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1. Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis

Author

Medische Staf Spoedeisende Hulp, De Jong, Cindy M.M., Van Den Hout, Wilbert B., Van Dijk, Christel E., Heim, Noor, Van Dam, Lisette F., Dronkers, Charlotte E.A., Gautam, Gargi, Ghanima, Waleed, Gleditsch, Jostein, Von Heijne, Anders, Hofstee, Herman M.A., Hovens, Marcel M.C., Huisman, Menno V., Kolman, Stan, Mairuhu, Albert T.A., Van Mens, Thijs E., Nijkeuter, Mathilde, Van De Ree, Marcel A., Van Rooden, Cornelis J., Westerbeek, Robin E., Westerink, Jan, Westerlund, Eli, Kroft, Lucia J.M., Klok, Frederikus A., Medische Staf Spoedeisende Hulp, De Jong, Cindy M.M., Van Den Hout, Wilbert B., Van Dijk, Christel E., Heim, Noor, Van Dam, Lisette F., Dronkers, Charlotte E.A., Gautam, Gargi, Ghanima, Waleed, Gleditsch, Jostein, Von Heijne, Anders, Hofstee, Herman M.A., Hovens, Marcel M.C., Huisman, Menno V., Kolman, Stan, Mairuhu, Albert T.A., Van Mens, Thijs E., Nijkeuter, Mathilde, Van De Ree, Marcel A., Van Rooden, Cornelis J., Westerbeek, Robin E., Westerink, Jan, Westerlund, Eli, Kroft, Lucia J.M., and Klok, Frederikus A.

Published
2024

2. Risk assessment tools for bleeding in patients with unprovoked venous thromboembolism: an analysis of the PLATO-VTE study

Author

MS Geriatrie, Guman, Noori A.M., Becking, Anne Marie L., Weijers, Suzanne S., Kraaijpoel, Noémie, Mulder, Frits I., Carrier, Marc, Jara-Palomares, Luis, Di Nisio, Marcello, Ageno, Walter, Beyer-Westendorf, Jan, Klok, Frederikus A., Vanassche, Thomas, Otten, Johannes M.M.B., Cosmi, Benilde, Peters, Mike J.L., Wolde, Marije ten, Delluc, Aurélien, Sanchez-Lopez, Veronica, Porreca, Ettore, Bossuyt, Patrick M.M., Gerdes, Victor E.A., Büller, Harry R., van Es, Nick, Kamphuisen, Pieter W., MS Geriatrie, Guman, Noori A.M., Becking, Anne Marie L., Weijers, Suzanne S., Kraaijpoel, Noémie, Mulder, Frits I., Carrier, Marc, Jara-Palomares, Luis, Di Nisio, Marcello, Ageno, Walter, Beyer-Westendorf, Jan, Klok, Frederikus A., Vanassche, Thomas, Otten, Johannes M.M.B., Cosmi, Benilde, Peters, Mike J.L., Wolde, Marije ten, Delluc, Aurélien, Sanchez-Lopez, Veronica, Porreca, Ettore, Bossuyt, Patrick M.M., Gerdes, Victor E.A., Büller, Harry R., van Es, Nick, and Kamphuisen, Pieter W.

Published
2024

3. Prevalence and 3-month follow-up of cerebrovascular MRI markers in hospitalized COVID-19 patients: the CORONIS study

Author

Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J., Sluis, Wouter M., Wijers, Naomi T., Meijer, Frederick J.A., Ulzen, Karin Kamphuis van, de Bresser, Jeroen, Dankbaar, Jan Willem, de Mast, Quirijn, Klok, Frederikus A., Cannegieter, Suzanne C., Wermer, Marieke J.H., Huisman, Menno V., Tuladhar, Anil M., van der Worp, H. Bart, de Leeuw, Frank Erik, Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J., Sluis, Wouter M., Wijers, Naomi T., Meijer, Frederick J.A., Ulzen, Karin Kamphuis van, de Bresser, Jeroen, Dankbaar, Jan Willem, de Mast, Quirijn, Klok, Frederikus A., Cannegieter, Suzanne C., Wermer, Marieke J.H., Huisman, Menno V., Tuladhar, Anil M., van der Worp, H. Bart, and de Leeuw, Frank Erik

Published
2024

4. Antithrombotic Therapy for VTE Disease: Compendium and Review of CHEST Guidelines 2012-2021

Author

HAG Trombose, Circulatory Health, Stevens, Scott M, Woller, Scott C, Baumann Kreuziger, Lisa, Doerschug, Kevin, Geersing, Geert-Jan, Klok, Frederikus A, King, Christopher S, Murin, Susan, Vintch, Janine R E, Wells, Philip S, Wasan, Suman, Moores, Lisa K, HAG Trombose, Circulatory Health, Stevens, Scott M, Woller, Scott C, Baumann Kreuziger, Lisa, Doerschug, Kevin, Geersing, Geert-Jan, Klok, Frederikus A, King, Christopher S, Murin, Susan, Vintch, Janine R E, Wells, Philip S, Wasan, Suman, and Moores, Lisa K

Published
2024

5. Safety of treating acute pulmonary embolism at home: an individual patient data meta-analysis

Author

Hart- en Vaatziekten Team A, Epi Methoden Team 3, Datascience, Infection & Immunity, Luijten, Dieuwke, Douillet, Delphine, Luijken, Kim, Tromeur, Cecile, Penaloza, Andrea, Hugli, Olivier, Aujesky, Drahomir, Barco, Stefano, Bledsoe, Joseph R., Chang, Kyle E., Couturaud, Francis, den Exter, Paul L., Font, Carme, Huisman, Menno V., Jimenez, David, Kabrhel, Christopher, Kline, Jeffrey A., Konstantinides, Stavros, van Mens, Thijs, Otero, Remedios, Peacock, W. Frank, Sanchez, Olivier, Stubblefield, William B., Valerio, Luca, Vinson, David R., Wells, Philip, van Smeden, Maarten, Roy, Pierre Marie, Klok, Frederikus A., Hart- en Vaatziekten Team A, Epi Methoden Team 3, Datascience, Infection & Immunity, Luijten, Dieuwke, Douillet, Delphine, Luijken, Kim, Tromeur, Cecile, Penaloza, Andrea, Hugli, Olivier, Aujesky, Drahomir, Barco, Stefano, Bledsoe, Joseph R., Chang, Kyle E., Couturaud, Francis, den Exter, Paul L., Font, Carme, Huisman, Menno V., Jimenez, David, Kabrhel, Christopher, Kline, Jeffrey A., Konstantinides, Stavros, van Mens, Thijs, Otero, Remedios, Peacock, W. Frank, Sanchez, Olivier, Stubblefield, William B., Valerio, Luca, Vinson, David R., Wells, Philip, van Smeden, Maarten, Roy, Pierre Marie, and Klok, Frederikus A.

Published
2024

6. Tailored anticoagulant treatment after a first venous thromboembolism: protocol of the Leiden Thrombosis Recurrence Risk Prevention (L-TRRiP) study - cohort-based randomised controlled trial

Author

Burggraaf-van Delft, J. Louise, I, Rein, Nienke van, Bemelmans, Remy H.H., Berg, Jan-Willem K. van den, Bruggeman, Coty Y., Cloos-van Balen, Marissa, Kuipers, S., Leentjens, J., Middeldorp, S., Klok, Frederikus A., Cannegieter, Suzanne C., Burggraaf-van Delft, J. Louise, I, Rein, Nienke van, Bemelmans, Remy H.H., Berg, Jan-Willem K. van den, Bruggeman, Coty Y., Cloos-van Balen, Marissa, Kuipers, S., Leentjens, J., Middeldorp, S., Klok, Frederikus A., and Cannegieter, Suzanne C.

Abstract

Contains fulltext : 307420.pdf (Publisher’s version ) (Open Access)

Published
2024

7. Splanchnic vein thrombosis in necrotizing pancreatitis:a post-hoc analysis of a nationwide prospective cohort

Author

Sissingh, Noor J., Timmerhuis, Hester C., Groen, Jesse V., de Jong, Mike J.P., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Bouwense, Stefan A.W., Hazen, Wouter L., Klok, Frederikus A., van Santvoort, Hjalmar C., van Eijck, Casper H.J., Verdonk, Robert C., Mieog, J. Sven D., van Hooft, Jeanin E., Sissingh, Noor J., Timmerhuis, Hester C., Groen, Jesse V., de Jong, Mike J.P., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Bouwense, Stefan A.W., Hazen, Wouter L., Klok, Frederikus A., van Santvoort, Hjalmar C., van Eijck, Casper H.J., Verdonk, Robert C., Mieog, J. Sven D., and van Hooft, Jeanin E.

Abstract

Background: Treatment guidelines for splanchnic vein thrombosis in necrotizing pancreatitis are lacking due to insufficient data on the full clinical spectrum. Methods: We performed a post-hoc analysis of a nationwide prospective necrotizing pancreatitis cohort. Multivariable analyses were used to identify risk factors and compare the clinical course of patients with and without SVT. Results: SVT was detected in 97 of the 432 included patients (22%) (median onset: 4 days). Risk factors were left, central, or subtotal necrosis (OR 28.52; 95% CI 20.11–40.45), right or diffuse necrosis (OR 5.76; 95% CI 3.89–8.51), and younger age (OR 0.94; 95% CI 0.90–0.97). Patients with SVT had higher rates of bleeding (n = 10,11%) and bowel ischemia (n = 4,4%) compared to patients without SVT (n = 14,4% and n = 2,0.6%; OR 3.24; 95% CI 1.27–8.23 and OR 7.29; 95% CI 1.31–40.4, respectively), and were independently associated with ICU admission (adjusted OR 2.53; 95% CI 1.37–4.68). Spontaneous recanalization occurred in 62% of patients (n = 40/71). Radiological and clinical outcomes did not differ between patients treated with and without anticoagulants. Discussion: SVT is a common and early complication of necrotizing pancreatitis, associated with parenchymal necrosis and younger age. SVT is associated with increased complications and a worse clinical course, whereas anticoagulant use does not appear to affect outcomes.

Published
2024

8. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

Author

Klok, Frederikus A. [0000-0001-9961-0754], Ay, Cihan [0000-0003-2607-9717], Bertoletti, Laurent [0000-0001-8214-3010], Becattini, Cecilia [0000-0002-8343-4888], Carlsen, Jørn [0000-0003-0389-5957], Delcroix, Marion [0000-0001-8394-9809], Es, Nick van [0000-0001-5256-6346], Jara Palomares, Luis [0000-0002-4125-3376], Konstantinides, Stavros [0000-0001-6359-7279], Lang, Irene [0000-0003-0485-2692], Ní Áinle, Fionnuala [0000-0003-0163-792X], Rosenkranz, Stephan [0000-0001-6237-1470], Pruszczyk, Piotr [0000-0002-9768-0000], Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Es, Nick van, Huisman, Menno V., Jara Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Ní Áinle, Fionnuala, Rosenkranz, Stephan, Pruszczyk, Piotr, Klok, Frederikus A. [0000-0001-9961-0754], Ay, Cihan [0000-0003-2607-9717], Bertoletti, Laurent [0000-0001-8214-3010], Becattini, Cecilia [0000-0002-8343-4888], Carlsen, Jørn [0000-0003-0389-5957], Delcroix, Marion [0000-0001-8394-9809], Es, Nick van [0000-0001-5256-6346], Jara Palomares, Luis [0000-0002-4125-3376], Konstantinides, Stavros [0000-0001-6359-7279], Lang, Irene [0000-0003-0485-2692], Ní Áinle, Fionnuala [0000-0003-0163-792X], Rosenkranz, Stephan [0000-0001-6237-1470], Pruszczyk, Piotr [0000-0002-9768-0000], Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Es, Nick van, Huisman, Menno V., Jara Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Ní Áinle, Fionnuala, Rosenkranz, Stephan, and Pruszczyk, Piotr

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

Published
2022

9. The risk of recurrent venous thromboembolism after discontinuation of anticoagulant therapy in patients with cancer-associated thrombosis:a systematic review and meta-analysis

Author

van Hylckama Vlieg, Marte A.M., Nasserinejad, Kazem, Visser, Chantal, Bramer, Wichor M., Ashrani, Aneel A., Bosson, Jean Luc, Crusan, Daniel J., D'Alessio, Andrea, Fluharty, Meg E., Ģībietis, Valdis, Hansson, Per Olof, Hara, Nobuhiro, Jara-Palomares, Luis, Kraaijpoel, Noémie, Mahé, Isabelle, Marshall, Andrea, Ogino, Yutaka, Otero, Remedios, Versmissen, Jorie, Klok, Frederikus A., Kruip, Marieke J.H.A., van der Rijt, Carin C.D., Geijteman, Eric C.T., van Hylckama Vlieg, Marte A.M., Nasserinejad, Kazem, Visser, Chantal, Bramer, Wichor M., Ashrani, Aneel A., Bosson, Jean Luc, Crusan, Daniel J., D'Alessio, Andrea, Fluharty, Meg E., Ģībietis, Valdis, Hansson, Per Olof, Hara, Nobuhiro, Jara-Palomares, Luis, Kraaijpoel, Noémie, Mahé, Isabelle, Marshall, Andrea, Ogino, Yutaka, Otero, Remedios, Versmissen, Jorie, Klok, Frederikus A., Kruip, Marieke J.H.A., van der Rijt, Carin C.D., and Geijteman, Eric C.T.

Abstract

Background: The optimal duration of anticoagulation in patients with active cancer and venous thromboembolism (VTE) is unknown. Current clinical guidelines advocate anticoagulant therapy for 3–6 months and to continue anticoagulant therapy for as long as the cancer is active. However, an adequate systematic review on the rate of recurrent VTE after discontinuation of anticoagulant therapy has not been performed. Methods: For this systemic review and meta-analysis, we searched Embase.com, Medline (Ovid), Web of Science, Cochrane Library, and Google Scholar, from database inception to February 16, 2023, for studies on anticoagulant therapy in patients with cancer and the recurrence of venous thromboembolism after discontinuation of this therapy. We included randomised controlled trials and cohort studies published in English that reported on patients who met the following: cancer and a first VTE, completed at least 3 months of anticoagulant therapy, were followed after discontinuation of anticoagulant therapy, and with symptomatic recurrent VTE as an outcome during follow-up. Study-level data were requested from study authors. The primary outcome was the rate of recurrent VTE after discontinuation of anticoagulant therapy. A Bayesian random-effects meta-analysis was used to estimate the rate of recurrent VTE per 100 person-years for the pooled studies at different time intervals after discontinuation of anticoagulation therapy. We also calculated the cumulative VTE recurrence rate at different time intervals. Forest plots were mapped and the results were summarized by the median and 95% credible interval (CIs). This study was registered with PROSPERO, CRD42021249060. Findings: Of 3856 studies identified in our search, 33 studies were identified for inclusion. After requesting study-level data, 14 studies involving 1922 patients with cancer-associated thrombosis were included. The pooled rate of recurrent VTE p

Published
2023

10. Highlights from the International Chronic Thromboembolic Pulmonary Hypertension Congress 2021.

Author

Simonneau, Gérald, Simonneau, Gérald, Fadel, Elie, Vonk Noordegraaf, Anton, Toshner, Mark, Lang, Irene M, Klok, Frederikus A, McInnis, Micheal C, Screaton, Nicholas, Madani, Michael M, Martinez, Guillermo, Salaunkey, Kiran, Jenkins, David P, Matsubara, Hiromi, Brénot, Philippe, Hoeper, Marius M, Ghofrani, Hossein A, Jaïs, Xavier, Wiedenroth, Christoph B, Guth, Stefan, Kim, Nick H, Pepke-Zaba, Joanna, Delcroix, Marion, Mayer, Eckhard, Simonneau, Gérald, Simonneau, Gérald, Fadel, Elie, Vonk Noordegraaf, Anton, Toshner, Mark, Lang, Irene M, Klok, Frederikus A, McInnis, Micheal C, Screaton, Nicholas, Madani, Michael M, Martinez, Guillermo, Salaunkey, Kiran, Jenkins, David P, Matsubara, Hiromi, Brénot, Philippe, Hoeper, Marius M, Ghofrani, Hossein A, Jaïs, Xavier, Wiedenroth, Christoph B, Guth, Stefan, Kim, Nick H, Pepke-Zaba, Joanna, Delcroix, Marion, and Mayer, Eckhard

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by chronic organised fibrotic clots, despite adequate anticoagulation. The pulmonary hypertension is also caused by concomitant microvasculopathy which may progress without timely treatment. Timely and accurate diagnosis requires the combination of imaging and haemodynamic assessment. Optimal therapy should be individualised to each case and determined by an experienced multidisciplinary CTEPH team with the ability to offer all current treatment modalities. This report summarises current knowledge and presents key messages from the International CTEPH Conference, Bad Nauheim, Germany, 2021. Sessions were dedicated to 1) disease definition; 2) pathophysiology, including the impact of the hypertrophied bronchial circulation, right ventricle (dys)function, genetics and inflammation; 3) diagnosis, early after acute pulmonary embolism, using computed tomography and perfusion techniques, and supporting the selection of appropriate therapies; 4) surgical treatment, pulmonary endarterectomy for proximal and distal disease, and peri-operative management; 5) percutaneous approach or balloon pulmonary angioplasty, techniques and complications; and 6) medical treatment, including anticoagulation and pulmonary hypertension drugs, and in combination with interventional treatments. Chronic thromboembolic pulmonary disease without pulmonary hypertension is also discussed in terms of its diagnostic and therapeutic aspects.

Published
2023

11. Mechanical Support Strategies for High-Risk Procedures in the Invasive Cardiac Catheterization Laboratory:A State-of-the-Art Review

Author

Groeneveld, Niels T.A., Swier, Carolien E.L., Montero-Cabezas, Jose, Elzo Kraemer, Carlos V., Klok, Frederikus A., van den Brink, Floris S., Groeneveld, Niels T.A., Swier, Carolien E.L., Montero-Cabezas, Jose, Elzo Kraemer, Carlos V., Klok, Frederikus A., and van den Brink, Floris S.

Abstract

Thanks to advancements in percutaneous cardiac interventions, an expanding patient population now qualifies for treatment through percutaneous endovascular procedures. High-risk interventions far exceed coronary interventions and include transcatheter aortic valve replacement, endovascular management of acute pulmonary embolism and ventricular tachycardia ablation. Given the frequent impairment of ventricular function in these patients, frequently deteriorating during percutaneous interventions, it is hypothesized that mechanical ventricular support may improve periprocedural survival and subsequently patient outcome. In this narrative review, we aimed to provide the relevant evidence found for the clinical use of percutaneous mechanical circulatory support (pMCS). We searched the Pubmed database for articles related to pMCS and to pMCS and invasive cath lab procedures. The articles and their references were evaluated for relevance. We provide an overview of the clinically relevant evidence for intra-aortic balloon pump, Impella, TandemHeart and ECMO and their role as pMCS in high-risk percutaneous coronary intervention, transcatheter valvular procedures, ablations and high-risk pulmonary embolism. We found that the right choice of periprocedural pMCS could provide a solution for the hemodynamic challenges during these procedures. However, to enhance the understanding of the safety and effectiveness of pMCS devices in an often high-risk population, more randomized research is needed.

Published
2023

12. Changes in incidence of hospitalization for cardiovascular diseases during the COVID-19 pandemic in The Netherlands in 2020

Author

Kempers, Eva K., Chen, Qingui, Visser, Chantal, van Gorp, Eric C.M., Klok, Frederikus A., Cannegieter, Suzanne C., Kruip, Marieke J.H.A., Kempers, Eva K., Chen, Qingui, Visser, Chantal, van Gorp, Eric C.M., Klok, Frederikus A., Cannegieter, Suzanne C., and Kruip, Marieke J.H.A.

Abstract

This population-based cohort study aimed to describe changes in incidence of cardiovascular disease (CVD) hospital diagnoses during the COVID-19 pandemic in The Netherlands compared with the pre-pandemic period. We used Dutch nationwide statistics about hospitalizations to estimate incidence rate ratios (IRR) of hospital diagnoses of CVD during the first and second COVID-19 waves in The Netherlands in 2020 versus the same periods in 2019. Compared with 2019, the incidence rate of a hospital diagnosis of ischemic stroke (IRR 0.87; 95% CI 0.79-0.95), major bleeding (IRR 0.74; 95% CI 0.68-0.82), atrial fibrillation (IRR 0.73; 95% CI 0.65-0.82), myocardial infarction (IRR 0.78; 95% CI 0.72-0.84), and heart failure (IRR 0.74; 95% CI 0.65-0.85) declined during the first wave, but returned to pre-pandemic levels throughout 2020. However, the incidence rate of a hospital diagnosis of pulmonary embolism (PE) increased during both the first and second wave in 2020 compared with 2019 (IRR 1.30; 95% CI 1.15-1.48 and IRR 1.31; 95% CI 1.19-1.44, respectively). In conclusion, we observed substantial declines in incidences of CVD during the COVID-19 pandemic in The Netherlands in 2020, especially during the first wave, with an exception for an increase in incidence of PE. This study contributes to quantifying the collateral damage of the COVID-19 pandemic.

Published
2023

13. Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis:A national survey and case-vignette study

Author

Sissingh, Noor J., Groen, Jesse V., Timmerhuis, Hester C., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Klok, Frederikus A., van Santvoort, Hjalmar C., Verdonk, Robert C., van Eijck, Casper H.J., van Hooft, Jeanin E., Mieog, Jan Sven D., Sissingh, Noor J., Groen, Jesse V., Timmerhuis, Hester C., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Klok, Frederikus A., van Santvoort, Hjalmar C., Verdonk, Robert C., van Eijck, Casper H.J., van Hooft, Jeanin E., and Mieog, Jan Sven D.

Abstract

BACKGROUND: Splanchnic vein thrombosis (SVT) is a major complication of moderate and severe acute pancreatitis. There is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and SVT. AIM: To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute pancreatitis. METHODS: A total of 139 pancreatologists of the Dutch Pancreatitis Study Group and Dutch Pancreatic Cancer Group were approached to complete an online survey and case vignette survey. The threshold to assume group agreement was set at 75%. RESULTS: The response rate was 67% (n = 93). Seventy-one pancreatologists (77%) regularly prescribed therapeutic anticoagulation in case of SVT, and 12 pancreatologists (13%) for narrowing of splanchnic vein lumen. The most common reason to treat SVT was to avoid complications (87%). Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation (90%). Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation (76%) and splenic vein thrombosis as the least preferred location (86%). The preferred initial agent was low molecular weight heparin (LMWH; 87%). In the case vignettes, therapeutic anticoagulation was prescribed for acute portal vein thrombosis, with or without suspected infected necrosis (82% and 90%), and thrombus progression (88%). Agreement was lacking regarding the selection and duration of long-term anticoagulation, the indication for thrombophilia testing and upper endoscopy, and about whether risk of bleeding is a major barrier for therapeutic anticoagulation. CONCLUSION: In this national survey, the pancreatologists seemed to agree on the use of therapeutic anticoagulation, using LMWH in the acute phase, for acute portal thrombosis and in the case of thrombus progression, irrespective of the presence of infected necrosis.

Published
2023

14. Chronic thromboembolic pulmonary hypertension and clot resolution after COVID-19-associated pulmonary embolism

Author

de Jong, Cindy M.M., Visser, Chantal, Bemelmans, Remy H.H., Boersma, Wim G., van den Borst, Bram, Louise, J., Cannegieter, Suzanne C., ten Cate-Hoek, Arina J., Nanne Croles, F., Faber, Harald J., Faber, Laura M., Hellemons, Merel E., Hessels, Lisa M., Huisman, Menno V., Kamphuisen, Pieter W., Koster, Stephanie C.E., Kroft, Lucia J.M., van der Lee, Ivo, Leentjens, Jenneke, Meijer, Karina, Ninaber, Maarten K., Sondermeijer, Brigitte M., Stads, Susanne, Vonk Noordegraaf, Anton, Winckers, Kristien, Kruip, Marieke J.H.A., Klok, Frederikus A., de Jong, Cindy M.M., Visser, Chantal, Bemelmans, Remy H.H., Boersma, Wim G., van den Borst, Bram, Louise, J., Cannegieter, Suzanne C., ten Cate-Hoek, Arina J., Nanne Croles, F., Faber, Harald J., Faber, Laura M., Hellemons, Merel E., Hessels, Lisa M., Huisman, Menno V., Kamphuisen, Pieter W., Koster, Stephanie C.E., Kroft, Lucia J.M., van der Lee, Ivo, Leentjens, Jenneke, Meijer, Karina, Ninaber, Maarten K., Sondermeijer, Brigitte M., Stads, Susanne, Vonk Noordegraaf, Anton, Winckers, Kristien, Kruip, Marieke J.H.A., and Klok, Frederikus A.

Published
2023

15. Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study

Author

MS HOD, Cancer, Sissingh, Noor J., Groen, Jesse V., Timmerhuis, Hester C., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Klok, Frederikus A., van Santvoort, Hjalmar C., Verdonk, Robert C., van Eijck, Casper H.J., van Hooft, Jeanin E., Mieog, Jan Sven D., MS HOD, Cancer, Sissingh, Noor J., Groen, Jesse V., Timmerhuis, Hester C., Besselink, Marc G., Boekestijn, Bas, Bollen, Thomas L., Bonsing, Bert A., Klok, Frederikus A., van Santvoort, Hjalmar C., Verdonk, Robert C., van Eijck, Casper H.J., van Hooft, Jeanin E., and Mieog, Jan Sven D.

Published
2023

16. Diagnostic management of acute pulmonary embolism: a prediction model based on a patient data meta-analysis

Author

HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Circulatory Health, van Es, Nick, Takada, Toshihiko, Kraaijpoel, Noémie, Klok, Frederikus A, Stals, Milou A M, Büller, Harry R, Courtney, D Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Grégoire, Ghanima, Waleed, Huisman, Menno V, Kline, Jeffrey A, Moons, Karel G M, Parpia, Sameer, Perrier, Arnaud, Righini, Marc, Robert-Ebadi, Helia, Roy, Pierre-Marie, Wells, Phil S, de Wit, Kerstin, van Smeden, Maarten, Geersing, Geert-Jan, HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Circulatory Health, van Es, Nick, Takada, Toshihiko, Kraaijpoel, Noémie, Klok, Frederikus A, Stals, Milou A M, Büller, Harry R, Courtney, D Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Grégoire, Ghanima, Waleed, Huisman, Menno V, Kline, Jeffrey A, Moons, Karel G M, Parpia, Sameer, Perrier, Arnaud, Righini, Marc, Robert-Ebadi, Helia, Roy, Pierre-Marie, Wells, Phil S, de Wit, Kerstin, van Smeden, Maarten, and Geersing, Geert-Jan

Published
2023

17. Accuracy of physicians' intuitive risk estimation in the diagnostic management of pulmonary embolism: An Individual Patient Data Meta-Analysis

Author

HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodology, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Epi Methoden Team 3, Infection & Immunity, Maanen, Rosanne van, Martens, Emily S L, Takada, Toshihiko, Roy, Pierre-Marie, de Wit, Kerstin, Parpia, Sameer, Kraaijpoel, Noémie, Huisman, Menno V, Wells, Philip S, Le Gal, Grégoire, Righini, Marc, Freund, Yonathan, Galipienzo, Javier, van Es, Nick, Blom, Jeanet W, Moons, Karel G M, Rutten, Frans H, Smeden, Maarten van, Klok, Frederikus A, Geersing, Geert-Jan, Luijken, Kim, HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodology, HAG Hart- Vaatziekten, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Epi Methoden Team 3, Infection & Immunity, Maanen, Rosanne van, Martens, Emily S L, Takada, Toshihiko, Roy, Pierre-Marie, de Wit, Kerstin, Parpia, Sameer, Kraaijpoel, Noémie, Huisman, Menno V, Wells, Philip S, Le Gal, Grégoire, Righini, Marc, Freund, Yonathan, Galipienzo, Javier, van Es, Nick, Blom, Jeanet W, Moons, Karel G M, Rutten, Frans H, Smeden, Maarten van, Klok, Frederikus A, Geersing, Geert-Jan, and Luijken, Kim

Published
2023

18. Eight lessons from 2 years of use of the Post-COVID-19 Functional Status scale

Author

de Jong, Cindy M M; https://orcid.org/0000-0002-2310-5820, Le, Y N Jenny; https://orcid.org/0000-0003-0729-4016, Boon, Gudula J A M; https://orcid.org/0000-0003-4532-436X, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Siegerink, Bob; https://orcid.org/0000-0002-8454-9142, de Jong, Cindy M M; https://orcid.org/0000-0002-2310-5820, Le, Y N Jenny; https://orcid.org/0000-0003-0729-4016, Boon, Gudula J A M; https://orcid.org/0000-0003-4532-436X, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, and Siegerink, Bob; https://orcid.org/0000-0002-8454-9142

Abstract

Based on the literature and users’ experiences, lessons could be learned after 2 years’ use of the Post-COVID-19 Functional Status (PCFS) scale, that could contribute to its optimal use. All in all, the PCFS scale provided added value during the pandemic. https://bit.ly/3KkI5Ak

Published
2023

19. Pre-existing chronic thromboembolic pulmonary hypertension in acute pulmonary embolism

Author

Barco, Stefano, Mavromanoli, Anna C, Kreitner, Karl-Friedrich, Bunck, Alexander C, Gertz, Roman J, Ley, Sebastian, Valerio, Luca, Klok, Frederikus A, Gerhardt, Felix, Rosenkranz, Stephan, Konstantinides, Stavros V, Barco, Stefano, Mavromanoli, Anna C, Kreitner, Karl-Friedrich, Bunck, Alexander C, Gertz, Roman J, Ley, Sebastian, Valerio, Luca, Klok, Frederikus A, Gerhardt, Felix, Rosenkranz, Stephan, and Konstantinides, Stavros V

Abstract

BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is considered a complication of pulmonary embolism (PE). However, signs of CTEPH may exist in patients with a first symptomatic PE. RESEARCH QUESTION Which radiologic findings on computed tomography pulmonary angiography (CTPA) at the time of acute PE could indicate the presence of a pre-existing CTEPH? RESULTS We included unselected patients with acute PE who were prospectively followed for 2 years with a structured visit schedule. Two expert radiologists independently assessed patients' baseline CTPAs for pre-existing CTEPH; in case of disagreement, a decision was reached by 2:1 majority with a third expert. In addition, the radiologists checked for predefined individual parameters suggesting chronic PE and pulmonary hypertension. Signs of chronic PE or CTEPH at baseline were identified in 46 (15%) of 303 included patients. Intravascular webs, arterial narrowing or retraction, dilated bronchial arteries and right ventricular hypertrophy were the main drivers of the assessment. Five (1.7%) patients were diagnosed with CTEPH during follow-up. All four patients diagnosed with CTEPH early (83-108 days after acute PE) could be found in enriched subgroups based on the experts' overall assessment or fulfilling a minimum number of the predefined radiologic criteria at baseline. The specificity of pre-existing CTEPH diagnosis and the level of radiologists' agreement improved as the number of required criteria increased. INTERPRETATION Searching for predefined radiologic parameters suggesting pre-existing CTEPH at the time of acute PE diagnosis may allow for targeted follow-up strategies and risk-adapted CTEPH screening, thus facilitating earlier CTEPH diagnosis.

Published
2023

20. Cancer Risk in Pulmonary Hypertension Patients

Author

Sørensen,Henrik Toft, Skajaa,Nils, Klok,Frederikus Albertus, Laugesen,Kristina, Farkas,Dóra Körmendiné, Sørensen,Henrik Toft, Skajaa,Nils, Klok,Frederikus Albertus, Laugesen,Kristina, and Farkas,Dóra Körmendiné

Abstract

Henrik Toft Sørensen,1 Nils Skajaa,1 Frederikus Albertus Klok,2 Kristina Laugesen,1 Dóra Körmendiné Farkas1 1Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, DK-8200, Denmark; 2Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the NetherlandsCorrespondence: Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, Aarhus N, DK-8200, Denmark, Email hts@clin.au.dkBackground: Strong evidence indicates that venous thromboembolism is a presenting symptom of cancer. Cancer is a known cause of pulmonary hypertension; however, it remains unknown whether pulmonary hypertension is a marker of occult cancer. We examined the association between a pulmonary hypertension diagnosis and cancer risk in a cohort study using population-based data from the Danish health system.Patients and Methods: Using Danish nationwide registries, we identified 6335 patients with a pulmonary hypertension diagnosis and without a previous cancer diagnosis between 1995 and 2017. We computed the age-, sex-, and calendar year-standardized incidence ratio (SIR) as the ratio of observed to expected number of cancers using national incidence rates as the reference. We performed a subgroup analysis among patients with chronic thromboembolic pulmonary hypertension in the period in which a specific ICD-10 code was available (2006– 2017).Results: We identified 212 cancers within the first year of follow-up and 796 cancers thereafter. The one-year risk of cancer was 3.3% and the one-year SIR was 1.96 (95% confidence interval [CI]: 1.70– 2.23). In the second and subsequent years, the SIR remained elevated (SIR: 1.15 [95% CI: 1.08– 1.24]). In patients with chronic thromboembolic pulmonary hypertension, the one-year SIR was 1.41 (95% CI: 0.82– 2.25).Conclusion: Cancer risk was clearly higher in patients with pulmonary hypertension compared with the general population.

Published
2022

21. Development of an international standard set of outcome measures for patients with venous thromboembolism: an International Consortium for Health Outcomes Measurement consensus recommendation

Author

Gwozdz, Adam M, de Jong, Cindy M M, Fialho, Luz Sousa, Likitabhorn, Theerawich, Sossi, Frieda, Jaber, Paula Blancarte, Højen, Anette Arbjerg, Arcelus, Juan I, Auger, William R, Ay, Cihan, Barco, Stefano, Gazzana, Marcelo B, Bayley, Julie, Bertoletti, Laurent, Cate-Hoek, Arina Ten, Cohen, Alexander T, Connors, Jean M, Galanaud, Jean-Philippe, Labropoulos, Nicos, Langlois, Nicole, Meissner, Mark H, Noble, Simon, Nossent, Esther J, de León Lovatón, Paula Ponce, Robert-Ebadi, Helia, Rosovsky, Rachel P, Smolenaars, Noa, Toshner, Mark, Tromeur, Cécile, Wang, Kang-Ling, Westerlund, Eli, de Wit, Kerstin, Black, Stephen A, Klok, Frederikus A, Gwozdz, Adam M, de Jong, Cindy M M, Fialho, Luz Sousa, Likitabhorn, Theerawich, Sossi, Frieda, Jaber, Paula Blancarte, Højen, Anette Arbjerg, Arcelus, Juan I, Auger, William R, Ay, Cihan, Barco, Stefano, Gazzana, Marcelo B, Bayley, Julie, Bertoletti, Laurent, Cate-Hoek, Arina Ten, Cohen, Alexander T, Connors, Jean M, Galanaud, Jean-Philippe, Labropoulos, Nicos, Langlois, Nicole, Meissner, Mark H, Noble, Simon, Nossent, Esther J, de León Lovatón, Paula Ponce, Robert-Ebadi, Helia, Rosovsky, Rachel P, Smolenaars, Noa, Toshner, Mark, Tromeur, Cécile, Wang, Kang-Ling, Westerlund, Eli, de Wit, Kerstin, Black, Stephen A, and Klok, Frederikus A

Abstract

The International Consortium for Health Outcomes Measurement assembled an international working group of venous thromboembolism experts and patient representatives to develop a standardised minimum set of outcomes and outcome measurements for integration into clinical practice and potentially research to support clinical decision making and benchmarking of quality of care. 15 core outcomes important to patients and health-care professionals were selected and categorised into four domains: patient-reported outcomes, long term consequences of the disease, disease-specific complications, and treatment-related complications. The outcomes and outcome measures were designed to apply to all patients with venous thromboembolism aged 16 years or older. A measurement tool package was selected for inclusion in the core standard set, with a minimum number of items to be measured at predefined timepoints, which capture all core outcomes. Additional measures can be introduced to the user by a cascade opt-in system that allows for further assessment if required. This set of outcomes and measurement tools will facilitate the implementation of the use of patient-centred outcomes in daily practice.

Published
2022

22. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG)

Author

Humbert, Marc, Kovacs, Gabor, Hoeper, Marius M., Badagliacca, Roberto, Berger, Rolf M. F., Brida, Margarita, Carlsen, Jorn, Coats, Andrew J. S., Escribano-Subias, Pilar, Ferrari, Pisana, Ferreira, Diogenes S., Ghofrani, Hossein Ardeschir, Giannakoulas, George, Kiely, David G., Mayer, Eckhard, Meszaros, Gergely, Nagavci, Blin, Olsson, Karen M., Pepke-Zaba, Joanna, Quint, Jennifer K., Radegran, Goran, Simonneau, Gerald, Sitbon, Olivier, Tonia, Thomy, Toshner, Mark, Vachiery, Jean-Luc, Noordegraaf, Anton Vonk, Delcroix, Marion, Rosenkranz, Stephan, Schwerzmann, Markus, Bush, Andy, Abdelhamid, Magdy, Aboyans, Victor, Arbustini, Eloisa, Asteggiano, Riccardo, Barbera, Joan-Albert, Beghetti, Maurice, Cikes, Maja, Condliffe, Robin, de Man, Frances, Falk, Volkmar, Fauchier, Laurent, Gaine, Sean, Galie, Nazzareno, Gin-Sing, Wendy, Granton, John, Grunig, Ekkehard, Hassoun, Paul M., Hellemons, Merel, Jaarsma, Tiny, Kjellstrom, Barbro, Klok, Frederikus A., Konradi, Aleksandra, Koskinas, Konstantinos C., Kotecha, Dipak, Lang, Irene, Lewis, Basil S., Linhart, Ales, Lip, Gregory Y. H., Lochen, Maja-Lisa, Mathioudakis, Alexander G., Mindham, Richard, Moledina, Shahin, Naeije, Robert, Nielsen, Jens Cosedis, Olschewski, Horst, Opitz, Isabelle, Petersen, Steffen E., Prescott, Eva, Rakisheva, Amina, Reis, Abilio, Ristic, Arsen D., Roche, Nicolas, Rodrigues, Rita, Selton-Suty, Christine, Souza, Rogerio, Swift, Andrew J., Touyz, Rhian M., Ulrich, Silvia, Wilkins, Martin R., Wort, Stephen John, Humbert, Marc, Kovacs, Gabor, Hoeper, Marius M., Badagliacca, Roberto, Berger, Rolf M. F., Brida, Margarita, Carlsen, Jorn, Coats, Andrew J. S., Escribano-Subias, Pilar, Ferrari, Pisana, Ferreira, Diogenes S., Ghofrani, Hossein Ardeschir, Giannakoulas, George, Kiely, David G., Mayer, Eckhard, Meszaros, Gergely, Nagavci, Blin, Olsson, Karen M., Pepke-Zaba, Joanna, Quint, Jennifer K., Radegran, Goran, Simonneau, Gerald, Sitbon, Olivier, Tonia, Thomy, Toshner, Mark, Vachiery, Jean-Luc, Noordegraaf, Anton Vonk, Delcroix, Marion, Rosenkranz, Stephan, Schwerzmann, Markus, Bush, Andy, Abdelhamid, Magdy, Aboyans, Victor, Arbustini, Eloisa, Asteggiano, Riccardo, Barbera, Joan-Albert, Beghetti, Maurice, Cikes, Maja, Condliffe, Robin, de Man, Frances, Falk, Volkmar, Fauchier, Laurent, Gaine, Sean, Galie, Nazzareno, Gin-Sing, Wendy, Granton, John, Grunig, Ekkehard, Hassoun, Paul M., Hellemons, Merel, Jaarsma, Tiny, Kjellstrom, Barbro, Klok, Frederikus A., Konradi, Aleksandra, Koskinas, Konstantinos C., Kotecha, Dipak, Lang, Irene, Lewis, Basil S., Linhart, Ales, Lip, Gregory Y. H., Lochen, Maja-Lisa, Mathioudakis, Alexander G., Mindham, Richard, Moledina, Shahin, Naeije, Robert, Nielsen, Jens Cosedis, Olschewski, Horst, Opitz, Isabelle, Petersen, Steffen E., Prescott, Eva, Rakisheva, Amina, Reis, Abilio, Ristic, Arsen D., Roche, Nicolas, Rodrigues, Rita, Selton-Suty, Christine, Souza, Rogerio, Swift, Andrew J., Touyz, Rhian M., Ulrich, Silvia, Wilkins, Martin R., and Wort, Stephen John

Published
2022

23. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

Author

Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Back, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jorn, Delcroix, Marion, van Es, Nick, Huisman, Menno, V, Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Ainle, Fionnuala Ni, Rosenkranz, Stephan, Pruszczyk, Piotr, Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Back, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jorn, Delcroix, Marion, van Es, Nick, Huisman, Menno, V, Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Ainle, Fionnuala Ni, Rosenkranz, Stephan, and Pruszczyk, Piotr

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

Published
2022

24. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study

Author

Valerio, Luca, Mavromanoli, Anna C., Barco, Stefano, Abele, Christina, Becker, Dorothea, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Fistera, David, Gerhardt, Felix, Ghofrani, Hossein-Ardeschir, Grgic, Aleksandar, Gruenig, Ekkehard, Halank, Michael, Held, Matthias, Hobohm, Lukas, Hoeper, Marius M., Klok, Frederikus A., Lankeit, Mareike, Leuchte, Hanno H., Martin, Nadine, Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Jurgen, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., Konstantinides, Stavros, V, Rosenkranz, Stephan, Valerio, Luca, Mavromanoli, Anna C., Barco, Stefano, Abele, Christina, Becker, Dorothea, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Fistera, David, Gerhardt, Felix, Ghofrani, Hossein-Ardeschir, Grgic, Aleksandar, Gruenig, Ekkehard, Halank, Michael, Held, Matthias, Hobohm, Lukas, Hoeper, Marius M., Klok, Frederikus A., Lankeit, Mareike, Leuchte, Hanno H., Martin, Nadine, Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Jurgen, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., Konstantinides, Stavros, V, and Rosenkranz, Stephan

Abstract

Aims To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. Methods and results A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. Conclusion In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.

Published
2022

25. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Author

Singh, Bhagteshwar, Lant, Suzannah, Cividini, Sofia, Cattrall, Jonathan W S, Goodwin, Lynsey C, Benjamin, Laura, Michael, Benedict D, Khawaja, Ayaz, Matos, Aline de Moura Brasil, Alkeridy, Walid, Pilotto, Andrea, Lahiri, Durjoy, Rawlinson, Rebecca, Mhlanga, Sithembinkosi, Lopez, Evelyn C, Sargent, Brendan F, Somasundaran, Anushri, Tamborska, Arina, Webb, Glynn, Younas, Komal, Al Sami, Yaqub, Babu, Heavenna, Banks, Tristan, Cavallieri, Francesco, Cohen, Matthew, Davies, Emma, Dhar, Shalley, Fajardo Modol, Anna, Farooq, Hamzah, Harte, Jeffrey, Hey, Samuel, Joseph, Albert, Karthikappallil, Dileep, Kassahun, Daniel, Lipunga, Gareth, Mason, Rachel, Minton, Thoma, Mond, Gabrielle, Poxon, Joseph, Rabas, Sophie, Soothill, Germander, Zedde, Marialuisa, Yenkoyan, Konstantin, Brew, Bruce, Contini, Erika, Cysique, Lucette, Zhang, Xin, Maggi, Pietro, van Pesch, Vincent, Lechien, Jérome, Saussez, Sven, Heyse, Alex, Brito Ferreira, Maria Lúcia, Soares, Cristiane N, Elicer, Isabel, Eugenín-von Bernhardi, Laura, Ñancupil Reyes, Waleng, Yin, Rong, Azab, Mohammed A, Abd-Allah, Foad, Elkady, Ahmed, Escalard, Simon, Corvol, Jean-Christophe, Delorme, Cécile, Tattevin, Pierre, Bigaut, Kévin, Lorenz, Norbert, Hornuss, Daniel, Hosp, Jona, Rieg, Siegbert, Wagner, Dirk, Knier, Benjamin, Lingor, Paul, Winkler, Andrea Sylvia, Sharifi-Razavi, Athena, Moein, Shima T, Seyedalinaghi, Seyedahmad, Jamalimoghadamsiahkali, Saeidreza, Morassi, Mauro, Padovani, Alessandro, Giunta, Marcello, Libri, Ilenia, Beretta, Simone, Ravaglia, Sabrina, Foschi, Matteo, Calabresi, Paolo, Primiano, Guido Alessandro, Servidei, Serenella, Biagio Mercuri, Nicola, Liguori, Claudio, Pierantozzi, Mariangela, Sarmati, Loredana, Boso, Federica, Garazzino, Silvia, Mariotto, Sara, Patrick, Kimani N, Costache, Oana, Pincherle, Alexander, Klok, Frederikus A, Meza, Roger, Cabreira, Verónica, Valdoleiros, Sofia R, Oliveira, Vanessa, Kaimovsky, Igor, Guekht, Alla, Koh, Jasmine, Fernández Díaz, Eva, Barrios-López, José María, Guijarro-Castro, Cristina, Beltrán-Corbellini, Álvaro, Martínez-Poles, Javier, Diezma-Martín, Alba María, Morales-Casado, Maria Isabel, García García, Sergio, Breville, Gautier, Coen, Matteo, Uginet, Marjolaine, Bernard-Valnet, Raphaël, Du Pasquier, Renaud, Kaya, Yildiz, Abdelnour, Loay H, Rice, Claire, Morrison, Hamish, Defres, Sylviane, Huda, Saif, Enright, Noelle, Hassell, Jane, D'Anna, Lucio, Benger, Matthew, Sztriha, Laszlo, Raith, Eamon, Chinthapalli, Krishna, Nortley, Ro, Paterson, Ro, Chandratheva, Arvind, Werring, David J, Dervisevic, Samir, Harkness, Kirsty, Pinto, Ashwin, Jillella, Dinesh, Beach, Scott, Gunasekaran, Kulothungan, Rocha Ferreira Da Silva, Ivan, Nalleballe, Krishna, Santoro, Jonathan, Scullen, Tyler, Kahn, Lora, Kim, Carla Y, Thakur, Kiran T, Jain, Rajan, Umapathi, Thirugnanam, Nicholson, Timothy R, Sejvar, James J, Hodel, Eva Maria, Tudur Smith, Catrin, Solomon, Tom, Calabresi, Paolo (ORCID:0000-0003-0326-5509), Primiano, Guido, Servidei, Serenella (ORCID:0000-0001-8478-2799), Singh, Bhagteshwar, Lant, Suzannah, Cividini, Sofia, Cattrall, Jonathan W S, Goodwin, Lynsey C, Benjamin, Laura, Michael, Benedict D, Khawaja, Ayaz, Matos, Aline de Moura Brasil, Alkeridy, Walid, Pilotto, Andrea, Lahiri, Durjoy, Rawlinson, Rebecca, Mhlanga, Sithembinkosi, Lopez, Evelyn C, Sargent, Brendan F, Somasundaran, Anushri, Tamborska, Arina, Webb, Glynn, Younas, Komal, Al Sami, Yaqub, Babu, Heavenna, Banks, Tristan, Cavallieri, Francesco, Cohen, Matthew, Davies, Emma, Dhar, Shalley, Fajardo Modol, Anna, Farooq, Hamzah, Harte, Jeffrey, Hey, Samuel, Joseph, Albert, Karthikappallil, Dileep, Kassahun, Daniel, Lipunga, Gareth, Mason, Rachel, Minton, Thoma, Mond, Gabrielle, Poxon, Joseph, Rabas, Sophie, Soothill, Germander, Zedde, Marialuisa, Yenkoyan, Konstantin, Brew, Bruce, Contini, Erika, Cysique, Lucette, Zhang, Xin, Maggi, Pietro, van Pesch, Vincent, Lechien, Jérome, Saussez, Sven, Heyse, Alex, Brito Ferreira, Maria Lúcia, Soares, Cristiane N, Elicer, Isabel, Eugenín-von Bernhardi, Laura, Ñancupil Reyes, Waleng, Yin, Rong, Azab, Mohammed A, Abd-Allah, Foad, Elkady, Ahmed, Escalard, Simon, Corvol, Jean-Christophe, Delorme, Cécile, Tattevin, Pierre, Bigaut, Kévin, Lorenz, Norbert, Hornuss, Daniel, Hosp, Jona, Rieg, Siegbert, Wagner, Dirk, Knier, Benjamin, Lingor, Paul, Winkler, Andrea Sylvia, Sharifi-Razavi, Athena, Moein, Shima T, Seyedalinaghi, Seyedahmad, Jamalimoghadamsiahkali, Saeidreza, Morassi, Mauro, Padovani, Alessandro, Giunta, Marcello, Libri, Ilenia, Beretta, Simone, Ravaglia, Sabrina, Foschi, Matteo, Calabresi, Paolo, Primiano, Guido Alessandro, Servidei, Serenella, Biagio Mercuri, Nicola, Liguori, Claudio, Pierantozzi, Mariangela, Sarmati, Loredana, Boso, Federica, Garazzino, Silvia, Mariotto, Sara, Patrick, Kimani N, Costache, Oana, Pincherle, Alexander, Klok, Frederikus A, Meza, Roger, Cabreira, Verónica, Valdoleiros, Sofia R, Oliveira, Vanessa, Kaimovsky, Igor, Guekht, Alla, Koh, Jasmine, Fernández Díaz, Eva, Barrios-López, José María, Guijarro-Castro, Cristina, Beltrán-Corbellini, Álvaro, Martínez-Poles, Javier, Diezma-Martín, Alba María, Morales-Casado, Maria Isabel, García García, Sergio, Breville, Gautier, Coen, Matteo, Uginet, Marjolaine, Bernard-Valnet, Raphaël, Du Pasquier, Renaud, Kaya, Yildiz, Abdelnour, Loay H, Rice, Claire, Morrison, Hamish, Defres, Sylviane, Huda, Saif, Enright, Noelle, Hassell, Jane, D'Anna, Lucio, Benger, Matthew, Sztriha, Laszlo, Raith, Eamon, Chinthapalli, Krishna, Nortley, Ro, Paterson, Ro, Chandratheva, Arvind, Werring, David J, Dervisevic, Samir, Harkness, Kirsty, Pinto, Ashwin, Jillella, Dinesh, Beach, Scott, Gunasekaran, Kulothungan, Rocha Ferreira Da Silva, Ivan, Nalleballe, Krishna, Santoro, Jonathan, Scullen, Tyler, Kahn, Lora, Kim, Carla Y, Thakur, Kiran T, Jain, Rajan, Umapathi, Thirugnanam, Nicholson, Timothy R, Sejvar, James J, Hodel, Eva Maria, Tudur Smith, Catrin, Solomon, Tom, Calabresi, Paolo (ORCID:0000-0003-0326-5509), Primiano, Guido, and Servidei, Serenella (ORCID:0000-0001-8478-2799)

Abstract

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different

Published
2022

26. Optimal follow-up after acute pulmonary embolism:A position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

Author

Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Van Es, Nick, Huisman, Menno V., Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Áinle, Fionnuala Ní, Rosenkranz, Stephan, Pruszczyk, Piotr, Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Van Es, Nick, Huisman, Menno V., Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Áinle, Fionnuala Ní, Rosenkranz, Stephan, and Pruszczyk, Piotr

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

Published
2022

27. Illustrated State-of-the-Art Capsules of the ISTH 2022 Congress

Author

Ariëns, Robert A., Hunt, Beverley J., Agbani, Ejaife O., Ahnström, Josefin, Ahrends, Robert, Alikhan, Raza, Assinger, Alice, Bagoly, Zsuzsa, Balduini, Alessandra, Barbon, Elena, Barrett, Christopher D., Batty, Paul, Carneiro, Jorge David Aivazoglou, Chan, Wee Shian, de Maat, Moniek, de Wit, Kerstin, Denis, Cécile, Ellis, Martin H., Eslick, Renee, Fu, Hongxia, Hayward, Catherine P.M., Ho-Tin-Noé, Benoit, Klok, Frederikus A, Kumar, Riten, Leiderman, Karin, Litvinov, Rustem I., Mackman, Nigel, McQuilten, Zoe, Neal, Matthew D., Parker, William A.E., Preston, Roger J.S., Rayes, Julie, Rezaie, Alireza R., Roberts, Lara N., Rocca, Bianca, Shapiro, Susan, Siegal, Deborah M., Sousa, Lirlândia P., Suzuki-Inoue, Katsue, Zafar, Tahira, Zhou, Jiaxi, Ariëns, Robert A., Hunt, Beverley J., Agbani, Ejaife O., Ahnström, Josefin, Ahrends, Robert, Alikhan, Raza, Assinger, Alice, Bagoly, Zsuzsa, Balduini, Alessandra, Barbon, Elena, Barrett, Christopher D., Batty, Paul, Carneiro, Jorge David Aivazoglou, Chan, Wee Shian, de Maat, Moniek, de Wit, Kerstin, Denis, Cécile, Ellis, Martin H., Eslick, Renee, Fu, Hongxia, Hayward, Catherine P.M., Ho-Tin-Noé, Benoit, Klok, Frederikus A, Kumar, Riten, Leiderman, Karin, Litvinov, Rustem I., Mackman, Nigel, McQuilten, Zoe, Neal, Matthew D., Parker, William A.E., Preston, Roger J.S., Rayes, Julie, Rezaie, Alireza R., Roberts, Lara N., Rocca, Bianca, Shapiro, Susan, Siegal, Deborah M., Sousa, Lirlândia P., Suzuki-Inoue, Katsue, Zafar, Tahira, and Zhou, Jiaxi

Abstract

The ISTH London 2022 Congress is the first held (mostly) face-to-face again since the COVID-19 pandemic took the world by surprise in 2020. For 2 years we met virtually, but this year’s in-person format will allow the ever-so-important and quintessential creativity and networking to flow again. What a pleasure and joy to be able to see everyone! Importantly, all conference proceedings are also streamed (and available recorded) online for those unable to travel on this occasion. This ensures no one misses out. The 2022 scientific program highlights new developments in hemophilia and its treatment, acquired and other inherited bleeding disorders, thromboinflammation, platelets and coagulation, clot structure and composition, fibrinolysis, vascular biology, venous thromboembolism, women’s health, arterial thrombosis, pediatrics, COVID-related thrombosis, vaccine-induced thrombocytopenia with thrombosis, and omics and diagnostics. These areas are elegantly reviewed in this Illustrated Review article. The Illustrated Review is a highlight of the ISTH Congress. The format lends itself very well to explaining the science, and the collection of beautiful graphical summaries of recent developments in the field are stunning and self-explanatory. This clever and effective way to communicate research is revolutionary and different from traditional formats. We hope you enjoy this article and will be inspired by its content to generate new research ideas.

Published
2022

28. Estimating incidence of venous thromboembolism in COVID-19:Methodological considerations

Author

Nab, Linda, Groenwold, Rolf H.H., Klok, Frederikus A., Bhoelan, Soerajja, Kruip, Marieke J.H.A., Cannegieter, Suzanne C., Nab, Linda, Groenwold, Rolf H.H., Klok, Frederikus A., Bhoelan, Soerajja, Kruip, Marieke J.H.A., and Cannegieter, Suzanne C.

Abstract

Background: Coagulation abnormalities and coagulopathy are recognized as consequences of severe acute respiratory syndrome coronavirus 2 infection and the resulting coronavirus disease 2019 (COVID-19). Specifically, venous thromboembolism (VTE) has been reported as a frequent complication. By May 27, 2021, at least 93 original studies and 25 meta-analyses investigating VTE incidence in patients with COVID-19 had been published, showing large heterogeneity in reported VTE incidence ranging from 0% to 85%. This large variation complicates interpretation of individual study results as well as comparisons across studies, for example, to investigate changes in incidence over time, compare subgroups, and perform meta-analyses. Objectives: This study sets out to provide an overview of sources of heterogeneity in VTE incidence studies in patients with COVID-19, illustrated using examples. Methods: The original studies of three meta-analyses were screened and a list of sources of heterogeneity that may explain observed heterogeneity across studies was composed. Results: The sources of heterogeneity in VTE incidence were classified as clinical sources and methodologic sources. Clinical sources of heterogeneity include differences between studies regarding patient characteristics that affect baseline VTE risk and protocols used for VTE testing. Methodologic sources of heterogeneity include differences in VTE inclusion types, data quality, and the methods used for data analysis. Conclusions: To appreciate reported estimates of VTE incidence in patients with COVID-19 in relation to its etiology, prevention, and treatment, researchers should unambiguously report about possible clinical and methodological sources of heterogeneity in those estimates. This article provides suggestions for that.

Published
2022

29. Optimal follow-up after acute pulmonary embolism:A position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

Author

Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Van Es, Nick, Huisman, Menno V., Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Áinle, Fionnuala Ní, Rosenkranz, Stephan, Pruszczyk, Piotr, Klok, Frederikus A., Ageno, Walter, Ay, Cihan, Bäck, Magnus, Barco, Stefano, Bertoletti, Laurent, Becattini, Cecilia, Carlsen, Jørn, Delcroix, Marion, Van Es, Nick, Huisman, Menno V., Jara-Palomares, Luis, Konstantinides, Stavros, Lang, Irene, Meyer, Guy, Áinle, Fionnuala Ní, Rosenkranz, Stephan, and Pruszczyk, Piotr

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

Published
2022

30. Prevalence, pathophysiology, prediction and health-related quality of life of long COVID:study protocol of the longitudinal multiple cohort CORona Follow Up (CORFU) study

Author

Ghossein-Doha, Chahinda, Wintjens, Marieke S.J.N., Janssen, Emma B.N.J., Klein, Dorthe, Heemskerk, Stella C.M., Asselbergs, Folkert W., Birnie, Erwin, Bonsel, Gouke J., van Bussel, Bas C.T., Cals, Jochen W.L., Ten Cate, Hugo, Haagsma, Juanita, Hemmen, Bena, van der Horst, Iwan C.C., Kietselaer, Bastiaan L.J.H., Klok, Frederikus A., de Kruif, Martijn D., Linschoten, Marijke, van Santen, Susanne, Vernooy, Kevin, Willems, Loes H., Westerborg, Rosa, Warle, Michiel, van Kuijk, Sander M.J., Ghossein-Doha, Chahinda, Wintjens, Marieke S.J.N., Janssen, Emma B.N.J., Klein, Dorthe, Heemskerk, Stella C.M., Asselbergs, Folkert W., Birnie, Erwin, Bonsel, Gouke J., van Bussel, Bas C.T., Cals, Jochen W.L., Ten Cate, Hugo, Haagsma, Juanita, Hemmen, Bena, van der Horst, Iwan C.C., Kietselaer, Bastiaan L.J.H., Klok, Frederikus A., de Kruif, Martijn D., Linschoten, Marijke, van Santen, Susanne, Vernooy, Kevin, Willems, Loes H., Westerborg, Rosa, Warle, Michiel, and van Kuijk, Sander M.J.

Abstract

INTRODUCTION: The variety, time patterns and long-term prognosis of persistent COVID-19 symptoms (long COVID-19) in patients who suffered from mild to severe acute COVID-19 are incompletely understood. Cohort studies will be combined to describe the prevalence of long COVID-19 symptoms, and to explore the pathophysiological mechanisms and impact on health-related quality of life. A prediction model for long COVID-19 will be developed and internally validated to guide care in future patients. METHODS AND ANALYSIS: Data from seven COVID-19 cohorts will be aggregated in the longitudinal multiple cohort CORona Follow Up (CORFU) study. CORFU includes Dutch patients who suffered from COVID-19 at home, were hospitalised without or with intensive care unit treatment, needed inpatient or outpatient rehabilitation and controls who did not suffer from COVID-19. Individual cohort study designs were aligned and follow-up has been synchronised. Cohort participants will be followed up for a maximum of 24 months after acute infection. Next to the clinical characteristics measured in individual cohorts, the CORFU questionnaire on long COVID-19 outcomes and determinants will be administered digitally at 3, 6, 12, 18 and 24 months after the infection. The primary outcome is the prevalence of long COVID-19 symptoms up to 2 years after acute infection. Secondary outcomes are health-related quality of life (eg, EQ-5D), physical functioning, and the prevalence of thromboembolic complications, respiratory complications, cardiovascular diseases and endothelial dysfunction. A prediction model and a patient platform prototype will be developed. ETHICS AND DISSEMINATION: Approval was obtained from the medical research ethics committee of Maastricht University Medical Center+ and Maastricht University (METC 2021-2990) and local committees of the participating cohorts. The project is supported by ZonMW and EuroQol Research Foundation. Results will be published in open access peer-reviewed sci

Published
2022

31. Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis:A systematic review and meta-analysis

Author

Sissingh, Noor J., Groen, Jesse V., Koole, Dylan, Klok, Frederikus A., Boekestijn, Bas, Bollen, Thomas L., van Santvoort, Hjalmar C., Verdonk, Robert C., Bonsing, Bert A., van Eijck, Casper H.J., van Hooft, Jeanin E., Mieog, J. Sven D., Sissingh, Noor J., Groen, Jesse V., Koole, Dylan, Klok, Frederikus A., Boekestijn, Bas, Bollen, Thomas L., van Santvoort, Hjalmar C., Verdonk, Robert C., Bonsing, Bert A., van Eijck, Casper H.J., van Hooft, Jeanin E., and Mieog, J. Sven D.

Abstract

Objectives: The optimal management of patients with acute pancreatitis (AP) and splanchnic vein thrombosis (SVT) remains unknown. This systematic review and meta-analysis aimed to see if therapeutic anticoagulation (AC) improves outcomes in patients with AP and SVT. Methods: A systematic review was performed according to PRISMA guidelines. Main outcomes were recanalization, recurrent venous thromboembolism, development of varices, collaterals or cavernoma, haemorrhage and mortality. Meta-analysis were performed with the Mantel-Haenszel random effect models. Results: Seven retrospective cohort studies (3495 patients) were included. SVT occurred in 233 (7%) patients and involved most frequently the splenic vein (44%). Therapeutic AC was administered to 109 (47%) patients, most frequently to those with triple vessel thrombosis (72%) and least to those with isolated splenic vein (22%) or superior mesenteric vein thrombosis (0%). Most studies administered (low molecular weight) heparin followed by warfarin (duration ranged between 1.5 and 12 months). This meta-analysis showed an absolute risk difference of 9% (95% confidence interval [CI] = -11-28%) for recanalization, −3% (95% CI = −19-12%) for the development of varices, collaterals or cavernoma, 3% (95% CI = −6-12%) for haemorrhage and 2% (95% CI = −8-12%) for mortality. Conclusions: Based on the currently available data, it remains unclear if therapeutic anticoagulation provides benefit to acute pancreatitis patients with splanchnic vein thrombosis. These results are based on low quality data underlining the need for further higher quality studies.

Published
2022

32. Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

Author

MS Interne Geneeskunde, Hendriks, Stephan V, van den Hout, Wilbert B, van Bemmel, Thomas, Bistervels, Ingrid M, Eijsvogel, Michiel, Faber, Laura M, Hofstee, Herman M A, van der Hulle, Tom, Iglesias Del Sol, Antonio, Mairuhu, Albert T A, Middeldorp, Saskia, Nijkeuter, Mathilde, Huisman, Menno V, Klok, Frederikus A, YEARS Investigators, MS Interne Geneeskunde, Hendriks, Stephan V, van den Hout, Wilbert B, van Bemmel, Thomas, Bistervels, Ingrid M, Eijsvogel, Michiel, Faber, Laura M, Hofstee, Herman M A, van der Hulle, Tom, Iglesias Del Sol, Antonio, Mairuhu, Albert T A, Middeldorp, Saskia, Nijkeuter, Mathilde, Huisman, Menno V, Klok, Frederikus A, and YEARS Investigators

Published
2022

33. Prevalence, risk factors, and long-term outcomes of cerebral ischemia in hospitalized COVID-19 patients - study rationale and protocol of the CORONIS study: A multicentre prospective cohort study

Author

Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J, Sluis, Wouter M, Wijers, Naomi T, Meijer, Frederick Ja, Kamphuis-van Ulzen, Karin, de Bresser, Jeroen, Dankbaar, Jan Willem, van den Heuvel, Frederik Ma, Antoni, M Louisa, Mulders-Manders, Catharina M, de Mast, Quirijn, van de Veerdonk, Frank L, Klok, Frederikus A, Tuladhar, Anil M, Cannegieter, Suzanne C, Wermer, Marieke Jh, van der Worp, H Bart, Huisman, Menno V, de Leeuw, Frank-Erik, Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J, Sluis, Wouter M, Wijers, Naomi T, Meijer, Frederick Ja, Kamphuis-van Ulzen, Karin, de Bresser, Jeroen, Dankbaar, Jan Willem, van den Heuvel, Frederik Ma, Antoni, M Louisa, Mulders-Manders, Catharina M, de Mast, Quirijn, van de Veerdonk, Frank L, Klok, Frederikus A, Tuladhar, Anil M, Cannegieter, Suzanne C, Wermer, Marieke Jh, van der Worp, H Bart, Huisman, Menno V, and de Leeuw, Frank-Erik

Published
2022

34. Management of bleeding risk in patients who receive anticoagulant therapy for venous thromboembolism: Communication from the ISTH SSC Subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease

Author

HAG Trombose, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, den Exter, Paul L, Woller, Scott C, Robert-Ebadi, Helia, Masias, Camila, Morange, Pierre-Emmanuel, Castelli, David, Hansen, John-Bjarne, Geersing, Geert-Jan, Siegal, Deborah M, de Wit, Kerstin, Klok, Frederikus A, HAG Trombose, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, den Exter, Paul L, Woller, Scott C, Robert-Ebadi, Helia, Masias, Camila, Morange, Pierre-Emmanuel, Castelli, David, Hansen, John-Bjarne, Geersing, Geert-Jan, Siegal, Deborah M, de Wit, Kerstin, and Klok, Frederikus A

Published
2022

35. Ruling out pulmonary embolism across different healthcare settings: A systematic review and individual patient data meta-analysis

Author

HAG Trombose, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Geersing, Geert Jan, Takada, Toshihiko, Klok, Frederikus A., Büller, Harry R., Courtney, D. Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Gregoire, Ghanima, Waleed, Kline, Jeffrey A., Huisman, Menno V., Moons, Karel G.M., Perrier, Arnaud, Parpia, Sameer, Robert-Ebadi, Helia, Righini, Marc, Roy, Pierre Marie, van Smeden, Maarten, Stals, Milou A.M., Wells, Philip S., de Wit, Kerstin, Kraaijpoel, Noémie, van Es, Nick, HAG Trombose, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Geersing, Geert Jan, Takada, Toshihiko, Klok, Frederikus A., Büller, Harry R., Courtney, D. Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Gregoire, Ghanima, Waleed, Kline, Jeffrey A., Huisman, Menno V., Moons, Karel G.M., Perrier, Arnaud, Parpia, Sameer, Robert-Ebadi, Helia, Righini, Marc, Roy, Pierre Marie, van Smeden, Maarten, Stals, Milou A.M., Wells, Philip S., de Wit, Kerstin, Kraaijpoel, Noémie, and van Es, Nick

Published
2022

36. Safety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups: A Systematic Review and Individual-Patient Data Meta-analysis

Author

HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Stals, Milou A.M., Takada, Toshihiko, Kraaijpoel, Noémie, van Es, Nick, Büller, Harry R., Courtney, D. Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Grégoire, Ghanima, Waleed, Huisman, Menno V., Kline, Jeffrey A., Moons, Karel G.M., Parpia, Sameer, Perrier, Arnaud, Righini, Marc, Robert-Ebadi, Helia, Roy, Pierre Marie, van Smeden, Maarten, Wells, Phil S., de Wit, Kerstin, Geersing, Geert Jan, Klok, Frederikus A., HAG Trombose, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Epi Methoden Team 3, Infection & Immunity, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Stals, Milou A.M., Takada, Toshihiko, Kraaijpoel, Noémie, van Es, Nick, Büller, Harry R., Courtney, D. Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Grégoire, Ghanima, Waleed, Huisman, Menno V., Kline, Jeffrey A., Moons, Karel G.M., Parpia, Sameer, Perrier, Arnaud, Righini, Marc, Robert-Ebadi, Helia, Roy, Pierre Marie, van Smeden, Maarten, Wells, Phil S., de Wit, Kerstin, Geersing, Geert Jan, and Klok, Frederikus A.

Published
2022

37. Estimating Bleeding Risk in Patients with Cancer-Associated Thrombosis: Evaluation of Existing Risk Scores and Development of a New Risk Score

Author

Acute geneeskunde, MS Interne Geneeskunde, Circulatory Health, De Winter, Maria A., Dorresteijn, Jannick A.N., Ageno, Walter, Ay, Cihan, Beyer-Westendorf, Jan, Coppens, Michiel, Klok, Frederikus A., Moustafa, Farès, Riva, Nicoletta, Ruiz Artacho, Pedro C., Vanassche, Thomas, Nijkeuter, Mathilde, Acute geneeskunde, MS Interne Geneeskunde, Circulatory Health, De Winter, Maria A., Dorresteijn, Jannick A.N., Ageno, Walter, Ay, Cihan, Beyer-Westendorf, Jan, Coppens, Michiel, Klok, Frederikus A., Moustafa, Farès, Riva, Nicoletta, Ruiz Artacho, Pedro C., Vanassche, Thomas, and Nijkeuter, Mathilde

Published
2022

38. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study

Author

Valerio, Luca; https://orcid.org/0000-0003-4466-0724, Mavromanoli, Anna C, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Abele, Christina, Becker, Dorothea, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Fistera, David, Gerhardt, Felix, Ghofrani, Hossein-Ardeschir, Grgic, Aleksandar, Grünig, Ekkehard, Halank, Michael, Held, Matthias, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Hoeper, Marius M; https://orcid.org/0000-0001-9086-2293, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Lankeit, Mareike, Leuchte, Hanno H, Martin, Nadine, Mayer, Eckhard, Meyer, F Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Jürgen, Wachter, Rolf; https://orcid.org/0000-0003-2231-2200, Wilkens, Heinrike, Wild, Philipp S, et al, Valerio, Luca; https://orcid.org/0000-0003-4466-0724, Mavromanoli, Anna C, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Abele, Christina, Becker, Dorothea, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Fistera, David, Gerhardt, Felix, Ghofrani, Hossein-Ardeschir, Grgic, Aleksandar, Grünig, Ekkehard, Halank, Michael, Held, Matthias, Hobohm, Lukas; https://orcid.org/0000-0002-4312-0366, Hoeper, Marius M; https://orcid.org/0000-0001-9086-2293, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Lankeit, Mareike, Leuchte, Hanno H, Martin, Nadine, Mayer, Eckhard, Meyer, F Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Jürgen, Wachter, Rolf; https://orcid.org/0000-0003-2231-2200, Wilkens, Heinrike, Wild, Philipp S, and et al

Abstract

AIMS: To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. METHODS AND RESULTS: A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. CONCLUSION: In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.

Published
2022

39. Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study

Author

Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Piazza, Gregory, Sharp, Andrew S P, Ní Áinle, Fionnuala; https://orcid.org/0000-0003-0163-792X, Jaff, Michael R, Chauhan, Nikhil, Patel, Binal, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Goldhaber, Samuel Z, Kucher, Nils; https://orcid.org/0000-0002-7352-8709, Lang, Irene M, Schmidtmann, Irene, Sterling, Keith M, Becker, Dorothea, Martin, Nadine, Rosenfield, Kenneth, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Piazza, Gregory, Sharp, Andrew S P, Ní Áinle, Fionnuala; https://orcid.org/0000-0003-0163-792X, Jaff, Michael R, Chauhan, Nikhil, Patel, Binal, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Goldhaber, Samuel Z, Kucher, Nils; https://orcid.org/0000-0002-7352-8709, Lang, Irene M, Schmidtmann, Irene, Sterling, Keith M, Becker, Dorothea, Martin, Nadine, Rosenfield, Kenneth, and Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279

Abstract

BACKGROUND: Due to the bleeding risk of full-dose systemic thrombolysis and the lack of major trials focusing on the clinical benefits of catheter-directed treatment, heparin antiocoagulation remains the standard of care for patients with intermediate-high-risk pulmonary embolism (PE). METHODS AND RESULTS: The Higher-Risk Pulmonary Embolism Thrombolysis (HI-PEITHO) study (ClinicalTrials.gov Identifier: NCT04790370) is a multinational multicenter randomized controlled parallel-group comparison trial. Patients with: (1) confirmed acute PE; (2) evidence of right ventricular (RV) dysfunction on imaging; (3) a positive cardiac troponin test; and (4) clinical criteria indicating an elevated risk of early death or imminent hemodynamic collapse, will be randomized 1:1 to treatment with a standardized protocol of ultrasound-facilitated catheter-directed thrombolysis plus anticoagulation, vs anticoagulation alone. The primary outcome is a composite of PE-related mortality, cardiorespiratory decompensation or collapse, or non-fatal symptomatic and objectively confirmed PE recurrence, within 7 days of randomization. Further assessments cover, apart from bleeding complications, a broad spectrum of functional and patient-reported outcomes including quality of life indicators, functional status and the utilization of health care resources over a 12-month follow-up period. The trial plans to include 406 patients, but the adaptive design permits a sample size increase depending on the results of the predefined interim analysis. As of May 11, 2022, 27 subjects have been enrolled. The trial is funded by Boston Scientific Corporation and through collaborative research agreements with University of Mainz and The PERT Consortium. CONCLUSIONS: Regardless of the outcome, HI-PEITHO will establish the first-line treatment in intermediate-high risk PE patients with imminent hemodynamic collapse. The trial is expected to inform international guidelines and set the standard for evaluation of ca

Published
2022

40. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society

Author

Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Ageno, Walter, Ay, Cihan; https://orcid.org/0000-0003-2607-9717, Bäck, Magnus; https://orcid.org/0000-0003-0853-5141, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bertoletti, Laurent; https://orcid.org/0000-0001-8214-3010, Becattini, Cecilia; https://orcid.org/0000-0002-8343-4888, Carlsen, Jørn; https://orcid.org/0000-0003-0389-5957, Delcroix, Marion; https://orcid.org/0000-0001-8394-9809, van Es, Nick; https://orcid.org/0000-0001-5256-6346, Huisman, Menno V, Jara-Palomares, Luis; https://orcid.org/0000-0002-4125-3376, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Lang, Irene; https://orcid.org/0000-0003-0485-2692, Meyer, Guy, Ní Áinle, Fionnuala; https://orcid.org/0000-0003-0163-792X, Rosenkranz, Stephan; https://orcid.org/0000-0001-6237-1470, Pruszczyk, Piotr; https://orcid.org/0000-0002-9768-0000, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Ageno, Walter, Ay, Cihan; https://orcid.org/0000-0003-2607-9717, Bäck, Magnus; https://orcid.org/0000-0003-0853-5141, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bertoletti, Laurent; https://orcid.org/0000-0001-8214-3010, Becattini, Cecilia; https://orcid.org/0000-0002-8343-4888, Carlsen, Jørn; https://orcid.org/0000-0003-0389-5957, Delcroix, Marion; https://orcid.org/0000-0001-8394-9809, van Es, Nick; https://orcid.org/0000-0001-5256-6346, Huisman, Menno V, Jara-Palomares, Luis; https://orcid.org/0000-0002-4125-3376, Konstantinides, Stavros; https://orcid.org/0000-0001-6359-7279, Lang, Irene; https://orcid.org/0000-0003-0485-2692, Meyer, Guy, Ní Áinle, Fionnuala; https://orcid.org/0000-0003-0163-792X, Rosenkranz, Stephan; https://orcid.org/0000-0001-6237-1470, and Pruszczyk, Piotr; https://orcid.org/0000-0002-9768-0000

Abstract

This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. We propose a holistic approach considering the whole spectrum of serious adverse events that patients with acute PE may encounter on the short and long run. We underline the relevance of assessment of modifiable risk factors for bleeding, of acquired thrombophilia and limited cancer screening (unprovoked PE) as well as a dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension as part of routine practice; routine testing for genetic thrombophilia should be avoided. We advocate the use of outcome measures for functional outcome and quality of life to quantify the impact of the PE diagnosis and identify patients with the post-PE syndrome early. Counselling patients on maintaining a healthy lifestyle mitigates the risk of the post-PE syndrome and improves cardiovascular prognosis. Therefore, we consider it important to discuss when and how to resume sporting activities soon after diagnosing PE. Additional patient-relevant topics that require Focused counselling are travel and birth control.

Published
2022

41. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19

Author

Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Yvonne M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., Spruit, Martijn A., Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Yvonne M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., and Spruit, Martijn A.

Abstract

Contains fulltext : 230660.pdf (publisher's version ) (Open Access)

Published
2021

42. Quality of Life 3 and 12 Months Following Acute Pulmonary Embolism Analysis From a Prospective Multicenter Cohort Study

Author

Valerio, Luca, Barco, Stefano, Jankowski, Marius, Rosenkranz, Stephan, Lankeit, Mareike, Held, Matthias, Gerhardt, Felix, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Freise, Julia, Ghofrani, Hossein-Ardeschir, Gruenig, Ekkehard, Halank, Michael, Hoeper, Marius M., Klok, Frederikus A., Leuchte, Hanno H., Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Juergen, Trudzinski, Franziska, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., Konstantinides, Stavros, V, Valerio, Luca, Barco, Stefano, Jankowski, Marius, Rosenkranz, Stephan, Lankeit, Mareike, Held, Matthias, Gerhardt, Felix, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Freise, Julia, Ghofrani, Hossein-Ardeschir, Gruenig, Ekkehard, Halank, Michael, Hoeper, Marius M., Klok, Frederikus A., Leuchte, Hanno H., Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Juergen, Trudzinski, Franziska, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., and Konstantinides, Stavros, V

Abstract

BACKGROUND: Few data are available on the long-term course and predictors of quality of life (QoL) following acute pulmonary embolism (PE). RESEARCH QUESTION: What are the kinetics and determinants of disease-specific and generic health-related QoL 3 and 12 months following an acute PE? STUDY DESIGN AND METHODS: The Follow-up after Acute Pulmonary Embolism (FOCUS) study prospectively followed up consecutive adult patients with objectively diagnosed PE. Patients were considered for study who completed the Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire at predefined visits 3 and 12 months following PE. The course of disease-specific QoL as assessed using the PEmb-QoL and the impact of baseline characteristics using multivariable mixed effects linear regression were studied; also assessed was the course of generic QoL as evaluated by using the EuroQoL Group 5-Dimension 5-Level utility index and the EuroQoL Visual Analog Scale. RESULTS: In 620 patients (44% women; median age, 62 years), overall disease-specific QoL improved from 3 to 12 months, with a decrease in the median PEmb-QoL score from 19.4% to 13.0% and a mean individual change of -4.3% (95% CI, -3.2 to -5.5). Female sex, cardiopulmonary disease, and higher BMI were associated with worse QoL at both 3 and 12 months. Over time, the association with BMI became weaker, whereas older age and previous VTE were associated with worsening QoL. Generic QoL also improved: the mean +/- SD EuroQoL Group 5-Dimension 5-Level utility index increased from 0.85 +/- 0.22 to 0.87 +/- 0.20 and the visual analog scale from 72.9 +/- 18.8 to 74.4 +/- 19.1. INTERPRETATION: In a large cohort of survivors of acute PE, the change of QoL was quantified between months 3 and 12 following diagnosis, and factors independently associated with lower QoL and slower recovery of QoL were identified. This information may facilitate the planning and interpretation of clinical trials assessing QoL and help guide patient management.

Published
2021

43. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19

Author

Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Yvonne M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., Spruit, Martijn A., Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Yvonne M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., and Spruit, Martijn A.

Abstract

Contains fulltext : 230660.pdf (publisher's version ) (Open Access)

Published
2021

44. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19

Author

Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Y.M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., Spruit, Martijn A., Machado, Felipe V.C., Meys, Roy, Delbressine, Jeannet M., Vaes, Anouk W., Goertz, Y.M.J., Herck, Maarten van, Hul, A.J. van 't, Klok, Frederikus A., and Spruit, Martijn A.

Abstract

Contains fulltext : 230660.pdf (Publisher’s version ) (Open Access)

Published
2021

45. Quality of Life 3 and 12 Months Following Acute Pulmonary Embolism Analysis From a Prospective Multicenter Cohort Study

Author

Valerio, Luca, Barco, Stefano, Jankowski, Marius, Rosenkranz, Stephan, Lankeit, Mareike, Held, Matthias, Gerhardt, Felix, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Freise, Julia, Ghofrani, Hossein-Ardeschir, Gruenig, Ekkehard, Halank, Michael, Hoeper, Marius M., Klok, Frederikus A., Leuchte, Hanno H., Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Juergen, Trudzinski, Franziska, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., Konstantinides, Stavros, V, Valerio, Luca, Barco, Stefano, Jankowski, Marius, Rosenkranz, Stephan, Lankeit, Mareike, Held, Matthias, Gerhardt, Felix, Bruch, Leonhard, Ewert, Ralf, Faehling, Martin, Freise, Julia, Ghofrani, Hossein-Ardeschir, Gruenig, Ekkehard, Halank, Michael, Hoeper, Marius M., Klok, Frederikus A., Leuchte, Hanno H., Mayer, Eckhard, Meyer, F. Joachim, Neurohr, Claus, Opitz, Christian, Schmidt, Kai-Helge, Seyfarth, Hans-Juergen, Trudzinski, Franziska, Wachter, Rolf, Wilkens, Heinrike, Wild, Philipp S., and Konstantinides, Stavros, V

Abstract

BACKGROUND: Few data are available on the long-term course and predictors of quality of life (QoL) following acute pulmonary embolism (PE). RESEARCH QUESTION: What are the kinetics and determinants of disease-specific and generic health-related QoL 3 and 12 months following an acute PE? STUDY DESIGN AND METHODS: The Follow-up after Acute Pulmonary Embolism (FOCUS) study prospectively followed up consecutive adult patients with objectively diagnosed PE. Patients were considered for study who completed the Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire at predefined visits 3 and 12 months following PE. The course of disease-specific QoL as assessed using the PEmb-QoL and the impact of baseline characteristics using multivariable mixed effects linear regression were studied; also assessed was the course of generic QoL as evaluated by using the EuroQoL Group 5-Dimension 5-Level utility index and the EuroQoL Visual Analog Scale. RESULTS: In 620 patients (44% women; median age, 62 years), overall disease-specific QoL improved from 3 to 12 months, with a decrease in the median PEmb-QoL score from 19.4% to 13.0% and a mean individual change of -4.3% (95% CI, -3.2 to -5.5). Female sex, cardiopulmonary disease, and higher BMI were associated with worse QoL at both 3 and 12 months. Over time, the association with BMI became weaker, whereas older age and previous VTE were associated with worsening QoL. Generic QoL also improved: the mean +/- SD EuroQoL Group 5-Dimension 5-Level utility index increased from 0.85 +/- 0.22 to 0.87 +/- 0.20 and the visual analog scale from 72.9 +/- 18.8 to 74.4 +/- 19.1. INTERPRETATION: In a large cohort of survivors of acute PE, the change of QoL was quantified between months 3 and 12 following diagnosis, and factors independently associated with lower QoL and slower recovery of QoL were identified. This information may facilitate the planning and interpretation of clinical trials assessing QoL and help guide patient management.

Published
2021

46. Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome

Author

Boon, Gudula J A M, Janssen, Steffi M J, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bogaard, Harm Jan, Ghanima, Waleed, Kroft, Lucia J M, Meijboom, Lilian J, Ninaber, Maarten K, Nossent, Esther J, Spruit, Martijn A, Symersky, Petr, Vliegen, Hubert W, Noordegraaf, Anton Vonk, Huisman, Menno V, Siegerink, Bob, Abbink, Jannie J, Klok, Frederikus A, Boon, Gudula J A M, Janssen, Steffi M J, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bogaard, Harm Jan, Ghanima, Waleed, Kroft, Lucia J M, Meijboom, Lilian J, Ninaber, Maarten K, Nossent, Esther J, Spruit, Martijn A, Symersky, Petr, Vliegen, Hubert W, Noordegraaf, Anton Vonk, Huisman, Menno V, Siegerink, Bob, Abbink, Jannie J, and Klok, Frederikus A

Abstract

BACKGROUND The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. OBJECTIVES To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients. METHODS 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite ≥3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures. RESULTS Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved ≥1 grade in 18 (67%) patients, and declined in one (3.7%). CONCLUSIONS Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.

Published
2021

47. Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis

Author

MS Interne Geneeskunde, Circulatory Health, Van Dam, Lisette F., Van Den Hout, Wilbert B., Gautam, Gargi, Dronkers, Charlotte E.A., Ghanima, Waleed, Gleditsch, Jostein, Heijne, Anders Von, Hofstee, Herman M.A., Hovens, Marcel M.C., Huisman, Menno V., Kolman, Stan, Mairuhu, Albert T.A., Nijkeuter, Mathilde, Ree, Marcel A.Van De, Rooden, Cornelis J.Van, Westerbeek, Robin E., Westerink, Jan, Westerlund, Eli, Kroft, Lucia J.M., Klok, Frederikus A., MS Interne Geneeskunde, Circulatory Health, Van Dam, Lisette F., Van Den Hout, Wilbert B., Gautam, Gargi, Dronkers, Charlotte E.A., Ghanima, Waleed, Gleditsch, Jostein, Heijne, Anders Von, Hofstee, Herman M.A., Hovens, Marcel M.C., Huisman, Menno V., Kolman, Stan, Mairuhu, Albert T.A., Nijkeuter, Mathilde, Ree, Marcel A.Van De, Rooden, Cornelis J.Van, Westerbeek, Robin E., Westerink, Jan, Westerlund, Eli, Kroft, Lucia J.M., and Klok, Frederikus A.

Published
2021

48. A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

Author

Boon, Gudula J A M; https://orcid.org/0000-0003-4532-436X, van den Hout, Wilbert B, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bogaard, Harm Jan, Delcroix, Marion; https://orcid.org/0000-0001-8394-9809, Huisman, Menno V, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Meijboom, Lilian J, Nossent, Esther J, Symersky, Petr; https://orcid.org/0000-0002-5181-881X, Vonk Noordegraaf, Anton; https://orcid.org/0000-0002-4057-758X, Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754, Boon, Gudula J A M; https://orcid.org/0000-0003-4532-436X, van den Hout, Wilbert B, Barco, Stefano; https://orcid.org/0000-0002-2618-347X, Bogaard, Harm Jan, Delcroix, Marion; https://orcid.org/0000-0001-8394-9809, Huisman, Menno V, Konstantinides, Stavros V; https://orcid.org/0000-0001-6359-7279, Meijboom, Lilian J, Nossent, Esther J, Symersky, Petr; https://orcid.org/0000-0002-5181-881X, Vonk Noordegraaf, Anton; https://orcid.org/0000-0002-4057-758X, and Klok, Frederikus A; https://orcid.org/0000-0001-9961-0754

Abstract

Background Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds 1 year, contributing to higher mortality. Health economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life-years (QALYs) and healthcare costs. Material and methods A Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC - VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens. Results For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at EUR 117 100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs. The associated cost increase was EUR 44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of EUR 21 900/QALY. Conclusion Our constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health economic standards, additional costs remain below the deemed acceptable limit of EUR 50 000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.

Published
2021

49. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19

Author

Klok, Frederikus A., Boon, Gudula J. A. M., Barco, Stefano, Endres, Matthias, Geelhoed, J. J. Miranda, Knauss, Samuel, Rezek, Spencer A., Spruit, Martijn A., Vehreschild, Jorg, Siegerink, Bob, Klok, Frederikus A., Boon, Gudula J. A. M., Barco, Stefano, Endres, Matthias, Geelhoed, J. J. Miranda, Knauss, Samuel, Rezek, Spencer A., Spruit, Martijn A., Vehreschild, Jorg, and Siegerink, Bob

Published
2020

50. Current practice patterns of outpatient management of acute pulmonary embolism:A post-hoc analysis of the YEARS study

Author

Hendriks, Stephan V., Bavalia, Roisin, van Bemmel, Thomas, Bistervels, Ingrid M., Eijsvogel, Michiel, Faber, Laura M., Fogteloo, Jaap, Hofstee, Herman M.A., van der Hulle, Tom, Iglesias del Sol, Antonio, Kruip, Marieke J.H.A., Mairuhu, Albert T.A., Middeldorp, Saskia, Nijkeuter, Mathilde, Huisman, Menno V., Klok, Frederikus A., Hendriks, Stephan V., Bavalia, Roisin, van Bemmel, Thomas, Bistervels, Ingrid M., Eijsvogel, Michiel, Faber, Laura M., Fogteloo, Jaap, Hofstee, Herman M.A., van der Hulle, Tom, Iglesias del Sol, Antonio, Kruip, Marieke J.H.A., Mairuhu, Albert T.A., Middeldorp, Saskia, Nijkeuter, Mathilde, Huisman, Menno V., and Klok, Frederikus A.

Abstract

Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. Aim: To determine current practice patterns of home treatment of acute PE in the Netherlands. Method: We performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. Results: Of the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital.

Published
2020

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