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Eikelboom R, Siegal D, Schulman S, Whitlock R, Belley-Cote E. DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONISTS IN THE FIRST 3 MONTHS AFTER BIOPROSTHETIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.182] [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: 11/02/2022] Open
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Little DH, Pinto T, Douketis J, Dionne J, Holbrook A, Xenodemetropoulos T, Siegal D. A146 MANAGEMENT OF ANTITHROMBOTIC THERAPY AFTER GASTROINTESTINAL BLEEDING: A MIXED METHODS STUDY OF HEALTHCARE PROVIDERS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Oral anticoagulants (OAC) are permanently discontinued in up to 50% of patients after gastrointestinal (GI) bleeding despite ongoing thrombotic risk and evidence of benefit to restarting. The reasons for permanent discontinuation of OAC are unclear, but likely include concerns about re-bleeding and a lack of high-quality evidence. There are no studies evaluating healthcare provider values and preferences following OAC-related GI bleeding and their influence on decision-making about whether and when to resume OACs.
Aims
We aimed to (i) identify key factors (attributes) that influence healthcare provider decision-making regarding resumption of OAC after GI bleeding, (ii) determine the relative importance of these attributes, and (iii) to identify preference groups.
Methods
We conducted focus group discussions (FGD) with healthcare providers involved in the care of patients with OAC-related GI bleeding. Participants ranked the relative importance of the attributes identified during the FGD through a dot voting exercise. Transcripts were reviewed and themes (attributes) were identified. Results of the FGD informed a discrete choice experiments survey developed and analyzed using the Sawtooth software platform (Sawtooth Software, USA). The survey was pilot tested and modified by iterative feedback. A sample choice task is shown in Image 1. Hierarchical Bayes analysis was used to estimate preference coefficients (utilities) for each attribute. Latent class analysis was used to identify preference groups.
Results
There were 4 FGD involving 29 participants. The most important attributes identified and included in the survey were thrombosis risk, indication for OAC, index bleed severity, re-bleeding risk, and patient characteristics. There were 130 survey respondents practicing in hematology (n=68), internal medicine (n=30), gastroenterology (n=7), cardiology (n=4), family medicine (n=3), and others (n=18). The mean age was 45 years (±11) and 51% were male. Thrombosis risk and re-bleeding risk equally had the highest utility followed by index bleed severity, patient characteristics, and indication for OAC. Two preference groups were identified. The dominant preference group (78% of respondents) placed the highest utility on thrombosis risk and re-bleeding risk, while a minority (22% of respondents) placed the highest utility on index bleed severity.
Conclusions
Thrombosis risk and re-bleeding risk are equally the most important factors influencing OAC resumption following OAC-related GI bleeding. The severity of the index bleed is the most important factor in decision-making for a minority segment of healthcare providers. Further research on the dose, type and timing of OAC resumption is needed to determine the optimal balance between thrombosis and re-bleeding.
Funding Agencies
Heart and Stroke Foundation
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Affiliation(s)
- D H Little
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - T Pinto
- Population Health Research Institute, Hamilton, ON, Canada
| | - J Douketis
- McMaster University, Hamilton, ON, Canada
| | - J Dionne
- McMaster University, Hamilton, ON, Canada
| | - A Holbrook
- McMaster University, Hamilton, ON, Canada
| | | | - D Siegal
- McMaster University, Hamilton, ON, Canada
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Laureano M, Goodlife L, Chu D, Siegal D. P6. Abstract Title: Risks and Benefits of Antithrombotic Therapy in Polycythemia Vera: A Systematic Review. Thromb Res 2019. [DOI: 10.1016/j.thromres.2019.09.016] [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: 11/30/2022]
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Martin A, Verbrugge F, Siegal D, Fiarresga A, Pieper K, Camm J, Fox K, Bassand J, Haas S, Goldhaber S, Kakkar A. Why do clinicians prescribe oral anticoagulation in patients with atrial fibrillation despite a low CHA2DS2-VASc score? Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.183] [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: 10/27/2022]
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Verbrugge FH, Martin AC, Siegal D, Fiarresga A, Pieper K, Camm J, Fox KAA, Bassand JP, Haas S, Goldhaber SZ, Kakkar AK. P4800Why do clinicians prescribe oral anticoagulation in patients with atrial fibrillation despite a low CHA2DS2-VASc score? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F H Verbrugge
- University Hospitals (UZ) Leuven, Cardiovascular Diseases, Leuven, Belgium
| | - A.-C Martin
- Percy Military Hospital, Cardiologie, Clamart, France
| | - D Siegal
- Population Health Research Institute, Medicine, Hamilton, Canada
| | - A Fiarresga
- Hospital de Santa Marta, Cardiology, Lisboa, Portugal
| | - K Pieper
- Duke Clinical Research Institute, Durham, United States of America
| | - J Camm
- St George's University of London, Cardiology, London, United Kingdom
| | - K A A Fox
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J.-P Bassand
- University of Besançon, Cardiology, Besançon, France
| | - S Haas
- Technical University of Munich, Medicine, Munich, Germany
| | - S Z Goldhaber
- Brigham and Women's Hospital, Medicine, Boston, United States of America
| | - A K Kakkar
- University College London, London, United Kingdom
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Siegal D, Su WS, DaBreo D, Puglia M, Gregor L, Gangji AS. Liver-kidney transplantation in primary hyperoxaluria type-1: case report and literature review. Int J Organ Transplant Med 2011; 2:126-32. [PMID: 25013605 PMCID: PMC4089259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary hyperoxaluria type-1 (PH1) is a rare inherited autosomal recessive disorder in which a deficiency of the hepatic enzyme alanine-glyoxylate aminotransferase leads to endogenous oxalate overproduction, renal failure, systemic oxalate deposition and death. As hemodialysis provides insufficient oxalate clearance, patients ultimately require both liver and kidney transplantation for correction of the metabolic abnormality and oxalate excretion. Herein, we describe a young adult male with end-stage renal disease and systemic oxalosis causing progressive disabling multi-organ dysfunction while awaiting transplantation. We review the literature regarding liver-kidney transplantation and suggest that for patients with PH1, a standardized assessment of organ dysfunction and functional impairment may improve identification of patients requiring urgent transplantation thereby reducing the morbidity and mortality that can occur with delayed transplantation.
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Affiliation(s)
- D. Siegal
- Division of Nephrology and Transplantation, McMaster University and St. Joseph’s Health Care, Hamilton, Ontario, Canada
| | - W. S. Su
- Division of Nephrology and Transplantation, McMaster University and St. Joseph’s Health Care, Hamilton, Ontario, Canada
| | - D. DaBreo
- Division of Nephrology and Transplantation, McMaster University and St. Joseph’s Health Care, Hamilton, Ontario, Canada
| | - M. Puglia
- Division of Gastroenterology, McMaster University, Ontario Canada
| | - L. Gregor
- Division of Nephrology, Grand River Hospital, Kitchener, Ontario, Canada
| | - A. S. Gangji
- Division of Nephrology and Transplantation, McMaster University and St. Joseph’s Health Care, Hamilton, Ontario, Canada,Correspondence: Azim S. Gangji MD, MSc, BSc, Pharm, FRCPC, FACP, Assistant Professor of Medicine, Division of Nephrology and Transplantation, McMaster University and St. Joseph’s Health Care, Hamilton, Ontario
Phone: +1-905-522-1155 ext 33261
Fax: +1-905-308-7222
E-mail:
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Kumar D, Humar A, Plevneshi A, Siegal D, Franke N, Green K, McGeer A. Invasive pneumococcal disease in adult hematopoietic stem cell transplant recipients: a decade of prospective population-based surveillance. Bone Marrow Transplant 2008; 41:743-7. [PMID: 18176614 DOI: 10.1038/sj.bmt.1705964] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Prospective population-based surveillance to assess the epidemiology of invasive pneumococcal disease (IPD) in hematopoietic stem cell transplant (HSCT) patients is limited and a comparison to the general population is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance of IPD in a large cohort of adult HSCT patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 14 cases of IPD (based on sterile site isolates) in our HSCT population over a 10-year period. This translated to an incidence rate of 347 infections per 100 000 persons per year. This compared to an incidence of 11.5 per 100 000 persons per year in the general population (regression ratio=30.2; 95% confidence interval (CI) 17.8-50.8, P<0.00001). If nonsterile site isolates (respiratory tract) were included, the incidence rate in transplant patients was 446 per 100 000 persons per year. Serotypes 23F and 6B were most common; 100 and 69.2% of isolates were a serotype included in the pneumococcal polysaccharide and conjugate vaccines, respectively. The antimicrobial resistance rates were high, especially for trimethoprim/sulfamethoxazole. HSCT recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.
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Affiliation(s)
- D Kumar
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
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Kumar D, Chen MH, Welsh B, Siegal D, Cobos I, Messner HA, Lipton J, Humar A. A Randomized, Double-Blind Trial of Pneumococcal Vaccination in Adult Allogeneic Stem Cell Transplant Donors and Recipients. Clin Infect Dis 2007; 45:1576-82. [DOI: 10.1086/523583] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kumar D, Humar A, Plevneshi A, Green K, Prasad GVR, Siegal D, McGeer A. Invasive pneumococcal disease in solid organ transplant recipients--10-year prospective population surveillance. Am J Transplant 2007; 7:1209-14. [PMID: 17286615 DOI: 10.1111/j.1600-6143.2006.01705.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [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: 01/25/2023]
Abstract
Prospective population-based surveillance to assess the incidence and impact of invasive pneumococcal disease (IPD) in organ transplant patients is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance pattern of IPD in a large cohort of adult transplant patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 21 cases of IPD (based on sterile-site isolates) in our organ transplant population over a 10-year period. This translated to an incidence rate of 146 infections per 100,000 persons per year. This compared to an incidence of 11.5 per 100,000 persons per year in the general population (R(R)=12.8; 95% CI 8.1-19.9, p<0.00001). If nonsterile-site isolates (respiratory tract) were included, the incidence rate in transplant patients was 419 of 100 000 persons per year. Serotypes 23F and 22F were most common, and 85.0% had a serotype included in the 23-valent pneumococcal vaccine. The antimicrobial resistance rates were high, especially for penicillin and trimethoprim-sulfamethoxazole (TMP/SMX), but were not significantly different from the general population. Solid organ transplant recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.
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Affiliation(s)
- D Kumar
- Infectious Diseases and Multi-Organ Transplant, University of Toronto, Toronto, Ontario, Canada.
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Kumar D, Welsh B, Siegal D, Chen MH, Humar A. Immunogenicity of pneumococcal vaccine in renal transplant recipients--three year follow-up of a randomized trial. Am J Transplant 2007; 7:633-8. [PMID: 17217436 DOI: 10.1111/j.1600-6143.2007.01668.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [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: 01/25/2023]
Abstract
Routine pneumococcal vaccination is recommended at regular intervals posttransplant. However, there is limited data on durability of vaccine response and the impact of vaccine type on antibody persistence. We determined the durability of response for patients enrolled in a randomized trial of conjugate (PCV7) versus polysaccharide (PPV23) pneumococcal vaccination. Response was defined as a twofold increase from baseline and a titer > or =0.35 microg/mL using a pneumococcal ELISA for seven serotypes (measured at 8 weeks and 3 years). Forty-seven patients were evaluated and had received either PPV23 (n = 24) or PCV7 (n = 23). Response rates and geometric mean titers varied by serotype but declined significantly at 3-years for 6 of 7 serotypes (p < 0.001). No significant difference in durability was found in patients that had received PPV23 versus PCV7. Compared to the 8-week response, 20.6% fewer patients had a response to at least one serotype by 3 years. The largest relative declines were seen for serotype 4 (response dropped from 40.4% at 8 weeks to 17.0% at 3 years) and serotype 9V (44.7% dropping to 21.3%). The only factor predictive of response durability was a strong multiserotype initial response (p < 0.001). In conclusion, vaccine responses decline significantly by 3 years and conjugate vaccine does not improve the durability of response.
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Affiliation(s)
- D Kumar
- Infectious Diseases and Multi-Organ Transplant, University of Toronto, Toronto, Ontario, Canada.
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Siegal D, Keller A, Xu W, Bhuta S, Loach D, Kim D, Walia J, Kuruvilla J, Lipton J, Minden M, Messner H, Gupta V. 241: Neurological complications in the recipients of allogeneic hematopoietic cell transplant. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.246] [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: 10/23/2022]
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