclusion: Early mobilization association with anticoagulation and compression was described as essential in the treatment of DVT, reducing deleterious effects of immobility, pain, edema, and promoting quality of life improvement.
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14
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Pulmonary Embolism in the Cancer Associated Thrombosis Landscape. J Clin Med 2022; 11:jcm11195650. [PMID: 36233519 PMCID: PMC9570910 DOI: 10.3390/jcm11195650] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
In cancer patients, pulmonary embolism (PE) is the second leading cause of death after the cancer itself, most likely because of difficulties in diagnosing the disease due to its nonclassical presentation. The risk of PE recurrence and possibly the case-fatality rate depends on whether the patient presents a symptomatic PE, an unsuspected PE, a subsegmental PE, or a catheter-related PE. Choosing the best therapeutic option is challenging and should consider the risk of both the recurrence of thrombosis and the occurrence of bleeding. The purpose of this review is to provide an overview of the clinical characteristics and the treatment of cancer-associated PE, which could benefit clinicians to better manage the deadliest form of thrombosis associated with cancer. After a brief presentation of the epidemiological data, we will present the current attitude towards the diagnosis and the management of cancer patients with PE. Finally, we will discuss the perspectives of how the medical community can improve the management of this severe medical condition.
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15
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Lidstrom SC, Wiggins KL, Harrington LB, McKnight B, Blondon M, Smith NL. Incident thrombus location and predicting risk of recurrent venous thromboembolism. Res Pract Thromb Haemost 2022; 6:e12762. [PMID: 35910943 PMCID: PMC9326286 DOI: 10.1002/rth2.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/19/2022] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Understanding venous thromboembolism (VTE) recurrence risk is central to determining the appropriate treatment course. Whether this risk varies after discontinuing anticoagulation or overall by type of incident event (pulmonary embolism [PE] vs deep vein thrombosis [DVT]) and by the detailed location of the DVT needs further clarification. Methods In this population-based inception cohort of incident VTE cases with follow-up by electronic health record review, incident DVT was categorized as distal, popliteal, or iliofemoral. We used the Fine-Gray regression model to describe the predictive association of the thrombus location with the risk of recurrence before death. Results Among 2766 participants with an incident event from 2002 to 2010, 1713 (62%) ceased anticoagulation and were followed for recurrent events; 301 events were observed during the 4.5 years of follow-up. Relative to participants with an incident thrombus in an iliofemoral location and no PE, those with a thrombus in a popliteal location and no PE had a similar risk of recurrence (adjusted subdistribution hazard ratio [aSHR], 0.82 [95% confidence interval (CI), 0.57-1.19]), while those with a thrombus in a distal location and no PE and those with a thrombus that included a PE had lower risk of recurrence: aSHR, 0.34 (95% CI, 0.20-0.57); and aSHR, 0.58 (95% CI 0.45-0.76), respectively. Conclusions The findings of this population-based inception cohort confirm that the risk of recurrent VTE after discontinuing anticoagulants is similar after iliofemoral and popliteal DVT but is lower after distal DVT. Recurrence may be lower after PE than proximal DVT.
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Affiliation(s)
- Sara C. Lidstrom
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kerri L. Wiggins
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Laura B. Harrington
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Barbara McKnight
- Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Marc Blondon
- Division of Angiology and HemostasisGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Nicholas L. Smith
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
- Department of Veterans AffairsSeattle Epidemiologic Research and Information Center, Office of Research & DevelopmentSeattleWashingtonUSA
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16
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Nevares A, Yaseen K, Tamaki H, Bena J, Messner W, Villa-Forte A. Recurrence rate of venous thromboembolic events in granulomatosis with polyangiitis. Rheumatol Adv Pract 2022; 6:rkac058. [PMID: 35855108 PMCID: PMC9291358 DOI: 10.1093/rap/rkac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
The incidence of first-time venous thromboembolic events (VTEs) is high in granulomatosis with polyangiitis (GPA). The incidence of recurrent VTEs is unknown. We aimed to describe the recurrence rate of second VTEs in patients with GPA.
Methods
Retrospective chart review was performed in patients with GPA and at least one VTE at a single centre from 2002 to 2016. Inclusion criteria were 1990 ACR criteria or 2012 Revised International Chapel Hill nomenclature for GPA, at least two follow-up visits, at least one VTE during the study period, and VTE occurrence after or within 3 months before GPA diagnosis. Second VTE event-free survival rates were estimated.
Results
Out of 147 patients initially screened for GPA and with at least one VTE, 84 met inclusion criteria. Median age at first VTE was 57 years. Incidence rate for second VTE was 8.4 events per 100 patient-years (95% CI: 5.7, 12.3). Eighty-three point three per cent of first VTEs and 57.7% of second VTEs occurred when disease was active (P < 0.001). Renal involvement and constitutional symptoms at the time of first VTE were associated with VTE recurrence.
Conclusion
GPA has a high rate of VTE recurrence compared with the reported data in the general population with unprovoked VTE. Our results suggest that VTE in GPA is a recurrent co-morbidity, not always during active vasculitis, and more so in those with renal involvement and constitutional symptoms at the time of first VTE.
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Affiliation(s)
- Alana Nevares
- Correspondence to: Alana Nevares, Division of Rheumatology and Clinical Immunology, Robert Larner, MD, College of Medicine, at the University of Vermont Medical Center, Main Campus, 111 Colchester Avenue, Burlington, VT 05401, USA. E-mail:
| | - Kinanah Yaseen
- Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - James Bena
- Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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Natour AK, Ahmed S, Kim DY, Malinzak L, Rteil A, Kabbani L. Risk of Ipsilateral Deep Vein Thrombosis After Kidney Transplantation: A Retrospective Study. Cureus 2022; 14:e24482. [PMID: 35651413 PMCID: PMC9132759 DOI: 10.7759/cureus.24482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: To investigate the incidence and characteristics of deep vein thrombosis (DVT) in kidney transplantation recipients and analyze whether the anatomical side of DVT was associated with the side of the transplanted organ. Methods: A single-center retrospective medical record review of patients who received a kidney transplant between January 2004 and July 2019 and who subsequently developed DVT. Only patients who received unilateral kidney transplants were included in the study. Patients who underwent concomitant pancreatic transplants, bilateral kidney transplants, or repeat procedures were excluded. Results: Of the 2449 kidney transplants performed during the study period, 1482 were included in the analysis (948 men [64%]; mean age 61 years). Of 606 duplex ultrasound tests, 115 results confirmed the presence of DVT. The incidence of symptomatic DVT was 4.7%. The most common time of DVT diagnosis was within four weeks after transplantation. Type 2 diabetes, heart failure, acute myocardial infarction, sepsis, chronic obstructive pulmonary disease/abnormal pulmonary function, and being confined to bed were associated with DVT after kidney transplant (all P < 0.05). Patients with ultrasound-confirmed DVT had higher mean Caprini scores than patients with negative duplex ultrasounds (P < 0.5). Approximately 53% of transplant patients with ultrasound-confirmed DVT had a 1:1 correlation of transplant side to the side of DVT. Cohen kappa statistic 0.03 indicated no correlation between the side of DVT and the side of transplant. Conclusions: The incidence of DVT after kidney transplant was lower than the incidence reported in the literature. Being confined to a bed may be a risk factor for DVT after transplant surgery. Kidney transplant recipients who had a positive duplex ultrasound had higher Caprini risk assessment scores than transplant recipients who had negative duplex ultrasounds. There was no correlation between the side of the DVT and the side of the transplant.
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18
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Poénou G, Tolédano E, Helfer H, Plaisance L, Happe F, Versini E, Diab N, Djennaoui S, Mahé I. In Search of the Appropriate Anticoagulant-Associated Bleeding Risk Assessment Model for Cancer-Associated Thrombosis Patients. Cancers (Basel) 2022; 14:cancers14081937. [PMID: 35454844 PMCID: PMC9029420 DOI: 10.3390/cancers14081937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Patients with venous thromboembolism events in the context of cancer should receive anticoagulants as long as the cancer is active. Therefore, a tailor-made anticoagulation strategy should rely on an individualized assessment of the risks of recurrent venous thromboembolism and anticoagulant-associated bleeding. No existing risk assessment model for anticoagulant-associated bleeding risk has been validated for cancer-associated thrombosis. To obtain a better risk assessment model to assess anticoagulant-associated bleeding risk in cancer-associated thrombosis patients, we deemed it necessary to answer questions related to how and when to assess anticoagulant-associated bleeding risk as well as what factors to assess for which patients. Abstract Patients with venous thromboembolism events (VTE) in the context of cancer should receive anticoagulants as long as the cancer is active. Therefore, a tailor-made anticoagulation strategy should rely on an individualized risk assessment model (RAM) of recurrent VTE and anticoagulant-associated bleeding. The aim of this review is to investigate the applicability of the currently available RAMs for anticoagulant-associated bleeding after VTE in the CAT population and to provide new insights on how we can succeed in developing a new anticoagulant-associated bleeding RAM for the current medical care of CAT patients. A systematic search for peer-reviewed publications was performed in PubMed. Studies, including systematic reviews, were eligible if they comprised patients with VTE and used a design for developing a prediction model, score, or other prognostic tools for anticoagulant-associated bleeding during anticoagulant treatment. Out of 15 RAMs, just the CAT-BLEED was developed for CAT patients and none of the presented RAMs developed for the VTE general population were externally validated in a population of CAT patients. The current review illustrates the limitations of the available RAMs for anticoagulant-associated bleeding in CAT patients. The development of a RAM for bleeding risk assessment in patients with CAT is warranted.
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Affiliation(s)
- Géraldine Poénou
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
- Correspondence:
| | - Emmanuel Tolédano
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
- Université de Paris Cité, 75006 Paris, France
| | - Hélène Helfer
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
| | - Ludovic Plaisance
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
| | - Florent Happe
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
| | - Edouard Versini
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
- Université de Paris Cité, 75006 Paris, France
| | - Nevine Diab
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
- Université de Paris Cité, 75006 Paris, France
| | - Sadji Djennaoui
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
| | - Isabelle Mahé
- Médecine Interne, Hôpital Louis Mourier, Assistance Publique Hôpitaux de Paris, 92700 Colombes, France; (E.T.); (H.H.); (L.P.); (F.H.); (E.V.); (N.D.); (S.D.); (I.M.)
- Université de Paris Cité, 75006 Paris, France
- Unité Inserm UMR-S1140 Innovation Thérapeutique en Hémostase, 75006 Paris, France
- INNOVTE-FCRIN, CEDEX 2, 42055 Saint-Etienne, France
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Le Mao R, Orione C, de Moreuil C, Tromeur C, Hoffmann C, Fauché A, Robin P, Didier R, Guegan M, Jiménez D, Le Moigne E, Leroyer C, Lacut K, Couturaud F. Risk stratification for predicting recurrent venous thromboembolism after discontinuation of anticoagulation: a post-hoc analysis of a French prospective multicenter study. Eur Respir J 2022; 60:13993003.03002-2021. [PMID: 35210315 DOI: 10.1183/13993003.03002-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to validate and to refine current recurrent venous thromboembolism (VTE) risk classification. METHODS We performed a post-hoc analysis of a multicentre cohort, including 1,881 patients with a first symptomatic VTE prospectively followed after anticoagulation discontinuation. The primary objective was to validate the International Society of Thrombosis and Haemostasis (ISTH) risk classification in predicting recurrence risk. Secondary objective was to evaluate a refined ISTH classification based on recurrence risk estimate for each individual risk factors. RESULTS During a 4.8-year median follow-up after anticoagulation discontinuation, symptomatic recurrent VTE occurred in 230 patients (12.2%). Based on ISTH classification, patients with unprovoked VTE or VTE with minor or major persistent risk factor had a 2-fold increased recurrence risk as compared to those with VTE and major transient risk factor. Recurrence risk was not increased in patients with minor transient factor (Hazard Ratio[HR] 1.31;95%CI0.84-2.06). Individual risk factors analysis identified hormone-related VTE (pregnancy: HR 0.26; 95%CI0.08-0.82; estrogens: HR 0.25; 95%CI0.14-0.47) and amyotrophic lateral sclerosis (HR 5.84; 95%CI1.82-18.70). After reclassification of these factors as major transient for the former and major persistent for the latter, refined ISTH classification allowed to accurately discriminate between patients at low-risk (i.e., with major transient risk factor) and those at high-risk of recurrence (i.e., without major transient risk factors). CONCLUSIONS Among patients who stopped anticoagulation after a first VTE, a refined ISTH classification based on recurrence risk intensity of individual factors allowed to discriminate between patients at low-recurrence risk, including hormonal exposure in women, and patients at high-recurrence risk.
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Affiliation(s)
- Raphael Le Mao
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France .,Centre d'Investigation Clinique INSERM 1412, Brest, France
| | - Charles Orione
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France
| | - Claire de Moreuil
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France
| | - Cécile Tromeur
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France
| | - Clément Hoffmann
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France
| | - Alexandre Fauché
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France
| | - Philippe Robin
- Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France.,Service de médecine nucléaire, EA3878, CHU de Brest, Univ_Brest, Brest, France
| | - Romain Didier
- Centre d'Investigation Clinique INSERM 1412, Brest, France.,Service de cardiologie, EA3878, CHU de Brest, Univ_Brest, Brest, France
| | - Marie Guegan
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Medicine Department, Universidad de Alcalá, (IRYCIS), Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Emmanuelle Le Moigne
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France
| | - Christophe Leroyer
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France
| | - Karine Lacut
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France.,In memory of Karine Lacut
| | - Francis Couturaud
- Département de médecine interne et pneumologie, EA3878, CHU de Brest, Univ_Brest, Brest, France.,Centre d'Investigation Clinique INSERM 1412, Brest, France.,FCRIN INNOVTE network, Brest, France
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20
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R Charlier SH, Meier C, Jick SS, Meier CR, Becker C. Association between glycemic control and risk of venous thromboembolism in diabetic patients: a nested case-control study. Cardiovasc Diabetol 2022; 21:2. [PMID: 34983504 PMCID: PMC8729078 DOI: 10.1186/s12933-021-01432-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM. METHODS We conducted a nested case-control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders. RESULTS We identified 2'653 VTE cases and 10'612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36-55% increased relative risk of VTE when compared to women with HbA1c > 6.5-7.0%. CONCLUSIONS Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5-7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.
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Affiliation(s)
- Sarah H R Charlier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christian Meier
- Division of Endocrinology, Diabetes & Metabolism, University Hospital Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, USA.,School of Public Health, Boston University, Boston University School of Medicine, Lexington, USA
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Lexington, USA.
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4056, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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21
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Scharrer S, Primas C, Eichinger S, Tonko S, Kutschera M, Koch R, Blesl A, Reinisch W, Mayer A, Haas T, Feichtenschlager T, Fuchssteiner H, Steiner P, Ludwiczek O, Platzer R, Miehsler W, Tillinger W, Apostol S, Schmid A, Schweiger K, Vogelsang H, Dejaco C, Herkner H, Novacek G. Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism. Inflamm Bowel Dis 2021; 27:1773-1783. [PMID: 33386735 DOI: 10.1093/ibd/izaa337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. METHODS This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. RESULTS We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. CONCLUSION The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.
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Affiliation(s)
- Susanna Scharrer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Sabine Eichinger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Tonko
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.,Praxis am rhy AG, Kriessern, Switzerland
| | - Maximilian Kutschera
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Robert Koch
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Andreas Mayer
- Department of Internal Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | | | | | - Harry Fuchssteiner
- Department of Internal Medicine IV, Hospital Elisabethinen Linz, Linz, Austria
| | - Pius Steiner
- Department of Internal Medicine I, Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Reingard Platzer
- Department of Internal Medicine I, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Wolfgang Miehsler
- Department of Internal Medicine, Hospital Brothers of St. John of God Salzburg, Salzburg, Austria
| | | | - Sigrid Apostol
- Department of Internal Medicine, Hietzing Clinic, Vienna, Austria
| | - Alfons Schmid
- Department of Internal Medicine 2, Danube Hospital, Vienna, Austria
| | - Karin Schweiger
- Department of Internal Medicine 4, Ottakring Clinic, Vienna, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Clemens Dejaco
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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22
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Eichinger S, Morange PE, Cattaneo M, Fretigny M, Rauch A, van Hylckama Vlieg A, Trégouët DA, Ruf W, Levi M, Páramo JA, van der Poll T, Kyrle PA, Garagiola I, Peyvandi F. The EHA Research Roadmap: Blood Coagulation and Hemostatic Disorders. Hemasphere 2021; 5:e643. [PMID: 34522845 PMCID: PMC8432639 DOI: 10.1097/hs9.0000000000000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
In 2016, the European Hematology Association (EHA) published the EHA Roadmap for European Hematology Research1 aiming to highlight achievements in the diagnostics and treatment of blood disorders, and to better inform European policy makers and other stakeholders about the urgent clinical and scientific needs and priorities in the field of hematology. Each section was coordinated by 1-2 section editors who were leading international experts in the field. In the 5 years that have followed, advances in the field of hematology have been plentiful. As such, EHA is pleased to present an updated Research Roadmap, now including 11 sections, each of which will be published separately. The updated EHA Research Roadmap identifies the most urgent priorities in hematology research and clinical science, therefore supporting a more informed, focused, and ideally funded future for European hematology research. The 11 EHA Research Roadmap sections include Normal Hematopoiesis; Malignant Lymphoid Diseases; Malignant Myeloid Diseases; Anemias and Related Diseases; Platelet Disorders; Blood Coagulation and Hemostatic Disorders; Transfusion Medicine; Infections in Hematology; Hematopoietic Stem Cell Transplantation; CAR-T and Other Cell-based Immune Therapies; and Gene Therapy.
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Affiliation(s)
- Sabine Eichinger
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Austria
| | | | | | | | - Antoine Rauch
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France
| | | | | | - Wolfram Ruf
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Marcel Levi
- Amsterdam University Medical Centers, Department of Vascular Medicine, University of Amsterdam, The Netherlands
- Department of Medicine, University College London Hospitals, United Kingdom
| | | | - Tom van der Poll
- Amsterdam University Medical Centers, Division of Infectious Diseases & Center of Experimental Molecular Medicine, University of Amsterdam, The Netherlands
| | - Paul A. Kyrle
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Austria
| | - Isabella Garagiola
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
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23
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Ferrari E, Fourrier E, Asarisi F, Heme N, Redjimi N, Berkane N, Labbaoui M, Breittmayer JP, Bun SS, Moceri P, Squara F. Is pulmonary embolism recurrence linked with the severity of the first event? A French retrospective cohort study. BMJ Open 2021; 11:e050910. [PMID: 34588255 PMCID: PMC8483023 DOI: 10.1136/bmjopen-2021-050910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Severity of a first pulmonary embolism (PE) is sometimes proposed as a criterion for prolonging anticoagulant treatment. However, little evidence supports this idea. We attempted to determine the connection between severity of first PE and the risk of recurrence. PARTICIPANTS Patients admitted with PE between 2012 and 2018 and for whom anticoagulant treatment had been discontinued were followed. PEs were classified according to the severity into the following two groups: those with associated cardiac involvement (increased cardiac biomarker(s) and/or echocardiographic right ventricular dysfunction) and those with no cardiac involvement which were classified as non-severe. Recurrence-free survivals were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS 417 patients with PEs (186 with cardiac involvement) were followed for at least 1 year after discontinuation of treatment with a mean follow-up of: 3.5±1.9 years. 72 patients (17.3%) experienced venous thromboembolism recurrence: 24 (5.8%), 44 (12 %) and 72 (28.3 %) respectively, at 1, 2 and 5 years. In 63 patients (88%), recurrence was a PE. Mean time to onset of recurrence was 24.9±19.9 months. At 5 years, the recurrence rate is higher when the first PE was associated with cardiac involvement p=0.043. In contrast, in patients with provoked PE, the recurrence rate is higher when the first PE event was associated with cardiac involvement: p=0.032. Multivariate analysis demonstrates that PE severity is an independent factor of recurrence (HR 1.634 (1.015-2.632), p=0.043). CONCLUSION We report for the first time a possible link between a higher recurrence rate and the severity of the first PE. This result which must be confirmed in a dedicated prospective trial could become an important criterion for the duration of anticoagulant therapy after a PE. TRIAL REGISTRATION NUMBER NCT04980924.
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Affiliation(s)
- Emile Ferrari
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Etienne Fourrier
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Florian Asarisi
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Nathan Heme
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Nassim Redjimi
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | | | - Mohamed Labbaoui
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | | | - Sok Sithikun Bun
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Pamela Moceri
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
| | - Fabien Squara
- Cardiology Department, Centre Hospitalier Universitaire de Nice Hopital Pasteur, Nice, France
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24
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Yamashita Y, Morimoto T, Kimura T. Venous thromboembolism: Recent advancement and future perspective. J Cardiol 2021; 79:79-89. [PMID: 34518074 DOI: 10.1016/j.jjcc.2021.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/21/2022]
Abstract
Clinicians have been more and more often encountering patients with venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, leading to the increased importance of VTE in daily clinical practice. VTE is becoming a common issue in Asian countries including Japan. The management strategies of VTE have changed dramatically in the past decade including the introduction of direct oral anticoagulants (DOACs). In addition, there have been several landmark clinical trials assessing acute treatment strategies including thrombolysis and inferior vena cava (IVC) filter. The current VTE guidelines do not recommend the routine use of thrombolysis or IVC filters based on recent evidence; Nevertheless, the prevalence of thrombolysis and IVC filter use in Japan was strikingly high. The novel profiles of DOACs with rapid onset of action and potential benefit of a lower risk for bleeding compared with vitamin K antagonist could make home treatment feasible and is safer even with extended anticoagulation therapy. One of the most clinically relevant issues for VTE treatment is optimal duration of anticoagulation for the secondary prevention of VTE. Considering recent evidence, optimal duration of anticoagulation should be determined based on the risk for recurrence as well as the risk for bleeding in an individual patient. Despite the recent advances for VTE management, there are still a number of uncertain issues that challenge clinicians in daily clinical practice, such as cancer-associated VTE and minor VTE including subsegmental pulmonary embolism and distal deep vein thrombosis, warranting future research. Several clinical trials are now ongoing for these issues, globally as well as in Japan. The current review is aimed to overview the recent advances in VTE management, describe the current status including some domestic issues in Japan, and discuss the future perspective of VTE.
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Affiliation(s)
- Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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25
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Salas E, Farm M, Pich S, Onelöv L, Guillen K, Ortega I, Antovic JP, Soria JM. Predictive Ability of a Clinical-Genetic Risk Score for Venous Thromboembolism in Northern and Southern European Populations. TH OPEN 2021; 5:e303-e311. [PMID: 34263111 PMCID: PMC8266419 DOI: 10.1055/s-0041-1729626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/01/2021] [Indexed: 11/01/2022] Open
Abstract
Venous thromboembolism (VTE) is a complex, multifactorial problem, the development of which depends on a combination of genetic and acqfiguired risk factors. In a Spanish population, the Thrombo inCode score (or TiC score), which combines clinical and genetic risk components, was recently proven better at determining the risk of VTE than the commonly used model involving the analysis of two genetic variants associated with thrombophilia: the Factor V Leiden (F5 rs6025) and the G20210A prothrombin (F2 rs1799963). The aim of the present case-control study was to validate the VTE risk predictive capacity of the TiC score in a Northern European population (from Sweden). The study included 173 subjects with VTE and 196 controls. All were analyzed for the genetic risk variants included in the TiC gene panel. Standard measures -receiver operating characteristic (ROC) area under the curve (AUC), sensitivity, specificity, and odds ratio (OR)-were calculated. The TiC score returned an AUC value of 0.673, a sensitivity of 72.25%, a specificity of 60.62%, and an OR of 4.11. These AUC, sensitivity, and OR values are all greater than those associated with the currently used combination of genetic variants. A TiC version adjusted for the allelic frequencies of the Swedish population significantly improved its AUC value (0.783). In summary, the TiC score returned more reliable risk estimates for the studied Northern European population than did the analysis of the Factor V Leiden and the G20210A genetic variations in combination. Thus, the TiC score can be reliably used with European populations, despite differences in allelic frequencies.
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Affiliation(s)
- Eduardo Salas
- Scientific Department, Gendiag, c/ Lepant, 141-4-1, 08013 Barcelona, Spain
| | - Maria Farm
- Institute for Molecular Medicine and Surgery and Department of Clinical Chemistry, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sara Pich
- Scientific Department, Gendiag, c/ Lepant, 141-4-1, 08013 Barcelona, Spain
| | - Liselotte Onelöv
- Institute for Molecular Medicine and Surgery and Department of Clinical Chemistry, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kevin Guillen
- Scientific Department, Gendiag, c/ Lepant, 141-4-1, 08013 Barcelona, Spain
| | - Israel Ortega
- Scientific Department, Gendiag, c/ Lepant, 141-4-1, 08013 Barcelona, Spain
| | - Jovan P Antovic
- Institute for Molecular Medicine and Surgery and Department of Clinical Chemistry, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jose Manuel Soria
- Genomic of Complex Diseases, Institut d'Investigació Sant Pau (IIB-Sant Pau), Barcelona, Spain
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26
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Ageno W. Difficult challenges in vascular medicine. Minerva Med 2021; 112:698-700. [PMID: 34236159 DOI: 10.23736/s0026-4806.21.07702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy -
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27
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Kirschner M, do Ó Hartmann N, Parmentier S, Hart C, Henze L, Bisping G, Griesshammer M, Langer F, Pabinger-Fasching I, Matzdorff A, Riess H, Koschmieder S. Primary Thromboprophylaxis in Patients with Malignancies: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO), the Society of Thrombosis and Hemostasis Research (GTH), and the Austrian Society of Hematology and Oncology (ÖGHO). Cancers (Basel) 2021; 13:2905. [PMID: 34200741 PMCID: PMC8230401 DOI: 10.3390/cancers13122905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer, both hematologic and solid malignancies, are at increased risk for thrombosis and thromboembolism. In addition to general risk factors such as immobility and major surgery, shared by non-cancer patients, cancer patients are exposed to specific thrombotic risk factors. These include, among other factors, cancer-induced hypercoagulation, and chemotherapy-mediated endothelial dysfunction as well as tumor-cell-derived microparticles. After an episode of thrombosis in a cancer patient, secondary thromboprophylaxis to prevent recurrent thromboembolism has long been established and is typically continued as long as the cancer is active or actively treated. On the other hand, primary prophylaxis, even though firmly established in hospitalized cancer patients, has only recently been studied in ambulatory patients. This recent change is mostly due to the emergence of direct oral anticoagulants (DOACs). DOACs have a shorter half-life than vitamin K antagonists (VKA), and they overcome the need for parenteral application, the latter of which is associated with low-molecular-weight heparins (LMWH) and can be difficult for the patient to endure in the long term. Here, first, we discuss the clinical trials of primary thromboprophylaxis in the population of cancer patients in general, including the use of VKA, LMWH, and DOACs, and the potential drug interactions with pre-existing medications that need to be taken into account. Second, we focus on special situations in cancer patients where primary prophylactic anticoagulation should be considered, including myeloma, major surgery, indwelling catheters, or immobilization, concomitant diseases such as renal insufficiency, liver disease, or thrombophilia, as well as situations with a high bleeding risk, particularly thrombocytopenia, and specific drugs that may require primary thromboprophylaxis. We provide a novel algorithm intended to aid specialists but also family practitioners and nurses who care for cancer patients in the decision process of primary thromboprophylaxis in the individual patient.
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Affiliation(s)
- Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Nicole do Ó Hartmann
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Stefani Parmentier
- Oncology and Hematology, Tumor Center, St. Claraspital, 4058 Basel, Switzerland;
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Larissa Henze
- Department of Medicine, Clinic III—Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Guido Bisping
- Department of Medicine I, Mathias Spital Rheine, 48431 Rheine, Germany;
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, 32429 Minden, Germany;
| | - Florian Langer
- II.Medical Clinic and Polyclinic, Center for Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Ingrid Pabinger-Fasching
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Axel Matzdorff
- Department of Internal Medicine II, Asklepios Clinic Uckermark, 16303 Schwedt, Germany;
| | - Hanno Riess
- Medical Department, Division of Oncology and Hematology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
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Dahm AEA. Cancer and Thrombosis: New Treatments, New Challenges. Med Sci (Basel) 2021; 9:medsci9020041. [PMID: 34204957 PMCID: PMC8293316 DOI: 10.3390/medsci9020041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 12/21/2022] Open
Abstract
The direct-acting oral anticoagulant (DOAC) has become an alternative to low-molecular-weight heparin (LMWH) for treatment and prophylaxis of venous thromboembolism (VTE) in cancer patients. The clinicians are, however, faced with difficult decisions regarding DOAC treatment: Which patients cannot use DOACs? Should incidental VTE be treated similar to symptomatic VTE? Is it safe to give DOACs to patients with gastrointestinal or urogenital cancers? How about drug–drug interactions? Should all cancer patients receive thromboprophylaxis? Is arterial thrombosis a problem? The current article reviews the available literature regarding these questions and aims to provide practical solutions based on data from the clinical trials and new guidelines.
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Affiliation(s)
- Anders Erik Astrup Dahm
- Department of Hematology, Akershus University Hospital, 1478 Lørenskog, Norway;
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
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Borjas Howard J, Ruiz-Sada P, de Leeuw K, López-Jiménez L, Font C, Marchena PJ, Madridano O, Debourdeau P, Meijer K, Monreal M. Risk of recurrent venous thromboembolism in patients with autoimmune diseases: data from the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry. Br J Haematol 2021; 194:195-199. [PMID: 34075574 PMCID: PMC8362114 DOI: 10.1111/bjh.17549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Autoimmune disease is a risk factor for first incident venous thromboembolism (VTE). However, data on the risk of recurrent VTE in people with autoimmune disease is sparse. We explored the risk of recurrent VTE using the RIETE registry, comparing people with autoimmune disease (n = 1305) to those without (n = 50608). Overall rates were 6.5 and 5.1 recurrent VTE/100 years for patients with autoimmune disease vs controls, respectively. After adjustment for sex and unprovoked/provoked VTE yielded an adjusted hazard ratio of 1.29 (95%CI 1.03‐1.62). The analysis was limited by short median follow up time (161 days overall), precluding definitive conclusions on recurrent VTE risks.
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Affiliation(s)
- Jaime Borjas Howard
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Pablo Ruiz-Sada
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain
| | - Karina de Leeuw
- Department of Rheumatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Pablo Javier Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Philippe Debourdeau
- Department of Supportive Care Oncology, Institut Sainte Catherine, Avignon, France
| | - Karina Meijer
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autonoma de Barcelona, Barcelona, Spain.,Chair of Thromboembolic Diseases, Universidad Católica de Murcia, Universidad Autónoma de Barcelona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Endogenous Cushing's syndrome (CS) is associated with increased patient morbidity (hypertension, diabetes mellitus, dyslipidemia, visceral obesity, osteoporosis, cognitive alterations, and impaired quality of life). Both arterial and venous thromboembolic events (TE) due to alterations in the hemostatic system and prothrombotic state are widely reported in patients with CS, more so postoperatively. Increased mortality, if not appropriately treated, is largely due to cardiovascular events and infections. RECENT FINDINGS Patients with CS have markedly increased risk of thromboembolic episodes compared to the general population. The prothrombotic state is mediated by increased levels of procoagulant factors, but also by an impaired fibrinolytic capacity. All contribute to TE, atherosclerosis, and subsequent cardiovascular morbidity and mortality. Some abnormalities progressively improve after CS remission, but do not fully normalize for at least 1 year or more. SUMMARY Due to the additional thrombotic risk of surgery or any invasive procedure, anticoagulation prophylaxis should be at least considered in patients with CS and balanced with individual bleeding risk. However, a clear protocol of thromboprophylaxis is lacking and increased awareness regarding risks per se is needed. Large prospective trials will clarify, which patients with CS are at the highest risk and the optimal prevention protocol to minimize risks and maximize efficacy.
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Affiliation(s)
- Cristina Capatina
- Department of Endocrinology, University of Medicine and Pharmacy 'Carol Davila' Bucharest, and Department of Pituitary and Neuroendocrine Pathology, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Maria Fleseriu
- Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery, and Pituitary Center, Oregon Health & Science University, Portland, Oregon, USA
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31
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Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood Adv 2021; 4:4296-4311. [PMID: 32915980 DOI: 10.1182/bloodadvances.2019001052] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.
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Benhamou Y, Delluc A, Mauge L, Fischer AM, Sanchez O. [Which aetiological investigations to undertake during the progress of PE/DVT?]. Rev Mal Respir 2021; 38 Suppl 1:e90-e98. [PMID: 33744073 DOI: 10.1016/j.rmr.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Y Benhamou
- Service de médecine interne, CHU Charles-Nicolle, Normandie université UNI Rouen U1096, 76000 Rouen, France
| | - A Delluc
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; EA 3878 GETBO, université de Bretagne occidentale, 29200 Brest, France
| | - L Mauge
- UMR-S 970, PARCC (Paris-Cardiovascular Research Center), service d'hématologie biologique, hôpital européen Georges-Pompidou, Assistance publique Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - A-M Fischer
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Service d'hématologie biologique hôpital européen Georges-Pompidou, Assistance publique des hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France.
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Meitei SP, Tale S, Negi AK, Dua R, Walia R, Saxena S. Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India. Monaldi Arch Chest Dis 2021; 91. [PMID: 33728884 DOI: 10.4081/monaldi.2021.1742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/07/2021] [Indexed: 11/23/2022] Open
Abstract
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA). Results were analysed using SPSS version 23. Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.
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Affiliation(s)
- Soibam Pahel Meitei
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikes.
| | - Sudheer Tale
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikes.
| | - Arjun Kumar Negi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikes.
| | - Ruchi Dua
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh.
| | - Rohit Walia
- Department of Cardiology, All India Institute of Medical Sciences, Rishikes.
| | - Sudhir Saxena
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikes.
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Platelet hyperaggregability and venous thrombosis risk: results from the RETROVE project. Blood Coagul Fibrinolysis 2021; 32:122-131. [PMID: 33337623 DOI: 10.1097/mbc.0000000000001006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to determine whether platelet hyperaggregability correlates with short closure times (PFA-100) and if hyperaggregability is associated with the risk of venous thrombosis in a Spanish population. Case--control study (RETROVE project) involving 400 patients with venous thrombosis and 400 healthy controls. We determined platelet aggregation in platelet-rich plasma (PRP) by light transmission aggregometry. Various concentrations of two aggregation agonists [ADP and epinephrine (EPI)] were tested to determine the percentage of maximal aggregation and the percentage area under the curve (AUC). Venous thrombosis risk associated with platelet hyperaggregability was calculated by logistic regression. We estimated the crude and adjusted (by sex and age) odds ratios (OR) for venous thrombosis risk. An agonist concentration of 0.5 μmol/l differentiated between hypo-responders and hyper-responders at the following AUC cut-off values: EPI: the 50th percentile for aggregation with 0.5 μmol/l of EPI (EPI_AUC) was 22.53% (>22.53% = hyper-EPI); the crude risk for venous thrombosis was statistically significant (OR = 1.37; 95% CI 1.03-1.82); ADP: the 75th percentile for aggregation with 0.5 μmol/l of ADP (ADP_AUC) was 29.6% (>29.6% = hyper-ADP), with a significant crude risk for venous thrombosis (OR = 1.44; 95% CI 1.05-1.98). However, after adjustment for confounders (age), the ORs for EPI or ADP aggregation were no longer significant. EPI_AUC and PFA-100 values with the EPI agonist were significantly correlated (R = -0.342, P < 0.01). Only 12% of the PFA-100 values were explained by platelet aggregation. In this case--control study, platelet hyperaggregability was not associated with the risk of developing venous thrombosis.
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35
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Weitz JI, Prandoni P, Verhamme P. Anticoagulation for Patients with Venous Thromboembolism: When is Extended Treatment Required? TH OPEN 2020; 4:e446-e456. [PMID: 33376944 PMCID: PMC7758152 DOI: 10.1055/s-0040-1721735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
The need for extended venous thromboembolism (VTE) treatment beyond 3 to 6 months is usually determined by balancing the risk of recurrence if treatment is stopped against the risk of bleeding from continuing treatment. The risk of recurrence, and in turn the decision to extend, can be determined through the nature of the index event. Patients with VTE provoked by surgery or trauma (major transient risk factors) are recommended to receive 3 months of anticoagulation therapy because their risk of recurrence is low, whereas patients with VTE provoked by a major persistent risk factor, such as cancer, or those considered to have “unprovoked” VTE, are recommended to receive an extended duration of therapy based on an established high risk of recurrence. Nonetheless, recent evidence and new guidance identify that this approach fails to consider patients with risk factors classed as minor transient (e.g., impaired mobility and pregnancy) or minor persistent (e.g., inflammatory bowel disease and congestive heart disease). Indeed, the risk of recurrence with respect to VTE provoked by minor persistent risk factors has been demonstrated to be not dissimilar to that of VTE without identifiable risk factors. This review provides an overview of the available data on the risk of recurrence according to the underlying cause of VTE, a critical evaluation of evidence from clinical studies on the available anticoagulants for extended VTE treatment, models of risk prediction for recurrent VTE and bleeding, and guidance on how to apply the evidence in practice.
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Affiliation(s)
- Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
| | - Paolo Prandoni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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36
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Bradbury CA, Craig Z, Cook G, Pawlyn C, Cairns DA, Hockaday A, Paterson A, Jenner MW, Jones JR, Drayson MT, Owen RG, Kaiser MF, Gregory WM, Davies FE, Child JA, Morgan GJ, Jackson GH. Thrombosis in patients with myeloma treated in the Myeloma IX and Myeloma XI phase 3 randomized controlled trials. Blood 2020; 136:1091-1104. [PMID: 32438407 PMCID: PMC7453153 DOI: 10.1182/blood.2020005125] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022] Open
Abstract
Newly diagnosed multiple myeloma (NDMM) patients treated with immunomodulatory drugs are at high risk of venous thromboembolism (VTE), but data are lacking from large prospective cohorts. We present thrombosis outcome data from Myeloma IX (n = 1936) and Myeloma XI (n = 4358) phase 3 randomized controlled trials for NDMM that treated transplant-eligible and transplant-ineligible patients before and after publication of thrombosis prevention guidelines. In Myeloma IX, transplant-eligible patients randomly assigned to cyclophosphamide, vincristine, doxorubicin, and dexamethasone (CVAD) induction had higher risk of VTE compared with patients treated with cyclophosphamide, thalidomide, and dexamethasone (CTD) (22.5% [n = 121 of 538] vs 16.1% [n = 89 of 554]; adjusted hazard ratio [aHR],1.46; 95% confidence interval [95% CI], 1.11-1.93). For transplant-ineligible patients, those randomly assigned to attenuated CTD (CTDa) induction had a higher risk of VTE compared with those treated with melphalan and prednisolone (MP) (16.0% [n = 68 of 425] vs 4.1% [n = 17 of 419]; aHR, 4.25; 95% CI, 2.50-7.20). In Myeloma XI, there was no difference in risk of VTE (12.2% [n = 124 of 1014] vs 13.2% [n = 133 of 1008]; aHR, 0.92; 95% CI, 0.72-1.18) or arterial thrombosis (1.2% [n = 12 of 1014] vs 1.5% [n = 15 of 1008]; aHR, 0.80; 95% CI, 0.37-1.70) between transplant-eligible pathways for patients treated with cyclophosphamide, lenalidomide, and dexamethasone (CRD) or CTD. For transplant-ineligible patients, there was no difference in VTEs between attenuated CRD (CRDa) and CTDa (10.4% [n = 95 of 916] vs 10.7% [n = 97 of 910]; aHR, 0.97; 95% CI, 0.73-1.29). However, arterial risk was higher with CRDa than with CTDa (3.1% [n = 28 of 916] vs 1.6% [n = 15 of 910]; aHR, 1.91; 95% CI, 1.02-3.57). Thrombotic events occurred almost entirely within 6 months of treatment initiation. Thrombosis was not associated with inferior progression-free survival (PFS) or overall survival (OS), apart from inferior OS for patients with arterial events (aHR, 1.53; 95% CI, 1.12-2.08) in Myeloma XI. The Myeloma XI trial protocol incorporated International Myeloma Working Group (IMWG) thrombosis prevention recommendations and compared with Myeloma IX, more patients received thromboprophylaxis (80.5% vs 22.3%) with lower rates of VTE for identical regimens (CTD, 13.2% vs 16.1%; CTDa, 10.7% vs 16.0%). However, thrombosis remained frequent in spite of IMWG-guided thromboprophylaxis, suggesting that new approaches are needed.
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Affiliation(s)
- Charlotte A Bradbury
- School of Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Zoe Craig
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds, United Kingdom
| | - Charlotte Pawlyn
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Anna Hockaday
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Andrea Paterson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Matthew W Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John R Jones
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark T Drayson
- Clinical Immunology, School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, United Kingdom
| | - Martin F Kaiser
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Faith E Davies
- Perlmutter Cancer Center, New York University Langone Health, New York, NY; and
| | - J Anthony Child
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Gareth J Morgan
- Perlmutter Cancer Center, New York University Langone Health, New York, NY; and
| | - Graham H Jackson
- Freeman Hospital, University of Newcastle, Newcastle Upon Tyne, United Kingdom
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37
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Monreal M, Agnelli G, Chuang LH, Cohen AT, Gumbs PD, Bauersachs R, Mismetti P, Gitt AK, Kroep S, Willich SN, Van Hout B. Deep Vein Thrombosis in Europe-Health-Related Quality of Life and Mortality. Clin Appl Thromb Hemost 2020; 25:1076029619883946. [PMID: 31840534 PMCID: PMC7027084 DOI: 10.1177/1076029619883946] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: Deep vein thrombosis (DVT) is a major health-care burden in Europe, but exact estimates
are lacking. This study reports results from the PREFER venous thromboembolism (VTE)
study concerning health-related quality of life (HrQoL) and mortality of patients with
DVT. Methods: PREFER VTE was a prospective, observational study, conducted in 7 European countries,
designed to provide data concerning treatment patterns, resource utilization, mortality,
and QoL. First-time or recurrent patients with DVT were followed at 1, 3, 6, and 12
months. Health-related QoL—as measured by the EuroQoL 5-Dimension 5-Level instrument (
EQ-5D-5L)—was analyzed using Tobit regression with repeated measures, assessing the
impact of baseline characteristics stratified by cancer activity. Mortality was analyzed
using logistic regression. Results: At baseline, patients with DVT had a 0.14 lower EQ-5D-5L index score (0.72 for total
sample) compared to the reference UK population (0.85). The EQ-5D-5L index score
improved from baseline to 12 months in patients with active cancer (from 0.70 to 0.79)
and those without (0.72-0.87); 7.3% died within a year, a 5.2% excess mortality compared
to the age- and gender-adfjusted general population. The 12-month mortality rate of DVT
varied between 2.9% in the pooled data from Germany, Switzerland, or Austria and 15.4%
in Italy. Furthermore, the mortality rate differed between patients with active cancer
and those without (42.9% vs 4.7%). Conclusions: Deep vein thrombosis is associated with a substantial burden of illness in terms of
HrQoL at baseline, which following treatment normalizes after 12 months and has a
significant mortality rate. In addition, active cancer has a significant impact on
mortality and the HrQoL of patients with DVT.
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Affiliation(s)
- M Monreal
- Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - G Agnelli
- University of Perugia, Italy, Perugia, Italy
| | - L H Chuang
- Pharmerit International, Rotterdam, the Netherlands
| | - A T Cohen
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - P D Gumbs
- Daiichi-Sankyo Europe GmbH, Munich, Germany
| | - R Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany
| | - P Mismetti
- CHU Saint-Etienne, Hospital Nord, Saint Etienne Cedex 2, France
| | - A K Gitt
- Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - S Kroep
- Pharmerit International, Rotterdam, the Netherlands
| | - S N Willich
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - B Van Hout
- University of Sheffield, Sheffield, United Kingdom
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38
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Booth S, Burton K, Hunt B, Desborough M. Antiphospholipid syndrome and challenges with direct oral anticoagulants. Br J Hosp Med (Lond) 2020; 81:1-11. [PMID: 32468937 DOI: 10.12968/hmed.2020.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Direct oral anticoagulants have become the mainstay of the management of venous thromboembolism and atrial fibrillation, and long-term anticoagulation is indicated for those at high risk of further thrombotic events. This includes patients diagnosed with antiphospholipid syndrome, for whom the 'triple positive' laboratory combination of lupus anticoagulant, β2-glycoprotein-1 and anti-cardiolipin antibodies signify those at greatest risk. Data from meta-analysis and randomised control trials have raised the concern that direct oral anticoagulants may be less effective than vitamin K antagonists for the prevention of thrombosis in patients with thrombotic antiphospholipid syndrome, particularly those with the triple positive profile. This article reviews the diagnosis of thrombotic antiphospholipid syndrome, strategies for testing without interruption of anticoagulation, evidence concerning the safety of direct oral anticoagulants in this setting, and the implications for current investigation and management of unprovoked venous thromboembolism.
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Affiliation(s)
- Stephen Booth
- Department of Oncology, University of Oxford, Oxford, UK
| | - Kieran Burton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Beverley Hunt
- Haemophilia and Thrombosis Centre, St Thomas' Hospital, London, UK
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39
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Gade IL, Severinsen MT, Kragholm KH, Kristensen SR, Torp-Pedersen C, Riddersholm SJ. Epidemiology of Venous Thromboembolism After Second Cancer. Clin Epidemiol 2020; 12:377-386. [PMID: 32308493 PMCID: PMC7152787 DOI: 10.2147/clep.s247823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/14/2020] [Indexed: 01/23/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a serious, yet preventable, complication in cancer. Some patients are diagnosed with a second cancer; however, little is known about the epidemiology of VTE in this population. Methods From Danish national healthcare registries, we studied all patients diagnosed with a first breast, prostate, lung, or colorectal cancer from 1995 to 2015. We estimated incidence rates (IRs) of VTE according to the timing of the diagnosis of a second cancer. We controlled for confounder variables in Poisson regression models. Results In total, 309,077 patients with a first breast, prostate, lung, or colorectal cancer were included in the study. A second cancer was diagnosed in 20,090 (6.5%) of these patients. In total, 11,908 VTEs were observed in the study period, 786 of these occurred after a diagnosis of second cancer. Second cancer types such as pancreas and stomach cancer were associated with fivefold higher IRs of VTE compared with second cancer types such as breast and prostate cancer. The IR of VTE was highest within the first 6 months after the second cancer was diagnosed (IR 40.5 per 1000 person-years, 95% CI 36.3–42.2) with no differences based on how long since the first cancer it was diagnosed. Conclusion The epidemiology of VTE after a second cancer is similar to the epidemiology of VTE after a first cancer with higher rates within the first months after aggressive second cancer types.
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Affiliation(s)
- Inger Lise Gade
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Hematology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology and Clinical Investigation, North Zealand Hospital, Hillerød, Denmark
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Li A, Carlson JJ, Kuderer NM, Schaefer JK, Li S, Garcia DA, Khorana AA, Carrier M, Lyman GH. Cost‐effectiveness analysis of low‐dose direct oral anticoagulant (DOAC) for the prevention of cancer‐associated thrombosis in the United States. Cancer 2020; 126:1736-1748. [DOI: 10.1002/cncr.32724] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ang Li
- Division of Hematology University of Washington School of Medicine Seattle Washington
| | - Josh J. Carlson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute University of Washington School of Pharmacy Seattle Washington
| | - Nicole M. Kuderer
- Advanced Cancer Research Group and Department of Medicine University of Washington Seattle Washington
| | - Jordan K. Schaefer
- Division of Hematology/Oncology, Department of Internal Medicine University of Michigan Ann Arbor Michigan
| | - Shan Li
- Pharmacy Services University of Washington Medical Center Seattle Washington
| | - David A. Garcia
- Division of Hematology University of Washington School of Medicine Seattle Washington
| | - Alok A. Khorana
- Department of Hematology and Medical Oncology Taussig Cancer Institute and Case Comprehensive Cancer Center Cleveland Clinic Cleveland Ohio
| | - Marc Carrier
- Department of Medicine Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario Canada
| | - Gary H. Lyman
- Division of Medical Oncology University of Washington School of Medicine Seattle Washington
- Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington
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Martinez C, Katholing A, Wallenhorst C, Cohen AT. Prediction of significant bleeding during vitamin K antagonist treatment for venous thromboembolism in outpatients. Br J Haematol 2020; 189:524-533. [PMID: 31997309 DOI: 10.1111/bjh.16383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
Abstract
Bleeding is the most concerning complication associated with anticoagulant therapy but poorly characterized and important for risk/benefit assessment. We developed a risk stratification score to predict vitamin K antagonist (VKA)-associated bleeding in venous thromboembolism (VTE) using the UK Clinical Practice Research Datalink. Significant bleeding events in outpatients consisted of major bleeding and clinically relevant non-major bleeding requiring hospitalisation (CRNMB-H) within 90 days of VKA initiation. A scoring scheme for predicting bleeding was developed from subhazard ratios, validated using cross-validation and expressed by the C-statistic. The study cohort consisted of 10,010 patients with first VTE receiving initial VKA treatment, mean age 62·2 years. Between 2008 and 2016, 167 significant bleeding events were recorded (1·7%), i.e. incidence rate was 7·4/100 person-years. Independent predictors for community-acquired significant bleeding included active cancer, trauma/surgical procedure, male gender, dementia, liver disease, anaemia, history of bleeding, cerebrovascular, renal and chronic pulmonary disease, VTE presenting as pulmonary embolism and age over 75. The overall C-statistic was 0·68 (95% CI, 0·60-0·76), 0·75 (0·60-0·88) for major bleeding and 0·65 (0·55-0·75) for CRNMB-H, and higher than in other risk schemes applied to our study population. The developed risk score may identify patients having a significant bleeding risk, in particular major bleeding events, in outpatients.
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Affiliation(s)
- Carlos Martinez
- Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
| | - Anja Katholing
- Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
| | | | - Alexander T Cohen
- Guys and St Thomas' NHS Foundation Trust, Haematological Medicine, London, United Kingdom
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Bialkowski W, Tan S, Mast AE, Kiss JE, Kor D, Gottschall J, Wu Y, Roubinian N, Triulzi D, Kleinman S, Choi Y, Brambilla D, Zimrin A. Equivalent inpatient mortality among direct-acting oral anticoagulant and warfarin users presenting with major hemorrhage. Thromb Res 2020; 185:109-118. [PMID: 31794885 PMCID: PMC7035631 DOI: 10.1016/j.thromres.2019.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Extrapolation of clinical trial results comparing warfarin and direct-acting oral anticoagulant (DOAC) users experiencing major hemorrhage to clinical care is challenging due to differences seen among non-randomized oral anticoagulant users, bleed location, and etiology. We hypothesized that inpatient all-cause-mortality among patients presenting with major hemorrhage differed based on the home-administered anticoagulant medication class, DOAC versus warfarin. METHODS More than 1.5 million hospitalizations were screened and 3731 patients with major hemorrhage were identified in the REDS-III Recipient Database. Propensity score matching and stratification were used to account for potentially confounding factors. RESULTS Inpatient all-cause-mortality was lower for DOAC (HR = 0.60, 95%CI 0.45-0.80, p = 0.0005) before accounting for confounding and competing events. Inpatient all-cause-mortality for 1266 propensity-score-matched patients compared using proportional hazards regression did not differ (HR = 0.84, 95%CI 0.58-1.22, p = 0.36). Inpatient all-cause-mortality in stratified analyses (warfarin as reference) produced: HR = 0.69 (95%CI 0.31-1.55) for traumatic head injuries; HR = 1.10 (95%CI 0.62-1.95) for non-traumatic head injuries; HR = 0.62 (95%CI 0.20-1.94) for traumatic, non-head injuries; and HR = 0.69 (95%CI 0.29-1.63) for non-traumatic, non-head injuries. Mean time to discharge was shorter for DOAC (HR = 1.17, 95%CI 1.05-1.30, p = 0.0034) in the propensity score matched analysis. Plasma transfusion occurred in 42% of warfarin hospitalizations and 11% of DOAC hospitalizations. Vitamin K was administered in 63% of warfarin hospitalizations. CONCLUSIONS After accounting for differences in patient characteristics, location of bleed, and traumatic injury, inpatient survival was no different in patients presenting with major hemorrhage while on DOAC or warfarin.
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Affiliation(s)
| | - Sylvia Tan
- Research Triangle International, MD, USA
| | | | | | - Daryl Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, MN, USA
| | | | - Yanyun Wu
- Bloodworks Northwest, Washington, USA; School of Medicine, Yale University, CT, USA
| | | | | | | | - Young Choi
- School of Medicine, Yale University, CT, USA
| | | | - Ann Zimrin
- School of Medicine, University of Maryland, MD, USA
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Bradbury C, Fletcher K, Sun Y, Heneghan C, Gardiner C, Roalfe A, Hardy P, McCahon D, Heritage G, Shackleford H, Hobbs FR, Fitzmaurice D. A randomised controlled trial of extended anticoagulation treatment versus standard treatment for the prevention of recurrent venous thromboembolism (VTE) and post-thrombotic syndrome in patients being treated for a first episode of unprovoked VTE (the ExACT study). Br J Haematol 2019; 188:962-975. [PMID: 31713863 DOI: 10.1111/bjh.16275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/06/2019] [Indexed: 12/19/2022]
Abstract
Venous thromboembolism (VTE) is prevalent and impactful, with a risk of death, morbidity and recurrence. Post-thrombotic syndrome (PTS) is a common consequence and associated with impaired quality of life (QoL). The ExACT study was a non-blinded, prospective, multicentred randomised controlled trial comparing extended versus limited duration anticoagulation following a first unprovoked VTE (proximal deep vein thrombosis or pulmonary embolism). Adults were eligible if they had completed ≥3 months anticoagulation (remaining anticoagulated). The primary outcome was time to first recurrent VTE from randomisation. The secondary outcomes included PTS severity, bleeding, QoL and D-dimers. Two-hundred and eighty-one patients were recruited, randomised and followed up for 24 months (mean age 63, male:female 2:1). There was a significant reduction in recurrent VTE for patients receiving extended anticoagulation [2·75 vs. 13·54 events/100 patient years, adjusted hazard ratio (aHR) 0·20 (95% confidence interval (CI): 0·09 to 0·46, P < 0·001)] with a non-significant increase in major bleeding [3·54 vs. 1·18 events/100 patient years, aHR 2·99 (95% CI: 0·81-11·05, P = 0·10)]. Outcomes of PTS and QoL were no different between groups. D-dimer results (on anticoagulation) did not predict VTE recurrence. In conclusion, extended anticoagulation reduced VTE recurrence but did not reduce PTS or improve QoL and was associated with a non-significant increase in bleeding. Results also suggest very limited clinical utility of D-dimer testing on anticoagulated patients.
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Affiliation(s)
- Charlotte Bradbury
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Kate Fletcher
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Yongzhong Sun
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Chris Gardiner
- Haemostasis Research Unit (HRU), Department of Haematology, University College London, London, UK
| | - Andrea Roalfe
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Pollyanna Hardy
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Debbie McCahon
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gail Heritage
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Helen Shackleford
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - David Fitzmaurice
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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Folkerts K, Broughton J, Sheikh U, Mckaig S. Cost-effectiveness of rivaroxaban versus apixaban for the initial treatment of venous thromboembolism and extended prevention of recurrences in the UK. J Med Econ 2019; 22:1179-1191. [PMID: 31433687 DOI: 10.1080/13696998.2019.1658589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aim: To evaluate the relative cost-effectiveness of using rivaroxaban vs apixaban for the initial treatment plus extended prevention of venous thromboembolism (VTE) in the UK. Extended prevention was assessed using a 10-mg rivaroxaban dose, as the 20-mg dose has already been evaluated. Methods: A Markov model compared the health outcomes and costs of treating VTE patient cohorts with either rivaroxaban (15 mg twice daily for 3 weeks, followed by 20 mg once daily for 6 months, then extended prevention with 10 mg once daily) or apixaban (10 mg twice daily for 1 week, followed by 5 mg twice daily for 6 months, then extended prevention with 2.5 mg twice daily) over a lifetime horizon. The model included an initial acute treatment and prevention phase (0-6 months) and an extended prevention phase (6-18 months). Efficacy and safety data were derived from two network meta-analyses. Reference treatment comparators were derived from the EINSTEIN-Pooled study and EINSTEIN-CHOICE trial. Healthcare costs and utility data were derived from published literature. Results: The rivaroxaban regimen was associated with increased quality-adjusted life years (QALYs) and slightly lower total costs compared with apixaban over a lifetime horizon. Deterministic and probabilistic sensitivity analyses demonstrated that rivaroxaban remained a cost-effective alternative to apixaban over a wide range of parameters. Incremental cost-effectiveness ratio estimates were below the £20,000 per QALY threshold in 74.1% of 2,000 model simulations. Scenario analyses further supported that rivaroxaban is a cost-effective alternative to apixaban. Limitations: Clinical and safety inputs were derived from network meta-analysis, which are subject to inherent limitations whereby small differences between study designs may severely impact efficacy and safety outcomes. Furthermore, these inputs were based on data from clinical trials, which may not reflect real-world data. Conclusions: Rivaroxaban was associated with a slightly lower total cost and increased QALYs compared with apixaban for VTE management in the UK over a lifetime horizon.
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Venous Thromboembolism Recurrence in Latvian Population: Single University Hospital Data. ACTA ACUST UNITED AC 2019; 55:medicina55090510. [PMID: 31438542 PMCID: PMC6780231 DOI: 10.3390/medicina55090510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022]
Abstract
Background and objectives: Recurrence of venous thromboembolism (VTE) after a primary event is common; however, no sufficient risk scores have been widely introduced in clinical practice. The aim of this study was to assess the risk factors for VTE recurrences, as well as the effect of treatment strategies on the recurrence rate in a single-center patient cohort. Materials and Methods: The prospective cohort study included consecutive patients in a single center from June 2014 till June 2018 presenting with acute VTE confirmed by imaging tests. All patients were followed up for at least one year or till death. Statistical analyses were conducted using IBM SPSS Statistics 23 and Stata 13. Competing risk of death was considered. Results: A total of 219 eligible patients were identified during the study period. Pulmonary embolism with or without deep vein thrombosis (DVT) was present in 95.9% (n = 210), isolated DVT was present in 4.1% (n = 9) of patients. The total number of documented recurrences was 13 (5.9%). Incidence rate was 5.6 per 100 person-years. Recurrent VTE predicted significantly higher mortality rate (hazard ratio (HR) 6.64 [95% CI 2.61–16.93]). In univariate analysis, active cancer was associated with higher recurrence rate (p = 0.036). In competing-risks regression model (with death as the competing risk), active cancer (subdistribution hazard ratio (SHR) 2.11 (95% CI 0.58–7.76)) did not retain statistical significance for VTE recurrence. Discontinuation and duration of anticoagulant treatment (≤6 or >6 months), and drug class in acute or long-term therapy (parenteral, vitamin K antagonist (VKA), direct oral anticoagulant (DOAC)) were not associated with recurrences (p > 0.05). Conclusions: Patients who experienced recurrent VTE had 6.6-fold higher mortality rate than patients with no recurrences. The presence of active cancer was not a statistically significant risk factor for recurrence when taking into account the competing risk of death. Duration and drug class of anticoagulation did not seem to impact recurrence rate.
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Tsuda K, Takahira N, Ejiri M, Sakai K, Sakamoto M, Akamine A. Effect of resistance of the exercise band on the peak femoral vein velocity during active ankle flexion. Phlebology 2019; 35:176-183. [DOI: 10.1177/0268355519865164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To examine the resistance effect of using an exercise band on the lower extremity venous velocity during active ankle flexion. Methods Twenty healthy young adult men performed active ankle flexion every 2 s either with no band or with two exercise bands, marked red and silver in the order of increasing tension. They held the band in its natural length with an elbow in extension and an ankle in maximal dorsiflexion at initiation of each active plantar flexion in each posture. The peak velocity in the right superficial femoral vein was measured in each condition. Results Holm’s multiple comparisons revealed significant increases in the mean (individual 95% confidence intervals) peak velocities (cm/s) with no, red, and silver bands (35.8 (28.9–42.7), 46.5 (38.8–54.3), and 56.9 (47.0–66.8), respectively, in the sitting posture, and 50.7 (39.2–62.3), 60.7 (46.8–74.6), and 69.0 (55.3–82.7), respectively, in the supine posture; all p < 0.01). Conclusion Resistance with the exercise bands efficiently enhanced the femoral venous velocity during active ankle plantar flexion.
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Affiliation(s)
- Kouji Tsuda
- Sensory and Motor Control, Kitasato University, Kanagawa, Japan
| | - Naonobu Takahira
- Sensory and Motor Control, Kitasato University, Kanagawa, Japan
- Department of Rehabilitation, Kitasato University, Kanagawa, Japan
| | - Motoki Ejiri
- Department of Rehabilitation, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kenta Sakai
- Sensory and Motor Control, Kitasato University, Kanagawa, Japan
| | - Miki Sakamoto
- Department of Rehabilitation, Kitasato University, Kanagawa, Japan
| | - Akihiko Akamine
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
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Llobet D, Vallvé C, Tirado I, Vilalta N, Murillo J, Cuevas B, Román L, Carrasco M, Oliver A, Mateo J, Fontcuberta J, Souto JC. VAMP8 and serotonin transporter levels are associated with venous thrombosis risk in a Spanish female population. Results from the RETROVE Project. Thromb Res 2019; 181:99-105. [PMID: 31382081 DOI: 10.1016/j.thromres.2019.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Platelet hyper-reactivity has been associated with thrombosis and high levels of human vesicle-associated membrane protein 8 (VAMP8) and serotonin transporter (SERT). Two polymorphisms (rs1010 of VAMP8 gene and in SERT gene (SLC6A4)) are associated with arterial thrombosis. AIM To determine if levels of serotonin, SERT and/or VAMP8 and these polymorphisms are associated with the risk of venous thrombosis. MATERIAL AND METHODS A total of 324 individuals were included in the RETROVE Study (Riesgo de Enfermedad TROmboembólica VEnosa). VAMP8, SERT and serotonin were determined by ELISA; polymorphisms of SLC6A4 and VAMP8 by polymerase chain reaction (PCR) and real time PCR. The venous thrombotic risk was calculated by a logistic regression method to estimate the crude and adjusted OR (adjusted for sex, age, body mass index and venous thrombosis risk co-factors). RESULTS Statistically significant high levels of VAMP8 and SERT were found in patients, but not in controls. In contrast, serotonin showed lower levels in patients than in controls. When individuals were studied by gender, only women exhibited a statistically significant difference: the OR for VAMP8 was 3.25 (1.61-6.56 95% CI). The adjusted OR did not change. The OR for SERT was 2.76 (1.36-5.60 95% CI), the adjusted OR was maintained also. For serotonin with OR of 2.62 (1.40-4.92 95% CI), the adjusted OR was not significant. In contrast males did not show significant differences. No statistically differences between patients and controls were found for both polymorphisms. CONCLUSIONS VAMP8 and SERT levels are associated with venous thrombosis in a female Spanish population.
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Affiliation(s)
- Dolors Llobet
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Cristina Vallvé
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Tirado
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Noèlia Vilalta
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquín Murillo
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Biel Cuevas
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lidia Román
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marina Carrasco
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Artur Oliver
- Haematology Department, Fundació Puigvert, Barcelona, Spain
| | - Jose Mateo
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Fontcuberta
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Souto
- Unitat de Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Novel Aspects of Extracellular Vesicles as Mediators of Cancer-Associated Thrombosis. Cells 2019; 8:cells8070716. [PMID: 31337034 PMCID: PMC6679024 DOI: 10.3390/cells8070716] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
The establishment of prothrombotic states during cancer progression is well reported but the precise mechanisms underlying this process remain elusive. A number of studies have implicated the presence of the clotting initiator protein, tissue factor (TF), in circulating tumor-derived extracellular vesicles (EVs) with thrombotic manifestations in certain cancer types. Tumor cells, as well as tumor-derived EVs, may activate and promote platelet aggregation by TF-dependent and independent pathways. Cancer cells and their secreted EVs may also facilitate the formation of neutrophil extracellular traps (NETs), which may contribute to thrombus development. Alternatively, the presence of polyphosphate (polyP) in tumor-derived EVs may promote thrombosis through a TF-independent route. We conclude that the contribution of EVs to cancer coagulopathy is quite complex, in which one or more mechanisms may take place in a certain cancer type. In this context, strategies that could attenuate the crosstalk between the proposed pro-hemostatic routes could potentially reduce cancer-associated thrombosis.
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Højen AA, Søgaard M, Melgaard L, Lane DA, Sørensen EE, Goldhaber SZ, Larsen TB. Psychotropic drug use following venous thromboembolism versus diabetes mellitus in adolescence or young adulthood: a Danish nationwide cohort study. BMJ Open 2019; 9:e026159. [PMID: 31092651 PMCID: PMC6530366 DOI: 10.1136/bmjopen-2018-026159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Critical and chronic illness in youth such as diabetes can lead to impaired mental health. Despite the potentially traumatic and life-threatening nature of venous thromboembolism (VTE), the long-term mental health of adolescents and young adults with VTE is unclear. We compared the long-term mental health of adolescents and young adults with VTE versus adolescents and young adults with insulin-dependent diabetes mellitus (IDDM) using psychotropic drug purchase as proxy for mental health. DESIGN Nationwide registry-based cohort study. SETTING Denmark 1997-2015. PARTICIPANTS All patients aged 13-33 years with an incident diagnosis of VTE (n=5065) or IDDM (n=6609). EXPOSURE First time primary hospital diagnosis of VTE or IDDM. PRIMARY AND SECONDARY OUTCOME MEASURES Adjusted absolute risk and risk difference at 1 and 5 years follow-up for first psychotropic drug purchase comparing patients with VTE and patients with IDDM. RESULTS The absolute 1 year risk of psychotropic drug use was 6.2% among VTE patients versus 3.6% among patients with IDDM, at 5 years this was 19.3%-14.7%, respectively. After adjusting for the effect of sex, age and risk factors for VTE this corresponded to a 1 year risk differences of 1.9% (95 % CI 0.1% to 3.3%). At 5 years follow-up the risk difference was 1.9% (95% CI 0.5% to 3.3%). CONCLUSION One-fifth of adolescents and young adults with incident VTE had claimed a prescription for a psychotropic drug within 5 years, a risk comparable to that of young patients with IDDM.
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Affiliation(s)
- Anette Arbjerg Højen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Line Melgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Deirdre A Lane
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Samuel Zachary Goldhaber
- Thrombosis Research Group, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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Cottin V, Avot D, Lévy-Bachelot L, Baxter CA, Ramey DR, Catella L, Bénard S, Sitbon O, Teal S. Identifying chronic thromboembolic pulmonary hypertension through the French national hospital discharge database. PLoS One 2019; 14:e0214649. [PMID: 30998690 PMCID: PMC6472741 DOI: 10.1371/journal.pone.0214649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/18/2019] [Indexed: 12/30/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH), a rare pulmonary vascular disease, is often misdiagnosed due to nonspecific symptoms. The objective of the study was to develop, refine and validate a case ascertainment algorithm to identify CTEPH patients within the French exhaustive hospital discharge database (PMSI), and to use it to estimate the annual number of hospitalized patients with CTEPH in France in 2015, as a proxy for disease prevalence. As ICD-10 coding specifically for CTEPH was not available at the time of the study, a case ascertainment algorithm was developed in close collaboration with an expert committee, using a two-step process (refinement and validation), based on matched data from PMSI and hospital medical records from 2 centres. The best-performing algorithm (specificity 95%, sensitivity 70%) consisted of ≥1 pulmonary hypertension (PH) diagnosis during 2015 and any of the following criteria over 2009-2015: (i) CTEPH interventional procedure, (ii) admission for PH and pulmonary embolism (PE), (iii) PE followed by hospitalization in competence centre then in reference centre, (iv) history of PE and right heart catheterization. Patients with conditions suggestive of pulmonary arterial hypertension were excluded. A total of 3,138 patients hospitalized for CTEPH was estimated for 2015 (47 cases/million, range 43 to 50 cases/million). Assuming that patients are hospitalized at least once a year, the present study provides an estimate of the minimal prevalence of CTEPH and confirms the heavy burden of this disease.
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Affiliation(s)
- V. Cottin
- National Reference Centre for rare pulmonary diseases, Competence centre for pulmonary arterial hypertension, Louis Pradel hospital, Claude Bernard University Lyon 1, UMR 754, Lyon, France
| | - D. Avot
- MSD France, Courbevoie, France
| | | | | | - D. R. Ramey
- Merck & Co., Inc., Kenilworth, NJ, United States of America
| | | | - S. Bénard
- stève consultants, Oullins, France
- * E-mail:
| | - O. Sitbon
- Université Paris-Sud, CHU de Bicêtre, Le Kremlin-Bicêtre, France
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