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Gutiérrez-Guisado J, Calvo-Sotelo AE, Hernández-Blasco L, Fidalgo Á, Gómez-Cuervo C, López-Ruiz A, Aibar J, Verhamme P, Meireles J, Monreal M. Venous thromboembolism (VTE) developing after ankle sprain. Comparison with VTE after knee arthroplasty. Thromb Res 2024; 237:94-99. [PMID: 38574519 DOI: 10.1016/j.thromres.2024.03.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/09/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a critical complication after non-major trauma or surgery. While the risk and severity of VTE following major orthopedic surgery is well-documented, there is significant knowledge gap regarding, non-major trauma such as ankle sprains. METHODS We analyzed data from the RIETE registry to assess the clinical characteristics, VTE prophylaxis usage, and outcomes in patients with VTE following ankle sprain versus those post elective knee arthroplasty. We aimed to assess the risk and severity of VTE in a population traditionally considered at lower risk. Risk stratification was performed using the TRiP(cast) score. RESULTS Among 1,250 patients with VTE, those with ankle sprain (n = 459) were much younger than those post knee arthroplasty (n = 791), less often female, had fewer comorbidities, and received VTE prophylaxis less often (27% vs. 93 %). During anticoagulation, 26 patients developed recurrent VTE, 31 had major bleeding, and 12 died (fatal PE 3, fatal bleeding 2). There were no differences between the two groups in the rates of VTE recurrences (rate ratio (RR): 1.65; 95%CI: 0.69-3.88) or death (RR: 1.12; 95%CI: 0.33-3.46), but patients with VTE after ankle sprain had a lower rate of major bleeding (RR: 0.39; 95%CI: 0.13-0.99). CONCLUSIONS Ankle sprain patients are often undertreated for VTE prophylaxis and have similar severity of VTE than those undergoing elective knee surgery, indicating the need for a more customized approach to VTE management.
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Affiliation(s)
- Javier Gutiérrez-Guisado
- Department of Internal Medicine, Hospital ASEPEYO Coslada, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Alejo Erice Calvo-Sotelo
- Department of Internal Medicine, Hospital ASEPEYO Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Luis Hernández-Blasco
- Pneumology Department of Clinical Medicine, Miguel Hernandez University, ISABIAL, Dr. Balmis University General Hospital, Alicante. Spain
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Antonio López-Ruiz
- Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain
| | - Jesús Aibar
- Department of Internal Medicine, Hospital Clínic, Barcelona, Spain
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - José Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa María da Feira, Portugal
| | - Manuel Monreal
- Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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2
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Soria B, Escacena N, Gonzaga A, Soria-Juan B, Andreu E, Hmadcha A, Gutierrez-Vilchez AM, Cahuana G, Tejedo JR, De la Cuesta A, Miralles M, García-Gómez S, Hernández-Blasco L. Cell Therapy of Vascular and Neuropathic Complications of Diabetes: Can We Avoid Limb Amputation? Int J Mol Sci 2023; 24:17512. [PMID: 38139339 PMCID: PMC10743405 DOI: 10.3390/ijms242417512] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Globally, a leg is amputated approximately every 30 seconds, with an estimated 85 percent of these amputations being attributed to complications arising from diabetic foot ulcers (DFU), as stated by the American Diabetes Association. Peripheral arterial disease (PAD) is a risk factor resulting in DFU and can, either independently or in conjunction with diabetes, lead to recurring, slow-healing ulcers and amputations. According to guidelines amputation is the recommended treatment for patients with no-option critical ischemia of the limb (CTLI). In this article we propose cell therapy as an alternative strategy for those patients. We also suggest the optimal time-frame for an effective therapy, such as implanting autologous mononuclear cells (MNCs), autologous and allogeneic mesenchymal stromal cells (MSC) as these treatments induce neuropathy relief, regeneration of the blood vessels and tissues, with accelerated ulcer healing, with no serious side effects, proving that advanced therapy medicinal product (ATMPs) application is safe and effective and, hence, can significantly prevent limb amputation.
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Affiliation(s)
- Bernat Soria
- Institute of Biomedical Research ISABIAL of the University Miguel Hernández, Dr. Balmis General and University Hospital, 03010 Alicante, Spain
- Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
- CIBERDEM Network Research Center for Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, 28029 Madrid, Spain
| | - Natalia Escacena
- Fresci Consultants, Human Health Innovation, 08025 Barcelona, Spain
| | - Aitor Gonzaga
- Institute of Biomedical Research ISABIAL of the University Miguel Hernández, Dr. Balmis General and University Hospital, 03010 Alicante, Spain
- Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
| | - Barbara Soria-Juan
- Reseaux Hôpitalieres Neuchatelois et du Jura, 2000 Neuchâtel, Switzerland
| | - Etelvina Andreu
- Institute of Biomedical Research ISABIAL of the University Miguel Hernández, Dr. Balmis General and University Hospital, 03010 Alicante, Spain
- Department of Applied Physics, University Miguel Hernández Elche, 03202 Elche, Spain
| | - Abdelkrim Hmadcha
- Biosanitary Research Institute (IIB-VIU), Valencian International University (VIU), 46002 Valencia, Spain
- Department of Molecular Biology, University Pablo de Olavide, 41013 Sevilla, Spain
| | - Ana Maria Gutierrez-Vilchez
- Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain
- Department of Pharmacology, Pediatrics and Organic Chemistry, University Miguel Hernández, 03202 Elche, Spain
| | - Gladys Cahuana
- Department of Molecular Biology, University Pablo de Olavide, 41013 Sevilla, Spain
| | - Juan R. Tejedo
- CIBERDEM Network Research Center for Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, 28029 Madrid, Spain
- Department of Molecular Biology, University Pablo de Olavide, 41013 Sevilla, Spain
| | | | - Manuel Miralles
- University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | | | - Luis Hernández-Blasco
- Institute of Biomedical Research ISABIAL of the University Miguel Hernández, Dr. Balmis General and University Hospital, 03010 Alicante, Spain
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Otero R, Lobo JL, López R, Fernández C, Jiménez D, Muriel A, Alfonso M, Ballaz A, Núñez-Ares A, Rodríguez-Matute C, de Miguel-Díez J, Rodríguez-Chiaradía DA, Alcalde M, Elías T, Jara-Palomares L, Rivas A, Alonso Á, García-Ortega A, Sancho T, Morillo R, García-Bragado F, Hernández-Blasco L, Uresandi F, Madridano O, Agüero R, Monreal M. Feasibility of a screening algorithm for chronic thromboembolic pulmonary hypertension: The OSIRIS study. Thromb Res 2023; 228:1-9. [PMID: 37263121 DOI: 10.1016/j.thromres.2023.05.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term sequel to pulmonary embolism (PE) whose incidence varies according to different published studies. We have carried out this study to determine its incidence within 2 years after index pulmonary embolism and to study limitations to an early diagnosis. MATERIAL AND METHODS OSIRIS is a multicentre, longitudinal cohort study. Patients were followed for 3, 6, 12, and 24 months after pulmonary embolism using a structured three-step algorithm. A physician-centered questionnaire at least one positive response in a screening proceeded to the second step, transthoracic echocardiography. The third step consisted of ventilation/perfusion lung scintigraphy and right heart catheterisation. A transthoracic echocardiography was performed in patients without positive response in the screening questionnaire after 2 years. CTEPH diagnosis required haemodynamic confirmation by right heart catheterisation and mismatched perfusion defects on lung scintigraphy. RESULTS A total of 1191 patients were enrolled in 18 Spanish hospitals. Cumulative CTEPH incidence after 2-years PE was: 2.49 % (95 % CI: 1.68-3.56) and the incidence rate of CTEPH was 1.1 cases per 1000 person-months (95 % CI: 0.725; 1.60). The CTEPH algorithm presented a lack of adherence of 29 %; patient and physician preferences posed barriers to the triage algorithm The screening questionnaire, in patients who completed the follow-up, shows a specificity of 91.3 % (89.0-93.2 %) and negative predictive value of 99.4 % (98.4-99.8 %).. CONCLUSIONS OSIRIS provides practiced clinical based data on the chronic thromboembolic pulmonary hypertension incidence and identified barriers to the implementation of a 3-step triage algorithm for its detection. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: NCT03134898.
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Affiliation(s)
- Remedios Otero
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - José Luis Lobo
- Hospital de Araba, Vitoria-Gasteiz, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Raquel López
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - David Jiménez
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Alfonso Muriel
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | | | | | | | | | - Teresa Elías
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain
| | - Luis Jara-Palomares
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (IBIS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | | | - Raquel Morillo
- Hospital Universitario Ramón y Cajal y Universidad de Alcalá, IRYCIS, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | - Olga Madridano
- Hospital Infanta Sofía, San Sebastían de los Reyes, Madrid, Spain
| | - Ramón Agüero
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Monreal
- Hospital Universitario Germans Trias i Pujol, Badalona, Spain
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Weinberg I, Elgendy IY, Dicks AB, Marchena PJ, Malý R, Francisco I, Pedrajas JM, Font C, Hernández-Blasco L, Monreal M. Comparison of Presentation, Treatment, and Outcomes of Venous Thromboembolism in Long-Term Immobile Patients Based on Age. J Gen Intern Med 2023; 38:1877-1886. [PMID: 36750505 PMCID: PMC10271988 DOI: 10.1007/s11606-023-08058-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic immobility is prevalent, especially as people age. However, little is known about venous thromboembolism (VTE) outcomes in this population. OBJECTIVE To compare the presentation, treatment, and outcomes in chronically immobile (>8 weeks) patients older vs. younger than 75 who presented with VTE. DESIGN An observational international registry of patients with VTE. PARTICIPANTS Patients with acute VTE from the "Registro Informatizado Enfermedad TromboEmbolica" (RIETE) registry who were chronically immobile. MAIN MEASURES Baseline characteristics, presenting signs and symptoms, treatment and outcomes including major bleeding, recurrent VTE, and mortality. KEY RESULTS Among 4612 immobile patients (mean age 75.7 years, 34% male), 2127 (46%) presented with pulmonary embolism (PE). Patients >75 years presented more often with dyspnea (44% vs. 38%) or altered mental status (23% vs. 8.1%) and less often with chest pain (13% vs. 18%). The median duration of anticoagulation was shorter in older compared with younger patients [126 vs. 169 days]. During the first 90 days of anticoagulation, major bleeding (4.0% vs. 2.2%), PE-related death (2.5% vs. 1.1%), and bleeding-related death (0.78% vs. 0.26%) occurred more frequently among older patients. In 3550 patients who received anticoagulation beyond 90 days, older patients had more major bleeding [4.23 vs. 2.21 events per 100 patient years]. After anticoagulation discontinuation, recurrent VTE and major bleeding occurred in 11.8 and 9.25 and 1.49 and 0.69 events per 100 patient years, respectively, both in similar rates in both groups. In multivariable analysis, after stopping anticoagulation, VTE recurrence was inversely associated with long-term facility residence [OR 0.51 (0.28-0.92)], anemia [OR 0.63 (0.42-0.95)], and anticoagulation duration < 90 days [OR 0.38 (0.27-0.54)]. CONCLUSIONS Chronically immobilized patients older than 75 years presenting with VTE experience a high rate of adverse events including major bleeding and recurrent VTE. When considering treatment beyond 90 days, we should account for bleeding, recurrence risk, and associated mortality.
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Affiliation(s)
- Ido Weinberg
- Vascular Medicine, Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, GRB-852G, Boston, MA, 02114, USA.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Andrew B Dicks
- Department of Vascular Surgery, Prisma Health/USC School of Medicine Greenville, Greenville, SC, USA
| | - Pablo J Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Radovan Malý
- Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - José M Pedrajas
- Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, Alicante, Spain
| | - Manuel Monreal
- Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
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5
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Baeza-Martínez C, Olmos S, González-Pleiter M, López-Castellanos J, García-Pachón E, Masiá-Canuto M, Hernández-Blasco L, Bayo J. First evidence of microplastics isolated in European citizens' lower airway. J Hazard Mater 2022; 438:129439. [PMID: 35777146 DOI: 10.1016/j.jhazmat.2022.129439] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Microplastics (MPs) have been detected in all environmental locations, including the atmosphere. However, few studies have investigated the presence of airborne MPs in the human respiratory system. Our research purpose was to investigate these pollutants in the lower human airways of 44 adult European citizens, using bronchoalveolar lavage fluid (BALF) collection as a minimally invasive method, that enables the detection of these pollutants in living patients. We studied the relationship between the patients' life habits and physiological parameters, based on background information and medical and occupational history, and the concentration of MPs isolated from their respiratory systems. Our results indicate that most MPs were in the form of microfibers (MFs) (97.06%), with an average concentration of 9.18 ± 2.45 items/100 mL BALF, and only 5.88% (0.57 ± 0.27 items/100 mL BALF) were particulate MPs, without a significant relationship with environmental, physiological, or clinical factors. The average size was 1.73 ± 0.15 mm, with the longest dimension (9.96 mm) corresponding to a polyacrylic fiber. Taken together, the results demonstrated the occurrence of MPs in the lower human airway, although more studies are necessary to elucidate the negative effects these pollutants could induce in the human respiratory system and its associated diseases.
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Affiliation(s)
- Carlos Baeza-Martínez
- Pneumology Service, Hospital General Universitari d'Elx, Camí de l'Almazara, 11, E-03203 Elx, Alicante, Spain
| | - Sonia Olmos
- Department of Chemical and Environmental Engineering, Technical University of Cartagena, Paseo Alfonso XIII 44, E-30203 Cartagena, Spain
| | - Miguel González-Pleiter
- Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Cantoblanco, E-28049 Madrid, Spain
| | - Joaquín López-Castellanos
- Department of Chemical and Environmental Engineering, Technical University of Cartagena, Paseo Alfonso XIII 44, E-30203 Cartagena, Spain
| | - Eduardo García-Pachón
- Pneumology Service, Hospital General Universitari d'Elx, Camí de l'Almazara, 11, E-03203 Elx, Alicante, Spain
| | - Mar Masiá-Canuto
- Departments of Clinical Medicine, Miguel Hernández University of Elche, E-03203 Elche, Alicante, Spain
| | - Luis Hernández-Blasco
- Departments of Clinical Medicine, Miguel Hernández University of Elche, E-03203 Elche, Alicante, Spain
| | - Javier Bayo
- Department of Chemical and Environmental Engineering, Technical University of Cartagena, Paseo Alfonso XIII 44, E-30203 Cartagena, Spain.
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Lecumberri R, Ruiz-Artacho P, Tzoran I, Brenner B, Farge Bancel D, Ay C, Rosa V, Iria F, Hernández-Blasco L, Trujillo Santos J, Monreal M. Outcome of cancer-associated venous thromboembolism is more favorable among patients with hematologic malignancies than in those with solid tumors. Thromb Haemost 2022; 122:1594-1602. [PMID: 35189661 DOI: 10.1055/a-1777-4006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The natural history of patients with hematologic cancer and venous thromboembolism (VTE) has not been consistently evaluated. We aimed to compare the rates of symptomatic recurrent VTE, major bleeding or death during anticoagulant therapy in patients with VTE associated to hematologic vs. solid cancers. METHODS Consecutive patients with active cancer recruited in RIETE were evaluated. Their baseline characteristics, treatments and outcomes during the course of anticoagulation were compared. Univariate and multivariate competing-risk analysis were performed. RESULTS As of December 2020, 16,694 patients with cancer and VTE were recruited. Of these, 1,062 (6.4%) had hematologic cancers. Hematologic patients were less likely to initially present with pulmonary embolism (48% vs. 63%) and more likely with upper-extremity deep vein thrombosis (25% vs. 18%). They also were more likely to have severe thrombocytopenia at baseline (5.6% vs. 0.7%) or to receive chemotherapy (67% vs. 41%). During the course of anticoagulation (median, 150 vs. 127 days), 1,071 patients (6.4%) developed VTE recurrences, 806 (4.8%) suffered major bleeding and 4,136 (24.8%) died. Patients with hematologic cancers had lower rates of recurrent VTE (rate ratio [RR]: 0.73; 95% confidence interval [CI]: 0.56-0.95), major bleeding (RR: 0.72; 95%CI: 0.53-0.98) or all-cause death (RR: 0.49; 95%CI: 0.41-0.57) than those with solid cancers. Patients with multiple myeloma showed the best outcomes. CONCLUSIONS Patients with hematologic cancers, particularly multiple myeloma, and VTE had better outcomes than those with solid cancers. These findings are relevant for the interpretation of previous clinical trials and the design of future studies.
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Affiliation(s)
| | | | - Inna Tzoran
- Thrombosis & Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University Vienna, Vienna, Austria
| | - Vladimir Rosa
- Internal Medicine, Hospital Universitario Virgen de Arrixaca., Murcia, Spain
| | - Francisco Iria
- Internal medicine department, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitari d'Alacant, Alicante, Spain
| | | | - Manuel Monreal
- Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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7
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Giorgi-Pierfranceschi M, Monreal M, Di Micco P, Francisco I, Hernández-Blasco L, Madridano O, López-Sáez JB, Hernando E, Meireles J, Dentali F. Prognostic Impact of Active Cigarette Smoking on Mortality in Patients with Acute Venous Thromboembolic Events, Findings from Real World Data. Medicina (B Aires) 2022; 58:medicina58020295. [PMID: 35208618 PMCID: PMC8880138 DOI: 10.3390/medicina58020295] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. Results: 50,881 patients (43,426 non-smoking and 7455 smoking patients) were included. After a median follow-up of 8.8 months, 7110 patients died (fatal PE 292 and fatal bleeding 281), 3243 presented VTE recurrence, and 1579 had major bleeding. At multivariate analysis, smoking behavior was associated with a higher hazard of death, (HR: 1.28; 95% CI: 1.19–1.40). The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI: 1.02–1.27). Major bleeding did not differ in smoking and non-smoking patients (1.15; 95% CI: 0.96–1.38). The presence of cancer did not appear to influence the association between smoking habits and death (HR: 1.34; 95% CI: 1.22–1.47 in cancer patients and HR: 1.23; 95% CI: 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms.
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Affiliation(s)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, 08016 Barcelona, Spain;
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, 17007 Gerona, Spain;
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, 03014 Alicante, Spain;
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, 28042 Madrid, Spain;
| | - Juan Bosco López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, 11006 Cádiz, Spain;
| | - Elena Hernando
- Department of Pneumonology, Hospital San Pedro, 26001 Logroño, Spain;
| | - Jose Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, 4520-195 Santa María da Feira, Portugal;
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy;
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8
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Soria-Juan B, Garcia-Arranz M, Llanos Jiménez L, Aparicio C, Gonzalez A, Mahillo Fernandez I, Riera Del Moral L, Grochowicz L, Andreu EJ, Marin P, Castellanos G, Moraleda JM, García-Hernández AM, Lozano FS, Sanchez-Guijo F, Villarón EM, Parra ML, Yañez RM, de la Cuesta Diaz A, Tejedo JR, Bedoya FJ, Martin F, Miralles M, Del Rio Sola L, Fernández-Santos ME, Ligero JM, Morant F, Hernández-Blasco L, Andreu E, Hmadcha A, Garcia-Olmo D, Soria B. Efficacy and safety of intramuscular administration of allogeneic adipose tissue derived and expanded mesenchymal stromal cells in diabetic patients with critical limb ischemia with no possibility of revascularization: study protocol for a randomized controlled double-blind phase II clinical trial (The NOMA Trial). Trials 2021; 22:595. [PMID: 34488845 PMCID: PMC8420067 DOI: 10.1186/s13063-021-05430-2] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. Methods A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. Discussion Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. Trial registration ClinicalTrials.govNCT04466007. Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.
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Affiliation(s)
- Barbara Soria-Juan
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Mariano Garcia-Arranz
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Lucía Llanos Jiménez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain.
| | - César Aparicio
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Alejandro Gonzalez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Ignacio Mahillo Fernandez
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | | | | | | | - Pedro Marin
- Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | | | - Francisco S Lozano
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Fermin Sanchez-Guijo
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Eva María Villarón
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Miriam Lopez Parra
- IBSAL-University Hospital of Salamanca, University of Salamanca, Salamanca, Spain
| | - Rosa María Yañez
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | | | | | - Francisco J Bedoya
- University of Pablo de Olavide, Sevilla, Spain.,Network Center for Research in Diabetes and Associated Metabolic Diseases (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas-CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | - José Manuel Ligero
- Institute for Health Research Gregorio Marañón (IISGM), General University Gregorio Marañón Hospital, Madrid, Spain
| | - Francisco Morant
- Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain
| | | | - Etelvina Andreu
- Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain.,University Miguel Hernández de Elche, Alicante, Spain
| | - Abdelkrim Hmadcha
- University of Pablo de Olavide, Sevilla, Spain.,The Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,University of Alicante, Alicante, Spain
| | - Damian Garcia-Olmo
- Jimenez Diaz Foundation University Hospital, FJD Health Research Institute, IIS-FJD UAM, Madrid, Spain
| | - Bernat Soria
- University of Pablo de Olavide, Sevilla, Spain.,Institute for Health Research-ISABIAL, General University Hospital, Alicante, Spain.,University Miguel Hernández de Elche, Alicante, Spain
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9
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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Marchena PJ, Tzoran I, Brenner B, Martín M, Malý R, Bura-Riviere A, Valle R, Hernández-Blasco L, López-Sáez JB, Monreal M. Psychotropic Drugs and Outcome in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism. Thromb Haemost 2020; 120:620-626. [PMID: 32289861 DOI: 10.1055/s-0040-1708482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The influence (if any) of the use of psychotropic drugs on outcome in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. METHODS We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the risk for VTE recurrences, major bleeding, or death during the course of anticoagulant therapy, according to the use of psychotropics at baseline. RESULTS Among 49,007 patients with VTE enrolled from February 2009 to September 2019, total 5,230 (11%) were using psychotropics at baseline: antidepressants 3,273 (6.7%), antipsychotics 1,588 (3.2%), and anticholinesterases 369 (0.7%). During the course of anticoagulation, 1,259 patients developed VTE recurrences, 1,231 bled, and 3,988 died (fatal pulmonary embolism 269 and fatal bleeding 187). On multivariable analysis, patients using psychotropics at baseline had a similar risk for VTE recurrences (adjusted hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.58-1.12), a nonsignificantly higher risk for major bleeding (adjusted HR: 1.15; 95% CI: 0.97-1.35), and a higher risk for intracranial bleeding (adjusted HR: 1.83; 95% CI: 1.32-2.53) or death (adjusted HR: 1.44; 95% CI: 1.32-1.57) compared with those not using psychotropics. When separately analyzed, the highest risk for intracranial bleeding was found in patients using antidepressants (adjusted HR: 1.60; 95% CI: 1.08-2.37) or antipsychotics (adjusted HR: 2.02; 95% CI: 1.17-3.49) but not in those on anticholinesterases (adjusted HR: 1.69; 95% CI: 0.62-4.60). CONCLUSION During the course anticoagulation for VTE, patients using psychotropics at baseline were at increased risk for intracranial bleeding.
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Affiliation(s)
- Pablo Javier Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Inna Tzoran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Benjamin Brenner
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Mar Martín
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Radovan Malý
- Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Czech Republic
| | | | - Reina Valle
- Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Juan Bosco López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
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11
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Maurizot A, Bura-Rivière A, Gritli K, Bertoletti L, Hernández-Blasco L, Ciammaichella M, Díaz-Pedroche MC, Alfonso M, Lorente MA, Monreal M. [Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. J Med Vasc 2017; 42:6-13. [PMID: 28705449 DOI: 10.1016/j.jdmv.2017.01.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.
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Affiliation(s)
- A Maurizot
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Consultations de médecine vasculaire, Centre cardiologique du Nord, 32-36, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - A Bura-Rivière
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - K Gritli
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Centre de consultation médicale spécialisée Delta Medical, rue Habib Chatti, Manar II, Tunis, Tunisie
| | - L Bertoletti
- SAINBIOSE, DVH, Inserm, département de médecine et thérapeutique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - L Hernández-Blasco
- ISABIAL, Department of Clinical Medicine, Universidad Miguel Hernández, Hospital General Universitario Alicante, Alicante, Espagne
| | - M Ciammaichella
- Department of Emergency Internal Medicine, Ospedale St. John, Rome, Italie
| | - M C Díaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Espagne
| | - M Alfonso
- Department of Pneumonology, Complejo Hospitalario de Navarra, Pamplona, Espagne
| | - M A Lorente
- Department of Internal Medicine. Hospital de la Agencia Valenciana de Salud Vega Baja, Alicante, Espagne
| | - M Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Murcia, Espagne
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12
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Tzoran I, Papadakis M, Brenner B, Fidalgo Á, Rivas A, Wells PS, Gavín O, Adarraga MD, Moustafa F, Monreal M, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Adarraga M, Aibar M, Alfonso M, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Cañada G, Cañas I, Chic N, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García A, García M, García-Bragado F, García-Brotons P, Gavín O, Gómez C, Gómez V, González J, González-Marcano D, Grau E, Grimón A, Guijarro R, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Hermosa-Los Arcos M, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Llamas P, Lecumberri R, Lobo J, López P, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Maestre A, Marchena P, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Odriozola M, Otero R, Pedrajas J, Pérez G, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez C, Rodríguez-Dávila M, Rosa V, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez-Martínez R, Sánchez Simón-Talero R, Sanz O, Soler S, Suriñach J, Torres M, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vicente M, Villalobos A, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, del Pozo G, Salgado E, Sánchez G, Bertoletti L, Bura-Riviere A, Mahé I, Merah A, Moustafa F, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Bortoluzzi C, Cattabiani C, Ciammaichella M, Di Biase J, Di Micco P, Duce R, Ferrazzi P, Giorgi-Pierfranceschi M, Grandone E, Imbalzano E, Lodigiani C, Maida R, Mastroiacovo D, Pace F, Pesavento R, Pinelli M, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Gibietis V, Skride A, Vitola B, Monteiro P, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Calanca L, Erdmann A, Mazzolai L. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation. Am J Med 2017; 130:482.e1-482.e9. [PMID: 27986523 DOI: 10.1016/j.amjmed.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. METHODS We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. RESULTS Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). CONCLUSIONS During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
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Affiliation(s)
- Inna Tzoran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | - Manolis Papadakis
- Haematology and Hemostasis Unit, Hospital Papageorgiou, Saloniki, Greece
| | - Benjamin Brenner
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain
| | - Agustina Rivas
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
| | - Olga Gavín
- Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Farès Moustafa
- Department of Emergency, Clermont-Ferrand University Hospital, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Newton DH, Monreal Bosch M, Amendola M, Wolfe L, Perez Ductor C, Lecumberri R, Levy MM, Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Agüero R, Aibar M, Alfonso M, Aranda R, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Binetti J, Blanco-Molina A, Bueso T, Cañas I, Carmona F, Chic N, Culla A, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Aracil C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García M, García-Bragado F, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Manrique-Abos I, Marchena P, Martín M, Martín-Antorán J, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez G, Pérez I, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez-Dávila M, Rosa V, Rosillo-Hernández E, Ruiz-Artacho P, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Suriñach J, Tolosa C, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vidal G, Villalta J, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Salgado E, Bertoletti L, Bura-Riviere A, Champion K, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Ciammaichella M, Dentali F, Di Micco P, Duce R, Ferrazzi P, Grandone E, Lodigiani C, Maida R, Pace F, Pesavento R, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Drucka E, Kigitovica D, Skride A, Ramos A, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Erdmann A, Mazzolai L, Ney B. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5:18-24.e1. [DOI: 10.1016/j.jvsv.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
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Martín-Martos F, Trujillo-Santos J, Barrón M, Vela J, Javier Marchena P, Braester A, Hij A, Hernández-Blasco L, Verhamme P, Manuel M. Gender differences in cancer patients with acute venous thromboembolism. Thromb Res 2015; 135 Suppl 1:S12-5. [PMID: 25903526 DOI: 10.1016/s0049-3848(15)50433-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The outcome of cancer patients with acute venous thromboembolism (VTE) may differ according to gender. METHODS We used the RIETE database to compare the rate of VTE (pulmonary embolism [PE] or deep vein thrombosis [DVT]) recurrences), major bleeding and mortality during the course of anticoagulation, according to gender. RESULTS As of August 2014, 11,055 patients with active cancer were enrolled in RIETE, of whom 5,104 (46%) were women. During the course of anticoagulation (mean: 142 days), 505 patients developed recurrent VTE, 429 bled and 2730 died. Compared with men, women had a significantly lower rate of fatal bleeding (risk ratio [RR]: 0.69; 95% CI: 0.47-0.99) and death (RR: 0.90; 95% CI: 0.83-0.97), and a non-significantly lower rate of PE recurrences (RR 0.83; 95% CI: 0.65-1.06) and major bleeding (RR: 0.89; 95% CI: 0.74-1.08). CONCLUSIONS During the course of anticoagulation, cancer women with VTE had a better outcome than men.
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Affiliation(s)
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain
| | - Manuel Barrón
- Department of Pneumonology, Complejo Hospitalario San Pedro, La Rioja, Spain
| | - Jerónimo Vela
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Pablo Javier Marchena
- Department of Internal Medicine, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
| | - Andrei Braester
- Department of Haematology, Western Galilee Hospital, Nahariya, Israel
| | - Adrian Hij
- Internal Medicine and Vascular Diseases Unit, Hôpital Saint-Louis, Paris, France
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Peter Verhamme
- Department of Cardiovascular Science, Vascular Medicine and Haemostasis, University of Leuven, Leuven, Beigium
| | - Monreal Manuel
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Masa JF, Corral J, Sanchez de Cos J, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso A, Chiner E, Aizpuru F, Vázquez-Polo FJ, Zamorano J, Montserrat JM, Garcia-Ledesma E, Pereira R, Cancelo L, Martinez A, Sacristan L, Salord N, Carrera M, Sancho-Chust JN, Negrín MA, Embid C. Effectiveness of three sleep apnea management alternatives. Sleep 2013; 36:1799-807. [PMID: 24293754 DOI: 10.5665/sleep.3204] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
RATIONALE Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients. OBJECTIVES To determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm). METHODS Multicentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy. RESULTS For equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted. CONCLUSION Home respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain ; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
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Masa JF, Corral J, Gomez de Terreros J, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso A, Chiner E, Aizpuru F, Zamorano J, Cano R, Montserrat JM, Garcia-Ledesma E, Pereira R, Cancelo L, Martinez A, Sacristan L, Salord N, Carrera M, Sancho-Chust JN, Embid C. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy. Sleep 2013; 36:249-57. [PMID: 23372273 DOI: 10.5665/sleep.2384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
RATIONALE Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals. OBJECTIVES We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal. METHODS We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations. RESULTS Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal. CONCLUSION Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain.
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Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso-Fernandez A, Chiner E, Vázquez-Polo FJ, Montserrat JM. Effectiveness of sequential automatic-manual home respiratory polygraphy scoring. Eur Respir J 2012; 41:879-87. [PMID: 22878873 DOI: 10.1183/09031936.00186811] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Automatic home respiratory polygraphy (HRP) scoring functions can potentially confirm the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS) (obviating technician scoring) in a substantial number of patients. The result would have important management and cost implications. The aim of this study was to determine the diagnostic cost-effectiveness of a sequential HRP scoring protocol (automatic and then manual for residual cases) compared with manual HRP scoring, and with in-hospital polysomnography. We included suspected SAHS patients in a multicentre study and assigned them to home and hospital protocols at random. We constructed receiver operating characteristic (ROC) curves for manual and automatic scoring. Diagnostic agreement for several cut-off points was explored and costs for two equally effective alternatives were calculated. Of 366 randomised patients, 348 completed the protocol. Manual scoring produced better ROC curves than automatic scoring. There was no sensitive automatic or subsequent manual HRP apnoea-hypopnoea index (AHI) cut-off point. The specific cut-off points for automatic and subsequent manual HRP scorings (AHI >25 and >20, respectively) had a specificity of 93% for automatic and 94% for manual scorings. The costs of manual protocol were 9% higher than sequential HRP protocol; these were 69% and 64%, respectively, of the cost of the polysomnography. A sequential HRP scoring protocol is a cost-effective alternative to polysomnography, although with limited cost savings compared to HRP manual scoring.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain
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Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso A, Chiner E, Zamorano J, Aizpuru F, Montserrat JM. Therapeutic decision-making for sleep apnea and hypopnea syndrome using home respiratory polygraphy: a large multicentric study. Am J Respir Crit Care Med 2011; 184:964-71. [PMID: 21737584 DOI: 10.1164/rccm.201103-0428oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Home respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea-hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis. OBJECTIVES This study aimed to determine the agreement between HRP and in-hospital PSG for therapeutic decision-making in a large sample. METHODS Patients with an intermediate or high SAHS suspicion were included in a multicenter study (eight sleep centers) and assigned to home and hospital protocols in a random order. Therapeutic decisions (continuous positive airway pressure, no continuous positive airway pressure, or impossible decision) were made by an investigator in each center, based on using either HRP or PSG and a single set of auxiliary clinical variables. Patients and diagnostic methods (HRP and PSG) were assessed in random order using an electronic database. After a month the same therapeutic decision-making procedure was repeated with the same method. MEASUREMENTS AND MAIN RESULTS Of 366 randomized patients, 348 completed the protocol. The "impossible decision" case was not observed with either PSG or HRP. Therapeutic decisions using HRP had a sensitivity of 73%, a specificity of 77%, and an agreement level (sum of true positives and negatives) of 76%. Patients with higher HRP apnea-hypopnea index (AHI) scores (≥ 30; 41% of the total sample) had a sensitivity of 94%, a specificity of 44%, and the agreement level was 91%. CONCLUSIONS The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Cáceres, Spain.
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Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso A, Chiner E, Rubio M, Garcia-Ledesma E, Cacelo L, Carpizo R, Sacristan L, Salord N, Carrera M, Sancho-Chust JN, Embid C, Vázquez-Polo FJ, Negrín MA, Montserrat JM. Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax 2011; 66:567-73. [PMID: 21602541 DOI: 10.1136/thx.2010.152272] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger evidence is needed. Normally, patients transport HRP equipment from the hospital to home and back, which may create difficulties for some patients. OBJECTIVES To determine both the diagnostic efficacy and cost of HRP (with and without a transportation service moving the device and telematic transmission of data) in a large sample compared with in-hospital polysomnography. METHODS Patients suspected of having SAHS were included in a multicentre study (eight hospitals). They were assigned to home and hospital protocols in random order. Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points. Diagnostic efficacies for several polysomnographic cut-off points were explored and costs for two equally effective alternatives were calculated. RESULTS Of 366 randomised patients, 348 completed the protocol. The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)≥5. The sensitive HRP AHI cut-off point (<5) had a sensitivity of 96%, a specificity of 57% and a negative likelihood ratio (LR) of 0.07; the specific cut-off (>10) had a sensitivity of 87%, a specificity of 86% and a positive LR of 6.25. The cost of HRP was half that of polysomnography. Telematic transmission costs were similar if the patients' costs were taken in to account. CONCLUSION HRP is an alternative to polysomnography in patients with suspected SAHS. Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre.
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Affiliation(s)
- Juan F Masa
- San Pedro de Alcántara Hospital, Pablo Naranjo s/n, Cáceres 10003, Spain.
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Villena MV, Hernández-Blasco L, Izquierdo-Patrón M, González-Garrido F, Echave-Sustaeta J. Pulmonary hamartoma syndrome. Chest 1992; 101:882-3. [PMID: 1599562 DOI: 10.1378/chest.101.3.882b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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