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Yang R, Wang H, Liu D, Li W. Incidence and risk factors of VTE in lung cancer: a meta-analysis. Ann Med 2024; 56:2390200. [PMID: 39183726 PMCID: PMC11348814 DOI: 10.1080/07853890.2024.2390200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Lung cancer has maintained a high prevalence and mortality. Besides, venous thromboembolism (VTE) is the third most common disease of cardiovascular disease. Lung cancer with VTE usually influenced the overall survival in the follow-up. In the development of lung cancer, vigilance against and early diagnosis of VTE is of significance. METHODS We searched the databases of PubMed, Web of Science, Embase and Cochrane for related research up to 30 November 2023 and extracted information of incidence, odds ratio (OR), hazard ratio (HR) and their 95% confidence intervals (CIs), for evaluating the incidence of VTE and its risk factors. RESULTS A total of 54 articles and 873,292 records were included in our study. The pooled incidences of VTE and PE were 6% and 3%, respectively. Subgroup analysis revealed that the tumour, node and metastasis (TNM) stage (HR= 5.43, 95% CI: 2.42, 12.22), metastasis (HR= 2.67, 95% CI: 1.35, 5.29) and chemotherapy (HR= 2.27, 95% CI: 1.11, 4.65) had major influence on VTE occurrence. CONCLUSIONS Lung cancer complicated with VTE is unignorable, and its occurrence varies widely by tumour staging, tissue type and treatment. The results may aid in clinical decision-making about lung cancer in higher risk with VTE and weather receiving anticoagulant prophylaxis.
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Affiliation(s)
- Ruiyuan Yang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Haoyu Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China, Chinses Academy of Medical Sciences, West China Hospital, Chengdu, China
- Institute of Respiratory Health Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Xue X, Hu J, Peng L, Li H, Jiang Y, Gao C, Chen Y, Chen J, Fu X, Yang L, Kong X, Chen M, Kan H, Xiang D, Chen R. Low ambient temperature might trigger the symptom onset of pulmonary embolism: A nationwide case-crossover study at hourly level in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158524. [PMID: 36063940 DOI: 10.1016/j.scitotenv.2022.158524] [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: 06/04/2022] [Revised: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is an important cause of death and its seasonality has long been observed. Very few epidemiological studies have explored the potential role of ambient temperature in PE symptom onset, especially at the hourly level. METHODS We conducted a time-stratified case-crossover study among 17,903 PE patients with hourly onset of symptom from 1590 hospitals across China between January 2015 and September 2020. Conditional logistic regression model combined with distributed lag non-linear models were used to explore the associations between hourly ambient temperature and PE symptom onset. The attributable fractions due to non-optimum temperature were calculated. RESULTS The exposure-response relationship curve was inverse and almost linear. Lower temperature was significantly associated with higher risk of PE symptom onset when temperature was below 18 °C. This risk occurred immediately at the same hour, attenuated thereafter, and became nonsignificant at approximately 72 h after exposure. Compared with the referent temperature (P99, 34.1 °C), the odds ratio of PE symptom onset associated with extremely low temperature (P1, -16.1 °C) over lag 0-72 h was 1.63 (95%CI: 1.23, 2.16). Low temperature may account for 16.19 % of the symptom onset nationally with higher proportion in the south of China. The effects were stronger in older adults, males, and cold seasons. CONCLUSIONS We provided the first-hand robust evidence that transient exposure (at the hourly level) to low temperature might trigger the symptom onset of PE and constitute a considerable burden for PE patients. Targeted protections and health education are needed for susceptible populations.
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Affiliation(s)
- Xiaowei Xue
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Li Peng
- Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China
| | - Huichu Li
- Department of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA, USA
| | - Yixuan Jiang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Chuanyu Gao
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Beijing, China
| | - Yuguo Chen
- Department of Cardiology, Qilu Hospital of Shandong University, Shandong, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xianghua Fu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lixia Yang
- Department of Cardiology, The 920th Hospital of Chinese People's Liberation Army Joint Support Force, Kunming, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dingcheng Xiang
- Department of Cardiology, General Hospital of the PLA Southern Theater Command, Guangzhou, China.
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
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Kim OT. Patient safety as a global health priority. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
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4
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Nair V, Singh S, Ashraf MZ, Yanamandra U, Sharma V, Prabhakar A, Ahmad R, Chatterjee T, Behera V, Guleria V, Patrikar S, Gupta S, Vishnoi MG, Rigvardhan, Kalshetty K, Sharma P, Bajaj N, Khaling TD, Wankhede TS, Bhattachar S, Datta R, Ganguli LP. Epidemiology and pathophysiology of vascular thrombosis in acclimatized lowlanders at high altitude: A prospective longitudinal study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 3:100016. [PMID: 37384264 PMCID: PMC10306047 DOI: 10.1016/j.lansea.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Previous literature suggests that thrombosis is more common in lowlanders sojourning at high altitude (HA) compared to near-sea-level. Though the pathophysiology is partly understood, little is known of its epidemiology. To elucidate this, an observational prospective longitudinal study was conducted in healthy soldiers sojourning for months at HA. METHODS A total of 960 healthy male subjects were screened in the plains, of which 750 ascended, to altitudes above 15,000ft (4,472m). Clinical examination, haemogram, coagulogram, markers of inflammation and endothelial dysfunction, were studied at three time points during ascent and descent. The diagnosis of thrombosis was confirmed radiologically in all cases where a thrombotic event was suspected clinically. Subjects developing thrombosis at HA were labelled as Index Cases (ICs) and compared to a nested cohort of the healthy subjects (comparison group,(CG)) matched for altitude of stay. FINDINGS Twelve and three subjects, developed venous (incidence: 5,926/105 person-years) and arterial (incidence: 1,482/105 person-years) thrombosis at HA, respectively. The ICs had enhanced coagulation (FVIIa: p<0.001; FXa: p<0.001) and decreased levels of natural anticoagulants (thrombomodulin, p=0.016; tissue factor pathway inhibitor [TFPI]: p<0.001) and a trend to dampened fibrinolysis (tissue plasminogen activator tPA; p=0.078) compared to CG. ICs also exhibited statistically significant increase in the levels of endothelial dysfunction and inflammation markers (vascular cell adhesion molecule-1[VCAM-1], intercellular adhesion molecule-1 [ICAM-1], vascular endothelial growth factor receptor 3 [VEGFR-3], P-Selectin, CD40 ligand, soluble C-reactive protein and myeloperoxidase: p<0.001). INTERPRETATION The incidence of thrombosis in healthy subjects at HA was higher than that reported in literature at near sea-level. This was associated with inflammation, endothelial dysfunction, a prothrombotic state and dampened fibrinolysis. FUNDING Research grants from the Armed Forces Medical Research Committee, Office of the Director General of Armed Forces Medical Services (DGAFMS) & Defence Research and Development Organization (DRDO), Ministry of Defence, India.
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Affiliation(s)
- Velu Nair
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Director General Medical Services (Army), India
- Comprehensive Blood & Cancer Center (CBCC), Gandhinagar, Gujarat, India
| | - Surinderpal Singh
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Army College of Medical Sciences, New Delhi, India
| | - Mohammad Zahid Ashraf
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Uday Yanamandra
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- 153 General Hospital, Leh, India
| | - Vivek Sharma
- Department of Imaging & Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiology, Bharati Vidyapeeth Hospital & Medical College, Pune, Maharashtra, India
| | - Amit Prabhakar
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
- Cardiovascular Research Institute (CVRI), University of California, San Francisco, USA
| | - Rehan Ahmad
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Luchkee Health Pvt Ltd Vasant Kunj, New Delhi, India
| | - Tathagata Chatterjee
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital (Research & Referral), New Delhi, India
- Department of Haematology and Stem Cell Transplant, ESIC Med College and Hospital, Faridabad, Haryana, India
| | - Vineet Behera
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Internal Medicine, INHS Asvini, Colaba, Mumbai, India
| | - Vivek Guleria
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
| | - Seema Patrikar
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shivi Gupta
- 403 Field Hospital, C/o 56 APO, India
- Indian Field Hospital, UN Mission, Malakal 71111, South Sudan
| | - Madan Gopal Vishnoi
- 403 Field Hospital, C/o 56 APO, India
- Department of Nuclear Medicine, Command Hospital (Eastern Command), Kolkata, India
| | - Rigvardhan
- Defense Institute of Physiology & Allied Science (DIPAS), New Delhi, India
| | - Kiran Kalshetty
- Regimental Medical Officer, 20 Grenadiers c/o 56 APO, India
- Department of Anaesthesiology, 305 Field Hospital, C/o 99 APO, India
| | - Prafull Sharma
- Department of the Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Cardiology, Military Hospital, Jalandhar, Punjab, India
| | - Nitin Bajaj
- Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, Haryana, India
- Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, India
| | - Thyelnai D. Khaling
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
| | - Tanaji Sitaram Wankhede
- Department of Physiology, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Sports Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Srinivasa Bhattachar
- Department of Physiology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
- High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rajat Datta
- Department of Cardiology, Army Hospital (Research & Referral), New Delhi, India
- Director General Armed Forces Medical Services, New Delhi, India
| | - Late Prosenjit Ganguli
- Department of Clinical Haematology and Centre for Stem Cell Therapy and Research, Army Hospital (Research and Referral), New Delhi, India
- Department of Pathology, Command Hospital (Eastern Command), Kolkata, India
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5
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Fernandes CJ, Calderaro D, Piloto B, Hoette S, Jardim CVP, Souza R. Extended anticoagulation after venous thromboembolism: should it be done? Ther Adv Respir Dis 2020; 13:1753466619878556. [PMID: 31558116 PMCID: PMC6767720 DOI: 10.1177/1753466619878556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Most physicians understand venous thromboembolism (VTE) to be an acute and
time-limited disease. However, pathophysiological and epidemiological data
suggest that in most patients VTE recurrence risk is not resolved after the
first 6 months of anticoagulation. Recurrence rates are high and potentially
life-threatening. In these cases, it would make sense to prolong anticoagulation
for an undetermined length of time. However, what about the bleeding rates,
induced by prolonged anticoagulation? Would they not outweigh the benefit of
reducing the VTE recurrent risk? How long should anticoagulation be continued,
and should all patients suffering from VTE be provided with extended
anticoagulation? This review will address the most recent data concerning
extended anticoagulation in VTE secondary prophylaxis. The reviews of this paper are available via the supplementary material
section.
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Affiliation(s)
- Caio J Fernandes
- Cardiopulmonary Department, Heart Institute, University of Sao Paulo Medical School, 44, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, 05403-000, Brazil.,Cancer Institute, University of Sao Paulo Medical School, 251, Dr. Arnaldo Avenue, Sao Paulo, SP, Brazil.,Sirio Libanes Hospital, 115, Adma Jafet St, Sao Paulo, SP, Brazil
| | - Daniela Calderaro
- Cardiopulmonology Department, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.,Sirio Libanes Hospital, Sao Paulo, SP, Brazil
| | - Bruna Piloto
- Cardiopulmonology Department, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.,Sirio Libanes Hospital, Sao Paulo, SP, Brazil
| | - Susana Hoette
- Cardiopulmonology Department, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Carlos Vianna Poyares Jardim
- Cardiopulmonology Department, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.,Sirio Libanes Hospital, Sao Paulo, SP, Brazil
| | - Rogério Souza
- Cardiopulmonology Department, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.,Sirio Libanes Hospital, Sao Paulo, SP, Brazil
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6
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Knotts TL, Mousa SA. Anticoagulation in Venous Thromboembolism Prophylaxis in Medically Ill Patients: Potential Impact of NOACs. Am J Cardiovasc Drugs 2019; 19:365-376. [PMID: 30809772 DOI: 10.1007/s40256-019-00329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While substantial evidence supports the use of standard-duration injectable anticoagulants for venous thromboembolism (VTE) prophylaxis, consensus is mixed about which agents may be preferred in acutely ill patients with ongoing need of VTE prophylaxis past the first 10-day duration of hospital stay and post-discharge. Non-vitamin K antagonist oral anticoagulants (NOACs) provide Factor Xa inhibition to prevent the thrombin generation essential in thromboembolism development, but evidence for the efficacy and safety of most NOACs is conflicting regarding extended-duration prophylaxis. Enoxaparin, a preferred injectable anticoagulant in standard-duration VTE prophylaxis, has shown an increased risk of major bleeding events when used in extended-duration prophylaxis, which outweighs its benefit. Rivaroxaban has demonstrated efficacy in extended-duration prophylaxis, but both rivaroxaban and apixaban have shown increased risks of major bleeding. Betrixaban remains the only NOAC approved in the USA for extended-duration VTE prophylaxis, and it demonstrates efficacy, with fewer adverse effects than other NOACs. This review evaluates the appropriateness of different NOAC agents compared with current therapies for the extended-duration VTE prophylaxis setting in medically ill populations.
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Affiliation(s)
- Tara L Knotts
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY, 12144, USA
| | - Shaker A Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY, 12144, USA.
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7
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Della Bella S, Calcaterra F, Bacci M, Carenza C, Pandolfo C, Ferrazzi P, Uva P, Pagani M, Lodigiani C, Mavilio D. Pathologic up-regulation of TNFSF15–TNFRSF25 axis sustains endothelial dysfunction in unprovoked venous thromboembolism. Cardiovasc Res 2019; 116:698-707. [DOI: 10.1093/cvr/cvz131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
Aims
The pathogenetic mechanisms underlying unprovoked venous thromboembolism (uVTE) are largely unknown. In this study, we investigated the molecular mechanisms involved in uVTE pathogenesis by using ex vivo expanded endothelial colony-forming cells (ECFCs), which represent a valuable non-invasive tool for the assessment of endothelial function.
Methods and results
We isolated and expanded ECFCs from the peripheral blood of uVTE patients and observed that these cells underwent earlier senescence and showed lower growth rate compared with ECFCs obtained from healthy donors. Through microarray expression profiling, we demonstrated that 2905 genes were differentially expressed between patients and controls. Among them, the anti-angiogenic cytokine TNF superfamily member 15 (TNFSF15) and its death-receptor TNFRSF25 were up-regulated in uVTE ECFCs, and this finding was validated by RT-qPCR. TNFSF15 up-regulation was confirmed at the protein level in ECFC supernatants, and the in vivo relevance of these findings was further corroborated by demonstrating that also the plasmatic levels of TNFSF15 are increased in uVTE patients. After proving that exogenous TNFSF15 exerts pro-apoptotic and anti-proliferative activity on control ECFCs, we demonstrated through blocking experiments that TNFSF15 up-regulation contributes to impaired survival and proliferation of uVTE ECFCs.
Conclusion
By providing evidence that TNFSF15 impairs ECFC functions crucial to endothelial repair, and that uVTE patients have increased TNFSF15 levels both ex vivo and in vivo, the results of this study suggest that pathologic up-regulation of TNFSF15–TNFRSF25 axis may contribute to uVTE pathogenesis, and may represent the target for novel therapeutic strategies aimed at preventing recurrences in uVTE patients.
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Affiliation(s)
- Silvia Della Bella
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center—IRCCS, via Manzoni 113, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Francesca Calcaterra
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center—IRCCS, via Manzoni 113, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Monica Bacci
- Thrombosis and Haemorragic Diseases Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudia Carenza
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center—IRCCS, via Manzoni 113, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Chiara Pandolfo
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center—IRCCS, via Manzoni 113, Rozzano, Milan, Italy
| | - Paola Ferrazzi
- Thrombosis and Haemorragic Diseases Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Uva
- Center for Advanced Studies, Research and Development in Sardinia (CRS4), Science and Technology Park Polaris, Pula, Cagliari, Italy
| | - Massimiliano Pagani
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- INGM-National Institute of Molecular Genetics “Romeo ed Enrica Invernizzi” Milan, Milan, Italy
| | - Corrado Lodigiani
- Thrombosis and Haemorragic Diseases Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center—IRCCS, via Manzoni 113, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
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8
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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Aspirin or Rivaroxaban for Venous Thromboembolism Prophylaxis After Hip or Knee Arthroplasty. Am J Phys Med Rehabil 2019; 98:e40-e42. [PMID: 30998542 DOI: 10.1097/phm.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Fernandes CJ, Morinaga LTK, Alves JL, Castro M, Calderaro D, Jardim CV, Souza R. Cancer-associated thrombosis: the when, how and why. Eur Respir Rev 2019; 28:28/151/180119. [PMID: 30918022 PMCID: PMC9488553 DOI: 10.1183/16000617.0119-2018] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Cancer-associated thrombosis (CAT) is a condition in which relevance has been increasingly recognised both for physicians that deal with venous thromboembolism (VTE) and for oncologists. It is currently estimated that the annual incidence of VTE in patients with cancer is 0.5% compared to 0.1% in the general population. Active cancer accounts for 20% of the overall incidence of VTE. Of note, VTE is the second most prevalent cause of death in cancer, second only to the progression of the disease, and cancer is the most prevalent cause of deaths in VTE patients. Nevertheless, CAT presents several peculiarities that distinguish it from other VTE, both in pathophysiology mechanisms, risk factors and especially in treatment, which need to be considered. CAT data will be reviewed in this review. Cancer-associated thrombosis (CAT) presents peculiar features (risk factors and pathophysiology) that distinguish it from common VTE cases. Treatment of CAT requires a different approach, since the patients are more prone to recurrence and bleeding.http://ow.ly/j1Lu30nYmd5
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10
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Suchon P, Trégouët DA, Morange PE. Genetics of Venous Thrombosis: update in 2015. Thromb Haemost 2017; 114:910-9. [DOI: 10.1160/th15-05-0410] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/14/2015] [Indexed: 11/05/2022]
Abstract
SummaryVenous thrombosis (VT) is a common multifactorial disease with a genetic component that was first suspected nearly 60 years ago. In this review, we document the genetic determinants of the disease, and update recent findings delivered by the application of high-throughput genotyping and sequencing technologies. To date, 17 genes have been robustly demonstrated to harbour genetic variations associated with VT risk: ABO, F2, F5, F9, F11, FGG, GP6, KNG1, PROC, PROCR, PROS1, SERPINC1, SLC44A2, STXBP5, THBD, TSPAN15 and VWF. The common polymorphisms are estimated to account only for a modest part (~5 %) of the VT heritability. Much remains to be done to fully disentangle the exact genetic (and epigenetic) architecture of the disease. A large suite of powerful tools and research strategies can be deployed on the large collections of patients that have already been assembled (and additional are ongoing).
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11
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Højen AA, Sørensen EE, Dreyer PS, Søgaard M, Larsen TB. Long-term mental wellbeing of adolescents and young adults diagnosed with venous thromboembolism: results from a multistage mixed methods study. J Thromb Haemost 2017; 15:2333-2343. [PMID: 29032639 DOI: 10.1111/jth.13873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 11/29/2022]
Abstract
Essentials Long-term mental wellbeing of adolescents and young adults with venous thromboembolism is unclear. This multistage mixed methods study was based on Danish nationwide registry data and interviews. Mental wellbeing is negatively impacted in the long-term and uncertainty of recurrence is pivotal. The perceived health threat is more important than disease severity for long-term mental wellbeing. SUMMARY Background Critical and chronic illness in youth can lead to impaired mental wellbeing. Venous thromboembolism (VTE) is a potentially traumatic and life-threatening condition. Nonetheless, the long-term mental wellbeing of adolescents and young adults (AYAS) with VTE is unclear. Objectives To investigate the long-term mental wellbeing of AYAS (aged 13-33 years) diagnosed with VTE. Methods We performed a multistage mixed method study based on data from the Danish nationwide health registries, and semistructured interviews with 12 AYAS diagnosed with VTE. An integrated mixed methods interpretation of the findings was conducted through narrative weaving and joint displays. Results The integrated mixed methods interpretation showed that the mental wellbeing of AYAS with VTE had a chronic perspective, with a persistently higher risk of psychotropic drug purchase among AYAS with a first-time diagnosis of VTE than among sex-matched and age-matched population controls and AYAS with a first-time diagnosis of insulin-dependent diabetes mellitus. Impaired mental wellbeing was largely connected to a fear of recurrence and concomitant uncertainty. Therefore, it was important for the long-term mental wellbeing to navigate uncertainty. The perceived health threat played a more profound role in long-term mental wellbeing than disease severity, as the potential life threat was the pivot which pointed back to the initial VTE and forward to the perception of future health threat and the potential risk of dying of a recurrent event. Conclusion Our findings show that the long-term mental wellbeing of AYAS diagnosed with VTE is negatively affected, and highlights these patients' need for adequate support.
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Affiliation(s)
- A A Højen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital Science and Innovation Center, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - E E Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital Science and Innovation Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - P S Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Institute of Public Health, Section of Nursing, Aarhus University, Aarhus, Denmark
| | - M Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - T B 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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Barco S, Woersching AL, Spyropoulos AC, Piovella F, Mahan CE. European Union-28: An annualised cost-of-illness model for venous thromboembolism. Thromb Haemost 2017; 115:800-8. [DOI: 10.1160/th15-08-0670] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
SummaryAnnual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5–2.2 billion, €1.0–1.5 billion, €0.5–1.1 billion and €0.2–0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8–3.3 billion, €1.2–2.4 billion, €0.6–1.8 billion and €0.2–0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0–8.5 billion, €2.2–6.2 billion, €1.1–4.6 billion and €0.5–1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5–13.2 billion, €1.0–9.7 billion, €0.5–7.3 billion and €0.2–6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28’s healthcare systems and that significant savings could be realised if better preventive measures are applied.
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Konstantinides SV. Trends in incidence versus case fatality rates of pulmonary embolism: Good news or bad news? Thromb Haemost 2017; 115:233-5. [DOI: 10.1160/th15-10-0832] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022]
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Barrios D, Chavant J, Jiménez D, Bertoletti L, Rosa-Salazar V, Muriel A, Viallon A, Fernández-Capitán C, Yusen RD, Monreal M. Treatment of Right Heart Thrombi Associated with Acute Pulmonary Embolism. Am J Med 2017; 130:588-595. [PMID: 28011316 DOI: 10.1016/j.amjmed.2016.11.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism. METHODS This study included patients who had acute pulmonary embolism associated with right heart thrombi and participated in the Registro Informatizado de la Enfermedad TromboEmbólica registry. We assessed the effectiveness of anticoagulation versus reperfusion treatment for the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrent venous thromboembolism, and major bleeding rates through 30 days after initiation of pulmonary embolism treatment. We used propensity score matching to adjust for the likelihood of receiving reperfusion treatment. RESULTS Of 325 patients with pulmonary embolism and right heart thrombi, 255 (78%; 95% confidence interval, 74-83) received anticoagulation and 70 (22%; 95% confidence interval, 17-26) also received reperfusion treatment. Propensity score-matched pairs analyses did not detect a statistically lower risk of all-cause death (6.2% vs 14%, P = .15) or pulmonary embolism-related mortality (4.7% vs 7.8%; P = .47) for reperfusion compared with anticoagulation. Of the patients who received reperfusion treatment, 6.2% had a recurrence during the study follow-up period, compared with 0% of those who received anticoagulation (P = .049). The incidence of major bleeding events was not statistically different between the 2 treatment groups (3.1% vs 3.1%; P = 1.00). CONCLUSIONS In patients with pulmonary embolism and right heart thrombi, no significant difference was found between reperfusion therapy and anticoagulant therapy for mortality and bleeding. The risk of recurrences was significantly higher for reperfusion therapy compared with anticoagulation. Right heart thrombi may not warrant riskier interventions than standard anticoagulation.
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Affiliation(s)
- Deisy Barrios
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Jeremy Chavant
- CHU Saint-Etienne, Service d'accueil des Urgences, France
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain.
| | - Laurent Bertoletti
- CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, France
| | - Vladimir Rosa-Salazar
- Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alain Viallon
- CHU Saint-Etienne, Service d'accueil des Urgences, France
| | | | - Roger D Yusen
- Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, Mo
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Spain
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Raskob EG. Venous thromboembolism: A Call for risk assessment in all hospitalised patients. Thromb Haemost 2016; 116:777-779. [PMID: 27734070 PMCID: PMC6374981 DOI: 10.1160/th16-09-0732] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/19/2023]
Affiliation(s)
- E. Gary Raskob
- Correspondence to: Gary E. Raskob College of Public HealthUniversity of Oklahoma Health Sciences Center801 NE 13th StreetOklahoma City, OK, 73104, USA+ 1 405 271 2232+ 1 405 271 3039
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Gurewich V. Why so little progress in therapeutic thrombolysis? The current state of the art and prospects for improvement. J Thromb Thrombolysis 2016; 40:480-7. [PMID: 25894475 PMCID: PMC4584119 DOI: 10.1007/s11239-015-1217-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Victor Gurewich
- Vascular Research Laboratory, Mt Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
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Cost-of-illness model for venous thromboembolism. Thromb Res 2016; 145:130-2. [PMID: 27354154 DOI: 10.1016/j.thromres.2016.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
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Barco S, Lankeit M, Binder H, Schellong S, Christ M, Beyer-Westendorf J, Duerschmied D, Bauersachs R, Empen K, Held M, Schwaiblmair M, Fonseca C, Jiménez D, Becattini C, Quitzau K, Konstantinides S. Home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial. Thromb Haemost 2016; 116:191-7. [PMID: 27010343 DOI: 10.1160/th16-01-0004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/03/2016] [Indexed: 11/05/2022]
Abstract
Pulmonary embolism (PE) is a potentially life-threatening acute cardiovascular syndrome. However, more than 95 % of patients are haemodynamically stable at presentation, and among them are patients at truly low risk who may qualify for immediate or early discharge. The Home Treatment of Pulmonary Embolism (HoT-PE) study is a prospective international multicentre single-arm phase 4 management (cohort) trial aiming to determine whether home treatment of acute low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. Patients with confirmed PE, who have no right ventricular dysfunction or free floating thrombi in the right atrium or ventricle, are eligible if they meet none of the exclusion criteria indicating haemodynamic instability, serious comorbidity or any condition mandating hospitalisation, or a familial/social environment unable to support home treatment. The first dose of rivaroxaban is given in hospital, and patients are discharged within 48 hours of presentation. Rivaroxaban is taken for at least three months. The primary outcome is symptomatic recurrent venous thromboembolism or PE-related death within three months of enrolment. Secondary outcomes include quality of life and patient satisfaction, and health care resource utilisation compared to existing data on standard-duration hospital treatment. HoT-PE is planned to analyse 1,050 enrolled patients, providing 80 % power to reject the null hypothesis that the recurrence rate of venous thromboembolism is >3 % with α≤0.05. If the hypothesis of HoT-PE is confirmed, early discharge and out-of-hospital treatment may become an attractive, potentially cost-saving option for a significant proportion of patients with acute PE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stavros Konstantinides
- Stavros V. Konstantinides, MD, FESC, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany, Tel.: +49 6131 17 8382, Fax: +49 6131 17 3456, E-mail:
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Blann AD, Lip GYH. Non-vitamin K antagonist oral anticoagulants (NOACs) for the management of venous thromboembolism. Heart 2016; 102:975-83. [PMID: 26984888 DOI: 10.1136/heartjnl-2014-307019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Andrew D Blann
- University of Birmingham Institute for Cardiovascular Disease, City Hospital, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute for Cardiovascular Disease, City Hospital, Birmingham, UK Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Dzeshka MS, Lip GYH. Edoxaban for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Expert Opin Pharmacother 2015; 16:2661-78. [PMID: 26559069 DOI: 10.1517/14656566.2015.1104301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Oral anticoagulation is central to the management of patients with atrial fibrillation (AF) and at least one additional stroke risk factor. For decades, the vitamin K antagonists (e.g. warfarin) remained the only oral anticoagulant available for stroke prevention in AF. The non-vitamin K oral anticoagulants (NOACs) are now available, and these drugs include the direct thrombin inhibitors and factor Xa inhibitors. The latter class includes edoxaban, which has recently been approved for stroke prevention in AF by the United States Food and Drug Administration and the European Medicine Agency. In line with other NOACs, edoxaban avoids the many limitations of warfarin associated with variability of anticoagulation effect and multiple food and drug interactions. AREAS COVERED In this review, the currently available evidence on edoxaban in patients with non-valvular AF is discussed. The pharmacology, efficacy and safety, and current aspects of use of edoxaban in patients with non-valvular AF for stroke and thromboembolism prevention are reviewed. EXPERT OPINION Phase III trials on edoxaban for stroke prevention in non-valvular AF confirms non-inferiority of edoxaban compared to well-managed warfarin both in terms of efficacy and safety. Currently ongoing and future trials as well as real-world data are warranted to confirm its effectiveness and safety for chronic anticoagulation and improve evidence in other areas which are lacking evidence where NOAC use remains controversial.
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Affiliation(s)
- Mikhail S Dzeshka
- a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham B18 7QH , UK.,b Grodno State Medical University , Grodno , Belarus
| | - Gregory Y H Lip
- a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham B18 7QH , UK.,c Aalborg Thrombosis Research Unit, Department of Clinical Medicine , Faculty of Health, Aalborg University , Aalborg , Denmark
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Konstantinides SV, Wärntges S. Acute phase treatment of venous thromboembolism: advanced therapy. Systemic fibrinolysis and pharmacomechanical therapy. Thromb Haemost 2015; 113:1202-9. [PMID: 25789580 DOI: 10.1160/th14-11-0998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/01/2015] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism, which encompasses deep-vein thrombosis and acute pulmonary embolism (PE), represents a major contributor to global disease burden worldwide. For patients who present with cardiogenic shock or persistent hypotension (acute high-risk PE), there is consensus that immediate reperfusion treatment applying systemic fibrinolysis or, in the case of a high bleeding risk, surgical or catheter-directed techniques, is indicated. On the other hand, for the large, heterogeneous group of patients presenting without overt haemodynamic instability, the indications for advanced therapy are less clear. The recently updated guidelines of the European Society of Cardiology emphasise the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function) and laboratory biomarkers (indicative of myocardial stress or injury) for distinguishing between an intermediate and a low risk for an adverse early outcome. In intermediate-high-risk PE defined by the presence of both right ventricular dysfunction on echocardiography (or computed tomography) and a positive troponin (or natriuretic peptide) test, the bleeding risks of full-dose fibrinolytic treatment have been shown to outweigh its potential clinical benefits unless clinical signs of haemodynamic decompensation appear (rescue fibrinolysis). Recently published trials suggest that catheter-directed, ultrasound-assisted, low-dose local fibrinolysis may provide an effective and particularly safe treatment option for some of these patients.
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Affiliation(s)
- Stavros V Konstantinides
- Stavros V. Konstantinides, MD, FESC, Center for Thrombosis and Haemostasis, University Medical Centre Mainz, Langenbeckstrasse 1, Bldg. 403, 55131 Mainz, Germany, Tel.: +49 6131 178382, Fax: +49 6131 173456, E-mail:
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