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Ariani A, Silva M, Seletti V, Bravi E, Saracco M, Parisi S, De Gennaro F, Lumetti F, Idolazzi L, Caramaschi P, Benini C, Bodini F, Scirè C, Alfieri V, Bonati E, Lucchini G, Aiello M, Santilli D, Mozzani F, Imberti D, Arrigoni E, Delsante G, Michieletti E, Pellerito R, Fusaro E, Chetta A, Sverzellati N. AB0930 Quantitative Chest Ct in Ild-Ssc Patients with Divergent Risks of Mortality. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ariani A, Bravi E, Saracco M, Parisi S, De Gennaro F, Idolazzi L, Silva M, Seletti V, Lumetti F, Caramaschi P, Benini C, Bodini F, Scirè C, Lucchini G, Santilli D, Imberti D, Arrigoni E, Michieletti E, Pellerito R, Fusaro E, Sverzellati N. FRI0260 Quantitative CT Indexes in ILD-SSC Patients with Different Autoantibodies: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ariani A, Silva M, Parisi S, Saracco M, Bravi E, De Gennaro F, Benini C, Caramaschi P, Lumetti F, Seletti V, Idolazzi L, Bodini F, Scirè C, Lucchini G, Santilli D, Mozzani F, Delsante G, Imberti D, Arrigoni E, Pellerito R, Fusaro E, Sverzellati N. FRI0443 Can Quantitative Chest CT Predict Interstitial Lung Disease Worsening in Systemic Sclerosis? Results from a Multi-Centre Prospective Cohort Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Monreal M, Folkerts K, Diamantopoulos A, Imberti D, Brosa M. Cost-effectiveness impact of rivaroxaban versus new and existing prophylaxis for the prevention of venous thromboembolism after total hip or knee replacement surgery in France, Italy and Spain. Thromb Haemost 2013; 110:987-94. [PMID: 23965805 DOI: 10.1160/th12-12-0919] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 08/06/2013] [Indexed: 12/14/2022]
Abstract
Venous thromboembolism (VTE) has a significant impact on healthcare costs but is largely preventable with anticoagulant prophylaxis using low-molecular-weight heparins (LMWHs), such as enoxaparin or dalteparin. Rivaroxaban and dabigatran etexilate are two new oral anticoagulants (NOACs) both compared with enoxaparin in separate trials. A decision analytic model with a healthcare and national payer perspective over a five-year time horizon was used to evaluate the cost-effectiveness of the NOACs for VTE prophylaxis after total hip replacement (THR) or total knee replacement (TKR) in France, Italy and Spain. Efficacy and safety data were obtained from randomised controlled trials of rivaroxaban vs enoxaparin and an indirect statistical comparison for rivaroxaban vs dabigatran. Rivaroxaban demonstrated dominance across all comparisons, indications and countries. In THR, total per-patient costs were reduced by up to €160 in the enoxaparin comparison and €115 in the dabigatran comparison, respectively. In addition, quality-adjusted life-years (QALYs) were increased by up to 0.0011 and 0.0012 in each comparison, respectively. Similarly, total costs were reduced in TKR by up to €137 and €28 in the enoxaparin and dabigatran comparisons, respectively. The total number of QALYs was increased by up to 0.0014 in the enoxaparin comparison and 0.0005 in the dabigatran comparison. The results were driven by costs since the incremental benefits were minimal. Rivaroxaban use could result in substantial healthcare cost savings and improved quality of life. The results are applicable across three European countries with differing healthcare systems so, potentially, could be generalised to a much wider population.
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Affiliation(s)
- M Monreal
- Alex Diamantopoulos, Symmetron Ltd., Kinetic Centre, Theobald Street, Elstree, Herts WD6 4PJ, UK, Tel.: +44 208 387 1595, Fax:+44 208 711 6876, E-mail:
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Della Rocca G, Danelli G, Randelli F, Romanini E, Biggi F, Laurora NR, Imberti D, Palaretti G, Prisco D. II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopedics and traumatology. Minerva Anestesiol 2013; 79:778-792. [PMID: 23511358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist to its regard in other fields of orthopedics and traumatology. Indeed, no guidelines or recommendations are available in the literature, except for a limited number of weak statements about knee arthroscopy and lower limb fractures. The present paper represents the first multidisciplinary effort to provide suggestions on the prophylaxis of VTE in the remaining fields of orthopedic surgery (minor orthopedic surgery and orthopedic trauma). The Italian Society for Studies on Hemostasis and Thrombosis (SISET), the Italian Society of Orthopedics and Traumatology (SIOT) and the association of Orthopedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down quick and easy suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal of improving its clinical application.
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Affiliation(s)
- G Della Rocca
- Clinica di Anestesia e Rianimazione, University of Udine, Udine, Italy.
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Randelli F, Romanini E, Biggi F, Danelli G, Della Rocca G, Laurora NR, Imberti D, Palareti G, Prisco D. II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery. J Orthop Traumatol 2013; 14:1-13. [PMID: 23224149 PMCID: PMC3585990 DOI: 10.1007/s10195-012-0214-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/03/2012] [Indexed: 11/28/2022] Open
Abstract
Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.
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Affiliation(s)
- F. Randelli
- Dipartimento di Ortopedia e Traumatologia V, I.R.C.C.S. Policlinico San Donato, S. Donato Milanese, MI Italy
| | - E. Romanini
- Divisione di Ortopedia e Traumatologia, Casa di Cura San Feliciano, Rome, Italy
| | - F. Biggi
- UOA Ortopedia e Traumatologia, Ospedale S. Martino, Belluno, Italy
| | - G. Danelli
- UO Anestesia Analgesia e Medicina Perioperatoria, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - G. Della Rocca
- Anestesia e Rianimazione, Università degli Studi di Udine, Udine, Italy
| | | | - D. Imberti
- UO di Medicina Interna, Centro Emostasi e Trombosi, Ospedale Civile di Piacenza, Piacenza, Italy
| | - G. Palareti
- UO Angiologia e Malattie della Coagulazione, Azienda Ospedaliera Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - D. Prisco
- SOD Patologia Medica, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Camporese G, Bernardi E, Scarano L, Ghirarduzzi A, Imberti D, Prandoni P. Outcome of patients with suspected lower limb symptomatic deep vein thrombosis and a normal ultrasound-based initial diagnostic workup: a prospective study. J Thromb Haemost 2012; 10:2605-6. [PMID: 23025495 DOI: 10.1111/jth.12015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cosmi B, Filippini M, Tonti D, Avruscio G, Ghirarduzzi A, Bucherini E, Camporese G, Imberti D, Palareti G. A randomized double-blind study of low-molecular-weight heparin (parnaparin) for superficial vein thrombosis: STEFLUX (Superficial ThromboEmbolism and Fluxum). J Thromb Haemost 2012; 10:1026-35. [PMID: 22487001 DOI: 10.1111/j.1538-7836.2012.04727.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Optimal doses and duration of low-molecular-weight heparin (LMWH) for the treatment of superficial vein thrombosis (SVT) are still uncertain. OBJECTIVES To compare the efficacy and safety of different doses and durations of LMWH parnaparin for symptomatic lower limb SVT. PATIENTS AND METHODS Outpatients with at least a 4-cm-long SVT of long or short saphenous veins or their collaterals were randomized to receive parnaparin either 8500 UI once daily ( o.d.) for 10 days followed by placebo for 20 days (group A) or 8500 UI o.d. for 10 days followed by 6400 UI once daily (o.d.) for 20 days (group B) or 4250 UI o.d. for 30 days (group C) in a double-blind fashion in 16 clinics. Primary outcome was the composite of symptomatic and asymptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and relapse and/or symptomatic or asymptomatic SVT recurrence in the first 33 days with 60 days follow-up. RESULTS Among 664 patients, primary outcome occurred in 33/212 (15.6%), 4/219 (1.8%) and 16/217 (7.3%) subjects in groups A, B and C, respectively (B vs. A: absolute risk reduction [ARR]: 13.7%, 95% confidence intervals [CI]: 8-18.9 P<0.001; B vs. C: ARR: 5.5%; 95% CI: 1.6-9.4 P= 0.011; C vs. A: ARR: 8.2%, 95% CI: 2-14 P=0.012). During days 0-93, the event rate was higher in group A (22.6%) than either in group B (8.7%; P=0.001) or C (14.3%, P=0.034). No major hemorrhages occurred. CONCLUSIONS An intermediate dose of parnaparin for 30 days is superior to either a 30-day prophylactic dose or a 10-day intermediate dose for lower limb SVT treatment.
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Affiliation(s)
- B Cosmi
- Department of Angiology & Blood Coagulation 'Marino Golinelli', S.Orsola-Malpighi University Hospital, Bologna, Italy.
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Imberti D, Agnelli G, Ageno W, Moia M, Palareti G, Pistelli R, Verso M. Long term clinical outcomes of cancer associated venous thromboembolism: findings from the MASTER registry. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Della Rocca G, Biggi F, Grossi P, Imberti D, Landolfi R, Palareti G, Randelli F, Prisco D. Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery. Minerva Anestesiol 2011; 77:1003-1010. [PMID: 21952601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Anticoagulant prophylaxis for preventing venous thrombembolism (VTE) is a worldwide established procedure in hip (HR) and knee replacement (KR) surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Hemostasis and Thrombosis, the Italian Society of Orthopedics and Traumatology, the association of Orthopedic Traumatology of Italian Hospitals, together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care have set down easy and quick suggestions for VTE prophylaxis in HR and KR surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and thus at improving its proper application. Special focus is given to fragile patients, those with high bleeding risk, and on those receiving chronic antiplatelet and vitamin K antagonists treatment. A special chapter is dedicated to regional anesthesia and VTE prophylaxis.
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Affiliation(s)
- G Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Italy.
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Randelli F, Biggi F, Della Rocca G, Grossi P, Imberti D, Landolfi R, Palareti G, Prisco D. Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery. J Orthop Traumatol 2011; 12:69-76. [PMID: 21246392 PMCID: PMC3052424 DOI: 10.1007/s10195-010-0125-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Anticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedists and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) have set down easy and quick suggestions for VTE prophylaxis in hip and knee surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and its goal is to benefit its clinical application. Special focus is given to fragile patients, those with high bleeding risk, and those receiving chronic antiplatelet (APT) and vitamin K antagonists treatment. A special chapter is dedicated to regional anaesthesia and VTE prophylaxis.
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Affiliation(s)
- F Randelli
- Hip Department, Orthopedics and Trauma II, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
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Dentali F, Ageno W, Giorgi Pierfranceschi M, Pierfranceschi MG, Imberti D, Malato A, Nitti C, Salvi A, Siragusa S, Squizzato A, Vitale J, Agnelli G. Prognostic relevance of an asymptomatic venous thromboembolism in patients with cancer. J Thromb Haemost 2011; 9:1081-3. [PMID: 21410640 DOI: 10.1111/j.1538-7836.2011.04259.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N, Imberti D, Squizzato A, Venco A, Agnelli G. PO-07 Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pierfranceschi MG, Imberti D, Orlando S, Vallisa D, Michieletti E. PO-76 Effectiveness of recombinant factor VIIa in haemorragic cancer-related disseminated intravascular coagulation: a case report. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palareti G, Agnelli G, Imberti D, Moia M, Ageno W, Pistelli R, Rossi R, Verso M. Do Italian vascular centers look for isolated calf deep vein thrombosis? Analysis of isolated calf deep vein thromboses included in the ''Master'' Registry. INT ANGIOL 2008; 27:482-488. [PMID: 19078910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Two diagnostic imaging strategies for suspected deep venous thrombosis (DVT) in symptomatic patients are currently used: a serial compression ultrasound examination of proximal veins, or a single complete ultrasound investigation of proximal and distal veins. These strategies lead to different results since only the latter allows diagnosis of isolated calf DVT (ICDVT). METHODS We analyzed the approach of Italian centers in looking for ICDVT using the observational MASTER registry which prospectively collected information on patients with acute symptomatic venous thromboembolism. RESULTS ICDVT was diagnosed in 170 of the 1772 patients with leg DVT (9.6%). The rate of diagnosed ICDVT vs total DVT differed between centers from 0% to 24%. Patients with ICDVT were younger (P<0.0001); diagnosis was more frequently delayed (P<0.0001), temporary risk factors were more frequent, cancer was less frequent (P<0.001), and pulmonary embolism (PE) was more frequent at presentation (P<0.05). More ICDVT patients received LMWH only, not followed by oral anticoagulation (P<0.001). CONCLUSIONS The diagnostic strategy for suspected leg DVT differs greatly among Italian centers. A relatively high rate of PE was recorded in patients with ICDVT for reasons which are open to debate. Prospective, well designed studies on the clinical risks and the need for diagnosing ICDVT, and the advantages/disadvantages of the two diagnostic procedures are urgently needed.
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Affiliation(s)
- G Palareti
- Department of Angiology and Blood Coagulation Marino Golinelli, University of Bologna, Bologna, Italy.
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Abstract
Retrievable filters are a new generation of inferior vena cava (IVC) filters and represent an attractive option because they may be either left in place permanently or safely retrieved after a quite long period when they become unnecessary. In this review the currently available literature regarding retrievable IVC filters is summarized and their efficacy and safety is discussed. Moreover, the appropriate indications for their use are reviewed. Retrievable filters are becoming safer and easier to use; in fact the bioengineering research has optimized the technical characteristics of these devices, in order to reduce the incidence of possible complications. However, there are important unresolved issues, including the appropriate maximum implantation time, the possibility to safely and efficaciously remove the filters without being compromised by entrapped clots, and the use of anticoagulation during the implantation and periremoval periods. Large prospective cohort studies or randomized trials are strongly warranted to definitely clarify the beneficial role of these devices.
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Affiliation(s)
- D Imberti
- Thrombosis Center, Emergency Department, Hospital of Piacenza, Italy.
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Affiliation(s)
- D. Imberti
- Thrombosis Center, Emergency Department, Ospedale Civile, Via Taverna 49, I-29100 Piacenza, Italy
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Imberti D, Agnelli G, Ageno W, Moia M, Palareti G, Pistelli R, Rossi R, Verso M. PO-90 Clinical characteristics of cancer associated acute venous thromboembolism: findings from the MASTER Registry. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Imberti D, Barillari G, Biasioli C, Bianchi M, Contino L, Duce R, D’Incà M, Mameli L, Pinna L, Ageno W. Prothrombin Complex Concentrates for Urgent Anticoagulation Reversal in Patients with Intracranial Haemorrhage. Pathophysiol Haemos Thromb 2007; 36:259-65. [DOI: 10.1159/000252822] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 04/13/2009] [Indexed: 11/19/2022]
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Imberti D, Ageno W, Dentali F, Giorgi Pierfranceschi M, Croci E, Garcia D. Management of primary care patients with suspected deep vein thrombosis: use of a therapeutic dose of low-molecular-weight heparin to avoid urgent ultrasonographic evaluation. J Thromb Haemost 2006; 4:1037-41. [PMID: 16689756 DOI: 10.1111/j.1538-7836.2006.01940.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Out of hospital management of patients with suspected deep vein thrombosis (DVT) can be problematic. The accuracy of clinical prediction rules in the primary care setting may be inadequate, D-dimer testing may not be available, and the cost-effectiveness of urgent ultrasonographic evaluation is uncertain. OBJECTIVE The purpose of this study was to determine the efficacy and safety of an empiric single therapeutic dose of low-molecular weight heparin (LMWH) in the time interval preceding ultrasound investigation in patients presenting to primary care physicians (PCPs) for suspicion of DVT. METHODS Consecutive patients with suspected DVT who presented to the office of a PCP outside regular thrombosis center working hours were enrolled. All eligible patients received a single therapeutic dose of LMWH (100 anti-Xa IU kg(-1) weight) and were scheduled to undergo clinical and instrumental evaluation at the thrombosis center the morning after. Clinical events were documented after a 3-month follow-up. RESULTS A total of 534 consecutive patients with suspected DVT were included in this study; of these 102 patients had subsequent diagnosis of DVT. We detected no episodes of pulmonary embolism, major bleeding, or death during the 18-h window between the administration of LMWH and objective evaluation. Of the 432 patients in whom diagnosis of DVT was subsequently excluded, only three (0.7%; CI: 0.2-2.0%) developed venous thromboembolic events during the 3-month follow-up period. CONCLUSIONS Empiric treatment with a single therapeutic dose of LMWH is effective and safe for outpatients with suspected DVT initially managed in a primary care setting. This strategy has the potential to reduce the need for urgent diagnostic imaging.
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Affiliation(s)
- D Imberti
- Emergency Department, Thrombosis Center, Hospital of Piacenza, Via Taverna 49, 29100 Piacenza, Italy.
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Imberti D, Bianchi M, Farina A, Siragusa S, Silingardi M, Ageno W. Clinical experience with retrievable vena cava filters: results of a prospective observational multicenter study. J Thromb Haemost 2005; 3:1370-5. [PMID: 15978093 DOI: 10.1111/j.1538-7836.2005.01448.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retrievable inferior vena cava (IVC) filters offer the attractive possibility to be definitive or to be removed when they become unnecessary. OBJECTIVE The purpose of this study was to evaluate the efficacy and the likelihood to remove the retrievable IVC filter ALN. METHODS A total of 30 patients (13 males and 17 females, mean age 57 +/- 15 years) underwent placement of ALN filters. Indications for implantation were acute venous thromboembolism (VTE) with a contraindication to anticoagulation in 26 cases (86%), primary prophylaxis after major trauma in two cases (7%) or before surgery in two patients with very high thromboembolic risk (7%). RESULTS The filter was successfully placed in all patients. After a median follow-up of 18.2 months, there were three cases (10%) of trapped emboli within the filter, one case (3%) of asymptomatic migration of the filter toward the heart and two patients (7%) had deep vein thrombosis (DVT) recurrences. ALN retrieval was attempted through transjugular approach in 18 patients (60%) and the maneuver was successful in 14 of them (78%); when the decision of removal was taken more than 3 months after the implantation, the retrieval was possible only in four of eight patients (50%). The median implantation period was 123 days (range: 30-345). CONCLUSIONS The present study shows the efficacy of ALN filter; it also demonstrates the feasibility and safety of retrieval after a medium-term period of placement. Removal after 3 months after implantation can be unsuccessful and maximum implantation time requires further studies.
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Affiliation(s)
- D Imberti
- Department of Internal Medicine, Ospedale Civile, Piacenza, Italy.
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Affiliation(s)
- W Ageno
- Department of Clinical Medicine, University of Insubria, Varese, Italy.
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Imberti D, Verso M, Silvestrini E, Taliani MR, Agnelli G. Successful treatment with dermatan sulfate in six patients with heparin-induced thrombocytopenia and acute venous thromboembolism. J Thromb Haemost 2003; 1:2696-7. [PMID: 14675116 DOI: 10.1111/j.1538-7836.2003.0543l.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Imberti D. [Antithrombin: prospects in clinical practice. Sespsi: anticoagulant or anti-inflammatory agents?]. Minerva Anestesiol 2003; 69:371-5. [PMID: 12768169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Sepsis and septic shock represent a frequent cause of mortality in Intensive Care Units, despite of the progress in antibiotic therapy and in the hemodynamic and respiratory support. The most frequent cause of death is the Multi Organ Dysfunction Syndrome (MODS), which is the clinical manifestation of the irreversibile damage of the microvascular bed. During sepsis and septic shock both activation of coagulation /fibrinolysis and release of mediators of inflammation contribute to the pathogenesis of disseminated intravascular coagulation (DIC); in particular the formation of fibrin in the microvascular bed is the pathological substrate of the clinical development of MODS. The rationale for employing antithrombin (AT) concentrates in the treatment of DIC associated to sepsis is based on the consideration that AT plasma levels are always decreased in patients with sepsis or septic shock; furthermore, the degree of the decrease is directly proportional to the severity of the disease and the prognosis and low AT plasma activities correlate with high mortality. AT has a double function: anticoagulant and anti-inflammatory. The most important mechanism responsible of the anti-inflammatory properties of AT is the binding to the glycosaminoglycans of the endothelial cells and the consequent release of prostacyclin. During sepsis and septic shock, treatment with AT was able, especially in animal models but also in clinical studies, to decrease plasma levels of mediators of inflammation and in some case to preserve organ failure and to reduce mortality.
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Affiliation(s)
- D Imberti
- Ambulatorio Trombosi, III Unità Operativa di Medicina Interna, Ospedale Civile di Piacenza, Piacenza, Italy.
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Scarpioni R, Cristinelli L, Quaretti P, Imberti D, Cavallotti P. Waldenström's macroglobulinaemia and acute renal failure: isoosmolal non-ionic contrast medium is not an absolute contraindication. Nephrol Dial Transplant 2001; 16:1083-4. [PMID: 11328931 DOI: 10.1093/ndt/16.5.1083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fornari F, Imberti D, Squillante MM, Squassante L, Civardi G, Buscarini E, Cavanna L, Caturelli E, Buscarini L. Incidence of gallstones in a population of patients with cirrhosis. J Hepatol 1994; 20:797-801. [PMID: 7930481 DOI: 10.1016/s0168-8278(05)80152-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
One hundred and sixty-five patients with cirrhosis were prospectively investigated, by regular ultrasonographic follow up, to assess the incidence of gallstones. The mean length of follow up was 33 months (range 12 to 108). Cholelithiasis was diagnosed in 31 patients (18.8%), with a cumulative incidence over 84 months of 38.3% (4.7% yearly incidence). The risk of gallstones was similar in males (38%) and females (38.3%), although the final cumulative incidence was reached at 72 months in males. The percentage of patients with new stones was higher in alcoholic cirrhosis (28.9%) (with a cumulative incidence of 48.8% at 84 months) and lower in hepatitis-related cirrhosis (1.9%) (only one new case at 96 months of follow up) (p < 0.001). The cumulative incidence of gallstones in the Child's C group reached 49.3% at 48 months versus 24% in Child's B and 6.4% in Child's A (p < 0.0001). At multivariate analysis, Child's C and alcoholic cirrhosis were shown to be the independent variables significantly associated with a high risk of development of cholelithiasis. This study confirms that cirrhosis represents a high risk factor for gallstones. The risk is greater for alcoholic cirrhosis and increases with the severity of the disease.
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Affiliation(s)
- F Fornari
- First Department of Medicine, Hospital of Piacenza, Italy
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Abstract
From January 1984 to December 1991 we carried out a prospective surveillance of the development of hepatocellular carcinoma (HCC) in 200 cirrhotic patients, monitored from the first histologic diagnosis of cirrhosis. Real-time ultrasonography (US) and serum alpha-fetoprotein (AFP) assays were performed every 3-6 months. During this period we detected HCC in 38 patients. The overall cumulative incidence of HCC in the 8 years was 41%, with a yearly incidence of 5.1%. Eighteen of 38 patients (48%) had a tumor < 5 cm in diameter. AFP reached diagnostic levels (> 500 ng/ml) in eight cases only (21%). Patients with initial AFP values > 20 ng/ml developed HCC more frequently than patients with values < or = 20 ng/ml; the percentage of HCC was statistically higher (p < 0.01) in patients in Child's B and C than in Child's A class. A periodic follow-up, using US and AFP, is suggested for the early diagnosis of HCC in cirrhotic patients.
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Affiliation(s)
- D Imberti
- First Dept. of Internal Medicine, Piacenza Hospital, Italy
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Buscarini L, Imberti D. [Increased incidence of spontaneous conversion to sinus rhythm in patients with paroxysmal atrial fibrillation]. G Ital Cardiol 1992; 22:949-52. [PMID: 1478395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of our study was to evaluate spontaneous conversion rate to sinus rhythm in patients with paroxysmal atrial fibrillation (AF) not submitted to any treatment (pharmacological and/or electrical). METHODS From January 1985 to September 1990, 123 consecutive patients with paroxysmal AF were hospitalized in our department. In 11 patients arrhythmia was due to arrhythmogenic conditions; 34 patients were submitted to emergency treatment with drugs (23 cases) or electrical cardioversion (11 cases); 78 patients (41 males; mean age 65.1 years; 37 females: mean age 68.6 years), without emergency problems were enrolled in our study and were submitted to a four-day observation period without any therapy, except in case of worsening. 35 patients were free from heart disease; in the other 43, 28 had chronic coronary disease, 11 hypertensive cardiovascular disease, 2 rheumatic valvular disease, 1 hypertrophic cardiomyopathy and 1 chronic cor pulmonale. RESULTS In all 78 patients sinus rhythm was restored spontaneously - in about 90% of them within 24 hours. Mean time to conversion was 21 hours (range 1-96 hours). Cardioversion occurred in similar percentage and at the same time in both subgroups of patients (with and without heart disease). CONCLUSIONS Therefore, given the risks and cost of every treatment, a 24-hour observation period without therapy could be useful in those patients presenting with paroxysmal atrial fibrillation without emergency problems.
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Affiliation(s)
- L Buscarini
- I Divisione di Medicina Generale, Ospedale di Piacenza
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Fornari F, Civardi G, Buscarini E, Cavanna L, Imberti D, Rossi S, Sbolli G, Di Stasi M, Buscarini L. Cirrhosis of the liver. A risk factor for development of cholelithiasis in males. Dig Dis Sci 1990; 35:1403-8. [PMID: 2226102 DOI: 10.1007/bf01536748] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An ultrasonographic study about the prevalence of cholelithiasis was performed in 410 cirrhotic patients and in 414 controls matched for age and sex. Gallstone disease was found more often in cirrhotic patients (31.9%) than in controls (20.7%) (P less than 0.001). The female-to-male ratio of gallstones prevalence in cirrhotic patients approached to 1:1. Gallstone disease in cirrhotic patients vs controls was significantly higher (30.2% vs 16.5%) (P less than 0.001) in males only. No difference was found, for gallstone disease prevalence in cirrhosis of different etiology. The prevalence of cholelithiasis increased from Child's A to Child's C with a significant trend (P less than 0.001); this difference was significant in males (12.3% vs 40.5%) (P less than 0.001) but not in females. This study shows that cirrhosis represents a risk factor for the development of cholelithiasis in males. We suggest that high levels of estrogens could play a role in these patients, by an impairment of gallbladder emptying similar to that observed in pregnant women.
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Affiliation(s)
- F Fornari
- I Divisione di Medicina, Servizio di Gastroenterologia, Ospedale di Piacenza, Italy
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