Author: "N. Ruiz-Giménez" / Topic: medicine - Searchworks@Jio Institute Digital Library Search Results

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1. Assessment of bleeding events in patients receiving DOACs with or without statins to treat venous thromboembolism: insights from the RIETE registry

Author: Dominique Farge-bancel, R Marqués, M Ortiz, Paolo Prandoni, J Roa, Manuel Monreal, F Couturaud, J Gutierrez, J Pagan, Peter Verhamme, A Aujayeb, Laurent Bertoletti, P Verhamme, M Monreal, S Fonseca, S Pinto, S Soler, A Lorenzo, R Lecumberri, R Otero, P DI MICCO, F Rivera-Cívico, A Molino, P Suchon, C Grange, JA Caprini, J Osorio, Henri Bounameaux, R Valle, F Negro, A Tufano, Remedios Otero, Aitor Ballaz, G Kenet, I Francisco, F Uresandi, G Barillari, Marijan Bosevski, F García-Bragado, E Grau, D Jiménez, A Maestre, A Visonà, J Criado, R Chopard, I Weinberg, M Lumbierres, B Leclercq, H Bounameaux, Farid Rashidi, Abílio Reis, Lucia Mazzolai, P Llamas, MJ Núñez-Fernández, F Dentali, O Espitia, C Siniscalchi, Rosaria Del Giorno, Sanjiv Keller, Carmine Siniscalchi, Luciano Lopez-Jimenez, Ana Cristina Montenegro, Benjamin Brenner, Raquel Barb, Pierpaolo Di Micco, Sebastian Schellong, Inna Tzoran, Radovan Malý, Joseph A. Caprini, Hanh My Bui, MD Adarraga, A Alberich-Conesa, J Aibar, A Alda-Lozano, J Alfonso, C Amado, M Angelina-García, JI Arcelus, A Ballaz, R Barba, C Barbagelata, M Barrón, B Barrón-Andrés, F Beddar-Chaib, A Blanco-Molina, JC Caballero, J Carrillo-Alonso, G Castellanos, L Chasco, C De Ancos, J Del Toro, P Demelo-Rodríguez, C De Juana-Izquierdo, MC Díaz-Pedroche, JA Díaz-Peromingo, A Dubois-Silva, JC Escribano, C Falgá, AI Farfán-Sedano, C Fernández-Aracil, C Fernández-Capitán, B Fernández-Jiménez, JL Fernández-Reyes, MA Fidalgo, C Gabara, F Galeano-Valle, C García-González, A García-Ortega, O Gavín-Sebastián, MA Gil-De Gómez, A Gil-Díaz, C Gómez-Cuervo, A González-Munera, L Guirado, L Hernández-Blasco, L Jara-Palomares, MJ Jaras, I Jou, MD Joya, JL Lobo, L López-Jiménez, P López-Miguel, H López-Brull, JJ López-Núñez, A López-Ruiz, JB LópezSáez, O Madridano, PJ Marchena, M Marcos, M Martín del Pozo, F Martín-Martos, R Martínez-Prado, JM Maza, E Mena, MI Mercado, J Moisés, MV Morales, MS Navas, JA Nieto, M Olid, L Ordieres-Ortega, S Otálora, N Pacheco-Gómez, AC Palomeque, E Paredes, P Parra-Caballero, P Parra-Rosado, JM Pedrajas, C Pérez-Ductor, M Pérez-Pinar, MA Pérez-Jacoiste, ML Peris, ML Pesce, JA Porras, R Puchades, A Rodríguez-Cobo, M Romero-Brugera, P Ruiz-Artacho, N Ruiz-Giménez, J Ruiz-Ruiz, G Salgueiro, T Sancho, V Sendín, P Sigüenza, A Steinherr, S Suárez-Fernández, R Tirado, A TorrentsVilar, MI Torres, J Trujillo-Santos, JF Varona, A Villalobos, P Villares, C Ay, S Nopp, I Pabinger, C Van Edom, A Verstraete, Yoo HHB, AC Montenegro, SN Morales, J Hirmerova, R Malý, L Bertoletti, A BuraRiviere, J Catella, R Le Mao, I Mahé, F Moustafa, L Plaisance, G Sarlon-Bartoli, E Versini, S Schellong, B Brenner, I Tzoran, P Sadeghipour, F Rashidi, A Abenante, M Basaglia, M Bertoni, F Bilora, B Brandolin, M Ciammaichella, D Colaizzo, E Grandone, E Imbalzano, R Pesavento, A Poz, P Prandoni, B Taflaj, B Zalunardo, A Skride, D Kigitovica, J Meireles, M Bosevski, M Zdraveska, L Mazzolai, and HM Bui
Subjects: Medicine
Abstract: Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.
Published: 2024
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2. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study

Author: Marc Blondon, David Jimenez, Helia Robert‐Ebadi, Jorge Del Toro, Luciano Lopez‐Jimenez, Conxita Falga, Andris Skride, Llorenç Font, Fernando Javier Vazquez, Henri Bounameaux, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge‐Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Radovan Malý, Peter Verhamme, Joseph A Caprini, Hanh My Bui, MD Adarraga, M Agud, J Aibar, MA Aibar, J Alfonso, C Amado, JI Arcelus, C Baeza, A Ballaz, R Barba, C Barbagelata, M Barrón, B Barrón‐Andrés, A Blanco‐Molina, E Botella, AM Camon, J Castro, MA Caudevilla, P Cerdà, L Chasco, J Criado, C de Ancos, J de Miguel, P Demelo‐Rodríguez, JA Díaz‐Peromingo, J Díez‐Sierra, R Díaz‐Simón, IM Domínguez, M Encabo, JC Escribano, C Falgá, AI Farfán, C Fernández‐Capitán, JL Fernández‐Reyes, MA Fidalgo, K Flores, C Font, I Francisco, C Gabara, F Galeano‐Valle, MA García, F García‐Bragado, MM García‐Mullor, O Gavín‐Blanco, O Gavín‐Sebastián, A Gil‐Díaz, C Gómez‐Cuervo, J González‐Martínez, E Grau, L Guirado, J Gutiérrez, L Hernández‐Blasco, L Jara‐Palomares, MJ Jaras, D Jiménez, MD Joya, I Jou, B Lacruz, R Lecumberri, J Lima, JL Lobo, H López‐Brull, L López‐Jiménez, P López‐Miguel, JJ López‐Núñez, R López‐Reyes, JB López‐Sáez, MA Lorente, A Lorenzo, M Loring, O Madridano, A Maestre, PJ Marchena, M Martín del Pozo, F Martín‐Martos, C Martínez‐Baquerizo, C Mella, M Mellado, MI Mercado, J Moisés, MV Morales, A Muñoz‐Blanco, D Muñoz‐Guglielmetti, N Muñoz‐Rivas, E Nart, JA Nieto, MJ Núñez, MC Olivares, C Ortega‐Michel, MD Ortega‐Recio, J Osorio, S Otalora, R Otero, P Parra, V Parra, JM Pedrajas, G Pellejero, A Pérez‐Jacoiste, ML Peris, D Pesántez, JA Porras, J Portillo, L Reig, A Riera‐Mestre, A Rivas, A Rodríguez‐Cobo, C Rodríguez‐Matute, J Rogado, V Rosa, CM Rubio, P Ruiz‐Artacho, N Ruiz‐Giménez, J Ruiz‐Ruiz, P Ruiz‐Sada, JC Sahuquillo, G Salgueiro, A Sampériz, JF Sánchez‐Muñoz‐Torrero, T Sancho, P Sigüenza, M Sirisi, S Soler, S Suárez, JM Suriñach, G Tiberio, MI Torres, C Tolosa, J Trujillo‐Santos, F Uresandi, E Usandizaga, R Valle, JR Vela, G Vidal, C Vilar, P Villares, C Zamora, P Gutiérrez, FJ Vázquez, T Vanassche, C Vandenbriele, P Verhamme, J Hirmerova, R Malý, E Salgado, I Benzidia, L Bertoletti, A Bura‐Riviere, B Crichi, P Debourdeau, O Espitia, D Farge‐Bancel, H Helfer, I Mahé, F Moustafa, G Poenou, S Schellong, A Braester, B Brenner, I Tzoran, M Amitrano, F Bilora, C Bortoluzzi, B Brandolin, M Ciammaichella, D Colaizzo, F Dentali, P Di Micco, E Giammarino, E Grandone, S Mangiacapra, D Mastroiacovo, R Maida, N Mumoli, F Pace, R Pesavento, F Pomero, P Prandoni, R Quintavalla, A Rocci, C Siniscalchi, A Tufano, A Visonà, N Vo Hong, B Zalunardo, RV Kalejs, K Maķe, M Ferreira, S Fonseca, F Martins, J Meireles, M Bosevski, M Zdraveska, L Mazzolai, JA Caprini, AJ Tafur, I Weinberg, H Wilkins, HM Bui, Blondon, M., Jimenez, D., Robert-Ebadi, H., Del Toro, J., Lopez-Jimenez, L., Falga, C., Skride, A., Font, L., Vazquez, F. J., Bounameaux, H., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Maly, R., Verhamme, P., Caprini, J. A., My Bui, H., Adarraga, M. D., Agud, M., Aibar, J., Aibar, M. A., Alfonso, J., Amado, C., Arcelus, J. I., Baeza, C., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Botella, E., Camon, A. M., Castro, J., Caudevilla, M. A., Cerda, P., Chasco, L., Criado, J., de Ancos, C., de Miguel, J., Demelo-Rodriguez, P., Diaz-Peromingo, J. A., Diez-Sierra, J., Diaz-Simon, R., Dominguez, I. M., Encabo, M., Escribano, J. C., Farfan, A. I., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Francisco, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia-Mullor, M. M., Gavin-Blanco, O., Gavin-Sebastian, O., Gil-Diaz, A., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Joya, M. D., Jou, I., Lacruz, B., Lecumberri, R., Lima, J., Lobo, J. L., Lopez-Brull, H., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Loring, M., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Martinez-Baquerizo, C., Mella, C., Mellado, M., Mercado, M. I., Moises, J., Morales, M. V., Munoz-Blanco, A., Munoz-Guglielmetti, D., Munoz-Rivas, N., Nart, E., Nieto, J. A., Nunez, M. J., Olivares, M. C., Ortega-Michel, C., Ortega-Recio, M. D., Osorio, J., Otalora, S., Otero, R., Parra, P., Parra, V., Pedrajas, J. M., Pellejero, G., Perez-Jacoiste, A., Peris, M. L., Pesantez, D., Porras, J. A., Portillo, J., Reig, L., Riera-Mestre, A., Rivas, A., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rogado, J., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Gimenez, N., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salgueiro, G., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Siguenza, P., Sirisi, M., Soler, S., Suarez, S., Surinach, J. M., Tiberio, G., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vela, J. R., Vidal, G., Vilar, C., Villares, P., Zamora, C., Gutierrez, P., Vanassche, T., Vandenbriele, C., Hirmerova, J., Salgado, E., Benzidia, I., Bura-Riviere, A., Crichi, B., Debourdeau, P., Espitia, O., Helfer, H., Mahe, I., Moustafa, F., Poenou, G., Braester, A., Amitrano, M., Bilora, F., Bortoluzzi, C., Brandolin, B., Ciammaichella, M., Colaizzo, D., Dentali, F., Giammarino, E., Grandone, E., Mangiacapra, S., Mastroiacovo, D., Maida, R., Mumoli, N., Pace, F., Pesavento, R., Pomero, F., Quintavalla, R., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Vo Hong, N., Zalunardo, B., Kalejs, R. V., Maie, K., Ferreira, M., Fonseca, S., Martins, F., Meireles, J., Zdraveska, M., Mazzolai, L., Tafur, A. J., Weinberg, I., Wilkins, H., and Bui, H. M.
Subjects: Registrie, medicine.medical_specialty, pulmonary embolism, Prognosi, Hemodynamics, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, Clinical prognosis, 0302 clinical medicine, Recurrence, Internal medicine, Case fatality rate, medicine, Humans, hemorrhage, mortality, prognosis, thrombolytic therapy, Registries, cardiovascular diseases, business.industry, Anticoagulant, Anticoagulants, Hematology, Venous Thromboembolism, Prognosis, medicine.disease, Confidence interval, Pulmonary embolism, Discontinuation, Cohort Studie, business, Venous thromboembolism, Cohort study, Human
Abstract: Aims Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. Methods and results We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (
Published: 2021

3. Timing and characteristics of venous thromboembolism after noncancer surgery

Author: Manuela Expósito-Ruiz, Juan Ignacio Arcelus, Joseph A. Caprini, Cristina López-Espada, Alessandra Bura-Riviere, Cristina Amado, Mónica Loring, Daniela Mastroiacovo, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Hanh My Bui, M.D. Adarraga, M. Agud, J. Aibar, M.A. Aibar, C. Amado, J.I. Arcelus, C. Baeza, A. Ballaz, R. Barba, C. Barbagelata, M. Barrón, B. Barrón-Andrés, A. Blanco-Molina, E. Botella, A.M. Camon, S. Campos, I. Cañas, I. Casado, J. Castro, J. Criado, C. de Ancos, J. de Miguel, J. del Toro, P. Demelo-Rodríguez, C. Díaz-Pedroche, J.A. Díaz-Peromingo, J. Díez-Sierra, I.M. Domínguez, J.C. Escribano, C. Falgá, A.I. Farfán, K. Fernández de Roitegui, C. Fernández-Aracil, C. Fernández-Capitán, J.L. Fernández-Reyes, M.A. Fidalgo, K. Flores, C. Font, L. Font, I. Francisco, I. Furest, C. Gabara, F. Galeano-Valle, M.A. García, F. García-Bragado, R. García-Hernáez, A. García-Raso, O. Gavín-Sebastián, A. Gil-Díaz, C. Gómez-Cuervo, J. González-Martínez, E. Grau, M. Giménez-Suau, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, E. Hernando, M. Herreros, L. Jara-Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, M.D. Joya, I. Jou, A. Lalueza, R. Lecumberri, J. Lima, P. Llamas, J.L. Lobo, L. López-Jiménez, P. López-Miguel, J.J. López-Núñez, R. López-Reyes, J.B. López-Sáez, A. Lorenzo, M. Loring, O. Madridano, A. Maestre, P.J. Marchena, M. Martín del Pozo, F. Martín-Martos, C. Mella, M. Mellado, M.I. Mercado, J. Moisés, M. Monreal, M.V. Morales, A. Muñoz-Blanco, D. Muñoz-Guglielmetti, N. Muñoz-Rivas, J.A. Nieto, A. Núñez-Ares, M.J. Núñez-Fernández, B. Obispo, M.C. Olivares, J.L. Orcastegui, M.D. Ortega-Recio, J. Osorio, S. Otalora, R. Otero, D. Paredes, P. Parra, V. Parra, J.M. Pedrajas, G. Pellejero, D. Pesántez, J.A. Porras, J. Portillo, A. Riera-Mestre, A. Rivas, F. Rivera, A. Rodríguez-Cobo, C. Rodríguez-Matute, J. Rogado, V. Rosa, C.M. Rubio, P. Ruiz-Artacho, N. Ruiz-Giménez, J. Ruiz-Ruiz, P. Ruiz-Sada, J.C. Sahuquillo, G. Salgueiro, A. Sampériz, J.F. Sánchez-Muñoz-Torrero, T. Sancho, P. Sigüenza, S. Soler, J.M. Suriñach, M.I. Torres, C. Tolosa, J. Trujillo-Santos, F. Uresandi, R. Valle, J.R. Vela, G. Vidal, P. Villares, C. Zamora, P. Gutiérrez, F.J. Vázquez, T. Vanassche, C. Vandenbriele, P. Verhamme, J. Hirmerova, R. Malý, I. Benzidia, L. Bertoletti, A. Bura-Riviere, B. Crichi, P. Debourdeau, O. Espitia, D. Farge-Bancel, H. Helfer, I. Mahé, F. Moustafa, G. Poenou, S. Schellong, A. Braester, B. Brenner, I. Tzoran, F. Bilora, B. Brandolin, E. Bucherini, M. Ciammaichella, D. Colaizzo, P. Di Micco, E. Grandone, D. Marchi, D. Mastroiacovo, R. Maida, F. Pace, R. Pesavento, P. Prandoni, R. Quintavalla, N. Rinzivillo, A. Rocci, C. Siniscalchi, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, D. Kigitovica, A. Skride, M. Ferreira, S. Fonseca, F. Martins, J. Meireles, M. Bosevski, G. Krstevski, H. Bounameaux, L. Mazzolai, J.A. Caprini, A.J. Tafur, I. Weinberg, H. Wilkins, H.M. Bui, Exposito-Ruiz, M., Arcelus, J. I., Caprini, J. A., Lopez-Espada, C., Bura-Riviere, A., Amado, C., Loring, M., Mastroiacovo, D., Monreal, M., Prandoni, P., Brenner, B., Farge-Bancel, D., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Verhamme, P., Bui, H. M., Adarraga, M. D., Agud, M., Aibar, J., Aibar, M. A., Baeza, C., Ballaz, A., Barbagelata, C., Barron, M., Barron-Andres, B., Blanco-Molina, A., Botella, E., Camon, A. M., Campos, S., Canas, I., Casado, I., Castro, J., Criado, J., de Ancos, C., de Miguel, J., Toro, J. D., Demelo-Rodriguez, P., Diaz-Pedroche, C., Diaz-Peromingo, J. A., Diez-Sierra, J., Dominguez, I. M., Escribano, J. C., Falga, C., Farfan, A. I., Fernandez de Roitegui, K., Fernandez-Aracil, C., Fernandez-Capitan, C., Fernandez-Reyes, J. L., Fidalgo, M. A., Flores, K., Font, C., Font, L., Francisco, I., Furest, I., Gabara, C., Galeano-Valle, F., Garcia, M. A., Garcia-Bragado, F., Garcia-Hernaez, R., Garcia-Raso, A., Gavin-Sebastian, O., Gil-Diaz, A., Gomez-Cuervo, C., Gonzalez-Martinez, J., Grau, E., Gimenez-Suau, M., Guirado, L., Gutierrez, J., Hernandez-Blasco, L., Hernando, E., Herreros, M., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Joya, M. D., Jou, I., Lalueza, A., Lecumberri, R., Lima, J., Llamas, P., Lobo, J. L., Lopez-Jimenez, L., Lopez-Miguel, P., Lopez-Nunez, J. J., Lopez-Reyes, R., Lopez-Saez, J. B., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin del Pozo, M., Martin-Martos, F., Mella, C., Mellado, M., Mercado, M. I., Moises, J., Morales, M. V., Munoz-Blanco, A., Munoz-Guglielmetti, D., Munoz-Rivas, N., Nieto, J. A., Nunez-Ares, A., Nunez-Fernandez, M. J., Obispo, B., Olivares, M. C., Orcastegui, J. L., Ortega-Recio, M. D., Osorio, J., Otalora, S., Otero, R., Paredes, D., Parra, P., Parra, V., Pedrajas, J. M., Pellejero, G., Pesantez, D., Porras, J. A., Portillo, J., Riera-Mestre, A., Rivas, A., Rivera, F., Rodriguez-Cobo, A., Rodriguez-Matute, C., Rogado, J., Rosa, V., Rubio, C. M., Ruiz-Artacho, P., Ruiz-Gimenez, N., Ruiz-Ruiz, J., Ruiz-Sada, P., Sahuquillo, J. C., Salgueiro, G., Samperiz, A., Sanchez-Munoz-Torrero, J. F., Sancho, T., Siguenza, P., Soler, S., Surinach, J. M., Torres, M. I., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valle, R., Vela, J. R., Vidal, G., Villares, P., Zamora, C., Gutierrez, P., Vazquez, F. J., Vanassche, T., Vandenbriele, C., Hirmerova, J., Benzidia, I., Crichi, B., Debourdeau, P., Espitia, O., Helfer, H., Mahe, I., Moustafa, F., Poenou, G., Braester, A., Bilora, F., Brandolin, B., Bucherini, E., Ciammaichella, M., Colaizzo, D., Grandone, E., Marchi, D., Maida, R., Pace, F., Pesavento, R., Quintavalla, R., Rinzivillo, N., Rocci, A., Siniscalchi, C., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Kigitovica, D., Skride, A., Ferreira, M., Fonseca, S., Martins, F., Meireles, J., Krstevski, G., Mazzolai, L., Tafur, A. J., Weinberg, I., and Wilkins, H.
Subjects: Adult, Male, Registrie, medicine.medical_specialty, Time Factors, Time Factor, Duration of risk, 030204 cardiovascular system & hematology, Drug Administration Schedule, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Deep vein thrombosi, Interquartile range, medicine, Humans, Registries, cardiovascular diseases, 030212 general & internal medicine, Aged, Venous Thrombosis, Benign disease, business.industry, Risk Factor, Incidence (epidemiology), Pulmonary embolism, Anticoagulant, Anticoagulants, Venous Thromboembolism, Heparin, Low-Molecular-Weight, Middle Aged, equipment and supplies, medicine.disease, Thrombosis, Surgery, Time course, Thromboprophylaxi, Female, Postoperative Complication, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Human, Surgical patients
Abstract: Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery. Methods We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes. Results The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days. Conclusions The risk of VTE after noncancer general surgery remains high for ≤2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.
Published: 2021

4. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site

Author: Alicia Lorenzo, E. Tiraferri, J.M. Martín-Antorán, I. Mahé, Bernardo Sopeña, Luciano López-Jiménez, Carmen Fernández-Capitán, M.L. Peris, M.A. Rodríguez-Dávila, Carme Font, Luca Calanca, Lidia Luciana Rota, A. Merah, C. Font, Lucia Mazzolai, J.M. Suriñach, M.A. Aibar, J. Vela, Daniela Mastroiacovo, Juan I. Arcelus, I. Casado, Elvira Grandone, Inna Tzoran, Laurent Bertoletti, Maria Luisa Peris, J.A. Nieto, C. Pérez, Adriana Visonà, L. Guirado, J. González, L. Bertoletti, G. Candeloro, J. Villalta, A. Riera, Ángeles Blanco-Molina, J. del Toro, J.L. Ribeiro, A. Belovs, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, Javier Trujillo-Santos, Vladimir Rosa, S. Otalora, G. Pérez, Fernando Uresandi, L. Ramírez, V. Gómez, Jean Chidiac, G. Tiberio, David Jiménez, Radovan Malý, T. Tomko, Aitor Ballaz, J. Hirmerova, Pablo Javier Marchena, C. Tolosa, Jose Gutierrez, Peter Verhamme, A. Grimón, M. Monreal, N. Ruiz-Giménez, E. Grau, G. Hernández, I. Suarez, M.V. Morales, Andris Skride, Raquel López-Reyes, Ángel Sampériz, Giovanni Barillari, Cristina Perez Ductor, R. Valle, M.S. Sousa, J.A. Porras, D. Farge-Bancel, Conxita Falga, P. García-Brotons, P. Malfante, Madalena Moreira, F. Martín-Martos, P. Gallego, O. Sanz, Santiago Nieto, B. Pagán, Hervé Decousus, O. Reig, L. Font, Corrado Lodigiani, F. García-Bragado, Maurizio Ciammaichella, A. Alatri, Isabelle Mahé, M. Pinelli, Philip S. Wells, Remedios Otero, Henri Bounameaux, José María Pedrajas, V. Isern, Manolis Papadakis, Pedro Ruiz-Artacho, B. Barrón-Andrés, F. Pace, E. Salgado, Beatriz Lacruz, Raquel Barba, A. Apollonio, J.B. López-Sáez, J. Bascuñana, M.A. Lorente, M.J. Núñez, Antonella Tufano, E. Grandone, A. Braester, Dolores Nauffal, Agustina Rivas, Barry M. Brenner, Silvia Soler, Paolo Prandoni, P. Di Micco, S. Nieto, J.C. Serrano, Abílio Reis, T. Bueso, Paola Ferrazzi, Luis Jara-Palomares, C. Ruiz-Martínez, Gianfranco Lessiani, José Luis Lobo, M. Zdraveska, Marijan Bosevski, C. Sala, J. de Miguel, L. Hernández-Blasco, A. Hij, Ramón Lecumberri, A. Culla, Olga Madridano, J.A. Díaz-Peromingo, M. Barrón, and J. Trujillo-Santos
Subjects: Male, Oncology, medicine.medical_specialty, Lung Neoplasms, Colorectal cancer, medicine.drug_class, Breast Neoplasms, Hemorrhage, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Recurrence, Prostate, Neoplasms, Internal medicine, medicine, Humans, Registries, Lung cancer, Aged, business.industry, Anticoagulant, Anticoagulants, Prostatic Neoplasms, Cancer, Venous Thromboembolism, General Medicine, Middle Aged, medicine.disease, Primary tumor, Confidence interval, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Disease Progression, Female, Colorectal Neoplasms, business
Abstract: Background We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. Aim and Methods We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). Results As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). Conclusions Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
Published: 2017

5. Pharmacogenetic algorithm for acenocoumarol dosing improve anticoagulation control: a multicenter randomized clinical trial

Author: Andrés Lorenzo, S. Fabra, P. Llamas Sillero, Alberto M. Borobia, Olga Madridano, M. A. Rodriguez Dávila, M. González Viñolis, Hoi Y. Tong, E. Arroyo Pardo, A. Carcas Sansuán, N. Ruiz Giménez, A. M. López Parra, and C. Baeza
Subjects: Pediatrics, medicine.medical_specialty, Acenocoumarol, Randomized controlled trial, law, business.industry, medicine, Dosing, business, Pharmacogenetics, medicine.drug, law.invention
Published: 2018

6. Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

Author: Farès Moustafa, Matteo Giorgi Pierfranceschi, Pierpaolo Di Micco, Eugenio Bucherini, Alicia Lorenzo, Aurora Villalobos, José A. Nieto, Beatriz Valero, Ángel L. Sampériz, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Laurent Bertoletti, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, MD Adarraga, P Agudo, MA Aibar, M Alfonso, JI Arcelus, A Ballaz, R Barba, M Barrón, B Barrón‐Andrés, J Bascuñana, A Blanco‐Molina, I Cañas, I Casado, N Chic, R del Pozo, J del Toro, MC Díaz‐Pedroche, JA Díaz‐Peromingo, C Falgá, C Fernández‐Aracil, C Fernández‐Capitán, MA Fidalgo, C Font, L Font, P Gallego, MA García, F García‐Bragado, O Gavín, C Gómez, V Gómez, J González, E Grau, A Grimón, R Guijarro, L Guirado, J Gutiérrez, G Hernández‐Comes, L Hernández‐Blasco, L Jara‐Palomares, MJ Jaras, D Jiménez, J Jiménez, MD Joya, P Llamas, JL Lobo, P López, L López‐Jiménez, R López‐Reyes, JB López‐Sáez, MA Lorente, M Lumbierres, JM Luque, PJ Marchena, F Martín‐Martos, M Mellado, S Nieto, A Núñez, MJ Núñez, S Otalora, R Otero, JM Pedrajas, G Pérez, C Pérez‐Ductor, ML Peris, I Pons, JA Porras, O Reig, A Riera‐Mestre, D Riesco, A Rivas, M Rodríguez, MA Rodríguez‐Dávila, V Rosa, E Rosillo‐Hernández, P Ruiz‐Artacho, N Ruiz‐Giménez, JC Sahuquillo, MC Sala‐Sainz, R Sánchez‐Martínez, O Sanz, S Soler, B Sopeña, JM Suriñach, C Tolosa, MI Torres, J Troya, J Trujillo‐Santos, F Uresandi, E Usandizaga, R Valle, J Vela, L Vela, MP Vicente, B Xifre, T Vanassche, P Verhamme, HHB Yoo, P Wells, J Hirmerova, R Malý, P Dulíček, E Salgado, L Bertoletti, A Bura‐Riviere, D Farge‐Bancel, A Hij, I Mahé, A Merah, A Braester, B Brenner, I Tzoran, G Antonucci, G Barillari, F Bilora, C Bortoluzzi, B Brandolin, C Cattabiani, M Ciammaichella, N Dell'Elce, F Dentali, R Duce, E Grandone, E Imbalzano, G Lessiani, R Maida, D Mastroiacovo, F Pace, R Parisi, M Pellegrinet, R Pesavento, M Pinelli, R Poggio, P Prandoni, R Quintavalla, A Rocci, E Tiraferri, D Tonello, A Tufano, A Visonà, V Gibietis, A Skride, B Vitola, M Bosevski, M Zdraveska, H Bounameaux, L Mazzolai, RIETE Investigators, Decousus, H., Prandoni, P., Brenner, B., Barba, R., Bertoletti, L., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Malý, R., Wells, P., Papadakis, M., Adarraga, M.D., Agudo, P., Aibar, M.A., Alfonso, M., Arcelus, J.I., Ballaz, A., Barrón, M., Barrón-Andrés, B., Bascuñana, J., Blanco-Molina, A., Cañas, I., Casado, I., Chic, N., Del Pozo, R., Del Toro, J., Díaz-Pedroche, M.C., Díaz-Peromingo, J.A., Falgá, C., Fernández-Aracil, C., Fernández-Capitán, C., Fidalgo, M.A., Font, C., Font, L., Gallego, P., García, M.A., García-Bragado, F., Gavín, O., Gómez, C., Gómez, V., González, J., Grau, E., Grimón, A., Guijarro, R., Guirado, L., Gutiérrez, J., Hernández-Comes, G., Hernández-Blasco, L., Jara-Palomares, L., Jaras, M.J., Jiménez, D., Jiménez, J., Joya, M.D., Llamas, P., Lobo, J.L., López, P., López-Jiménez, L., López-Reyes, R., López-Sáez, J.B., Lorente, M.A., Lumbierres, M., Luque, J.M., Marchena, P.J., Martín-Martos, F., Mellado, M., Nieto, S., Núñez, A., Núñez, M.J., Otalora, S., Otero, R., Pedrajas, J.M., Pérez, G., Pérez-Ductor, C., Peris, M.L., Pons, I., Porras, J.A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodríguez, M., Rodríguez-Dávila, M.A., Rosa, V., Rosillo-Hernández, E., Ruiz-Artacho, P., Ruiz-Giménez, N., Sahuquillo, J.C., Sala-Sainz, M.C., Sánchez-Martínez, R., Sanz, O., Soler, S., Sopeña, B., Suriñach, J.M., Tolosa, C., Torres, M.I., Troya, J., Trujillo-Santos, J., Uresandi, F., Usandizaga, E., Valle, R., Vela, J., Vela, L., Vicente, M.P., Xifre, B., Vanassche, T., Verhamme, P., Yoo, H., Hirmerova, J., Dulíček, P., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahé, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Brandolin, B., Cattabiani, C., Ciammaichella, M., Dell'Elce, N., Dentali, F., Duce, R., Grandone, E., Imbalzano, E., Lessiani, G., Maida, R., Mastroiacovo, D., Pace, F., Parisi, R., Pellegrinet, M., Pesavento, R., Pinelli, M., Poggio, R., Quintavalla, R., Rocci, A., Tiraferri, E., Tonello, D., Tufano, A., Visonà, A., Gibietis, V., Skride, A., Vitola, B., Zdraveska, M., Mazzolai, L., Moustafa, F., Giorgi Pierfranceschi, M., Di Micco, P., Bucherini, E., Lorenzo, A., Villalobos, A., Nieto, J. A., Valero, B., Samperiz, A. L., Monreal, M., Maly, R., Adarraga, M. D., Aibar, M. A., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Canas, I., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Garcia, M. A., Garcia-Bragado, F., Gavin, O., Gomez, C., Gomez, V., Gonzalez, J., Grimon, A., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Jaras, M. J., Jimenez, D., Jimenez, J., Joya, M. D., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Luque, J. M., Marchena, P. J., Martin-Martos, F., Nunez, A., Nunez, M. J., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Rodriguez, M., Rodriguez-Davila, M. A., Rosillo-Hernandez, E., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Sanchez-Martinez, R., Sopena, B., Surinach, J. M., Torres, M. I., Vicente, M. P., Yoo, H. H. B., Dulicek, P., Mahe, I., and Visona, A.
Subjects: medicine.medical_specialty, Gastrointestinal bleeding, anticoagulants, recurrence, venous thromboembolism, hemorrhage, mortality, recurrences, Renal function, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, 030212 general & internal medicine, business.industry, anticoagulant, Retrospective cohort study, Hematology, Odds ratio, medicine.disease, Confidence interval, Surgery, Natural history, Original Article, business, Original Articles: Thrombosis
Abstract: Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs.The frequency, clinical characteristics and outcome of these patients have not been reported in real life.Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.
Published: 2017

7. Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

Author: Chatree Chai-Adisaksopha, Alfonso Iorio, Mark A. Crowther, Javier de Miguel, Estuardo Salgado, Marija Zdraveska, Carmen Fernández-Capitán, José Antonio Nieto, Giovanni Barillari, Laurent Bertoletti, Manuel Monreal, M.A. Aibar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, B. Calvo, G. Cañada, I. Cañas, I. Casado, A. Culla, J. de Miguel, J. del Toro, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, V. Gómez, J. González, E. Grau, M. Guil, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, I. Manrique-Abos, P.J. Marchena, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, R. Morillo, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, M.L. Peris, I. Pons, J.A. Porras, L. Ramirez, A. Riera, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, A. Sampériz, R. Sánchez, M.C. Sala, J.C. Sahuquillo, O. Sanz, S. Soler, I. Suárez-González, J.M. Suriñach, G. Tiberio, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, G. Vidal, V. Vilella-Tomás, J. Villalta, P.C. Malfante, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, G. Candelero, M. Ciammaichella, P. Di Micco, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, and J.C. Serrano
Subjects: Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, Deep vein, Low molecular weight heparin, Anticoagulants, Cancer, Low-molecular-weight heparin, Thromboembolism, Warfarin, 030204 cardiovascular system & hematology, Recurrent deep vein thrombosis, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Neoplasms, medicine, Humans, Registries, Propensity Score, Aged, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Venous Thromboembolism, Heparin, Low-Molecular-Weight, medicine.disease, Thrombosis, Pulmonary embolism, Surgery, Venous thrombosis, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, business, medicine.drug
Abstract: BACKGROUND: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. RESULTS: After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). CONCLUSIONS: In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH. (C) 2018 Elsevier Inc. All rights reserved.
Published: 2017

8. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry

Author: C. Pérez-Ductor, Raffaele Pesavento, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Luciano López-Jiménez, Pierpaolo Di Micco, S. Nieto, Renzo Poggio, Inna Tzoran, T. Bueso, Alicia Lorenzo, Carmen Fernández-Capitán, F. García-Bragado, D. Riesco, Thomas Vanassche, M. Papadakis, J. del Toro, N. Ruiz-Giménez, M.J. Núñez, F. Martín-Martos, Mark M. Levy, Benjamin Brenner, J.A. Porras, G. Vidal, V. Gómez, A. Braester, Cristina Perez Ductor, R. Barba, R. Valle, Bernardo Sopeña, Lidia Luciana Rota, J.C. Sahuquillo, E. Tiraferri, J.M. Martín-Antorán, M.S. Sousa, Conxita Falga, Jose Gutierrez, Ángeles Blanco-Molina, J.M. Suriñach, H. Bounameaux, Isabelle Mahé, María del Carmen Díaz-Pedroche, Philip S. Wells, B. Pagán, Agustina Rivas, J. Bascuñana, G. Antonucci, Carme Font, Antonella Tufano, Maurizio Ciammaichella, S. Otalora, Ángel Sampériz, J. González, R. Maida, Giovanni Barillari, Andris Skride, P. Di Micco, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, F. Pace, Diego Tonello, Remedios Otero, R. Malý, L. Bertoletti, R. Lecumberri, M.A. Aibar, K. Champion, D. Kigitovica, J. Binetti, M.L. Peris, M.A. Rodríguez-Dávila, Adriana Visonà, L. Guirado, Miguel Martín, Abílio Reis, P. Gallego, O. Reig, G. Pérez, Hervé Decousus, Daniel H. Newton, E. Salgado, P. Prandoni, Laurent Bertoletti, Peter Verhamme, Luke G. Wolfe, Javier Trujillo-Santos, M.A. García, M.A. Fidalgo, Paola Ferrazzi, Pablo Javier Marchena, J. Villalta, M.A. Lorente, Elvira Grandone, O. Sanz, M.C. Sala-Sainz, F. Bilora, M. Bosevski, I. Cañas, Vladimir Rosa, David Jiménez, Juan I. Arcelus, E. Grau, B. Zalunardo, Beatriz Valero, Luis Jara-Palomares, Manuel Monreal Bosch, José María Pedrajas, Pedro Ruiz-Artacho, B. Barrón-Andrés, Fernando Uresandi, E. Rosillo-Hernández, M.D. Joya, Rita Duce, L. Font, C. Tolosa, Francesco Dentali, I. Manrique-Abos, F. Carmona, Andreas Erdmann, Antoni Riera-Mestre, L. Hernández-Blasco, Nuria Chic, J.B. López-Sáez, J. Vela, J. Hirmerova, A. Grimón, G. Hernández-Comes, D. Farge-Bancel, C. Fernández-Aracil, Raquel López-Reyes, Raúl Sánchez, Michael F. Amendola, J.A. Nieto, A. Merah, I. Tzoran, J.L. Ribeiro, E. Drucka, Lucia Mazzolai, Radovan Malý, María Belén Alfonso, José Luis Lobo, M. Zdraveska, I. Pérez, Marijan Bosevski, Manolis Papadakis, Raquel Barba, R. Aranda, A.R. Ramos, R. del Pozo, M. Barrón, A. Hij, R. Agüero, Ramón Lecumberri, Corrado Lodigiani, Henri Bounameaux, A. Culla, A. Núñez, J.A. Díaz-Peromingo, and Barbara Ney
Subjects: Adult, Male, medicine.medical_specialty, Multivariate analysis, Adolescent, Hemorrhage, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Catheterization, Peripheral, 03 medical and health sciences, Immobilization, Young Adult, 0302 clinical medicine, Recurrence, Aged, Aged, 80 and over, Catheterization, Peripheral, Female, Humans, Middle Aged, Neoplasms, Pulmonary Embolism, Registries, Upper Extremity Deep Vein Thrombosis, Venous Thromboembolism, 80 and over, Medicine, cardiovascular diseases, Young adult, Prospective cohort study, business.industry, Odds ratio, medicine.disease, Thrombosis, Confidence interval, Surgery, Pulmonary embolism, Venous thrombosis, 030228 respiratory system, Cardiology and Cardiovascular Medicine, business
Abstract: We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients.The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hemorrhage. Multivariate analysis was performed using stepwise logistic regression.Of the 1100 patients who met the study criteria, 580 (53%) were male. The mean age of the patients was 50 ± 20 years, and overall patient survival at 1 year was 85%. Recurrent VTE occurred in 59 patients (5.4%). Of these, 46 patients (4%) had recurrent DVT, 10 (0.9%) had a PE following UEDVT diagnosis, and 3 (0.3%) had both. PE was fatal in three patients (0.3%). Bleeding occurred in 50 patients (4.5%), major bleeding in 19 patients (1.7%), and fatal bleeding in 6 patients (0.5%). On multivariate analysis, malignant disease was associated with VTE recurrence (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.04-3.45; P .04), whereas hemorrhage was associated with age (OR, 1.03; 95% CI, 1.01-1.05; P = .002) and malignant disease (OR, 2.53; 95% CI, 1.34-4.76; P .005). Hemorrhage and recurrent VTE were also significantly associated (OR, 2.79; 95% CI, 1.16-6.76; P .03).PE following non-CA-UEDVT is rare. Malignant disease was associated with VTE recurrence. Age and malignant disease were associated with hemorrhage, and VTE recurrence was associated with hemorrhage. Further prospective studies should be undertaken to best determine length of anticoagulation treatment for the varied populations of patients with UEDVT.
Published: 2017

9. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE

Author: Luis Jara-Palomares, Remedios Otero, David Jimenez, Marc Carrier, Inna Tzoran, Benjamin Brenner, Mireia Margeli, Juan Manuel Praena-Fernandez, Elvira Grandone, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, M.A. Aibar, M. Alfonso, M.I. Asensio-Cruz, T. Auguet, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. Cañas, A. Ceausu, N. Chic, A. Culla, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, M. Duffort, T. Elias-Hernández, C. Falgá, C. Fernández-Aracil, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, M.A. García, F. García-Bragado, M. García-Rodenas, V. Gómez, J. González, E. Grau, A. Grimón, R. Guijarro, L. Guirado, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, E. Hernando-López, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, M. Martín, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, S. Otalora, R. Otero, A. Ovejero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, M.A. Rodríguez-Dávila, V. Rosa, P. Ruiz-Artacho, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, B. Sopeña, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, P. Vicente, G. Vidal, A. Villalobos, J. Villalta, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, E. Salgado, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, A. Bertone, F. Bilora, C. Bortoluzzi, M. Ciammaichella, C. Di Girolamo, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Jara-Palomares, L., Otero, R., Jimenez, D., Carrier, M., Tzoran, I., Brenner, B., Margeli, M., Praena-Fernandez, J. M., Grandone, E., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Aibar, M. A., Alfonso, M., Asensio-Cruz, M. I., Auguet, T., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canas, I., Ceausu, A., Chic, N., Culla, A., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Duffort, M., Elias-Hernandez, T., Falga, C., Fernandez-Aracil, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, M. A., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, J., Grau, E., Grimon, A., Guijarro, R., Guirado, L., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hernando-Lopez, E., Jaras, M. J., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin, M., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otalora, S., Ovejero, A., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rivas, A., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Artacho, P., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez, R., Sanz, O., Soler, S., Sopena, B., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, P., Vidal, G., Villalobos, A., Villalta, J., Vanassche, T., Verhamme, P., Hirmerova, J., Salgado, E., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Moustafa, F., Braester, A., Antonucci, G., Barillari, G., Bertone, A., Bilora, F., Bortoluzzi, C., Ciammaichella, M., Di Girolamo, C., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Sousa, M. S., Zdraveska, M., and Mazzolai, L.
Subjects: Pulmonary and Respiratory Medicine, Lung Diseases, Male, medicine.medical_specialty, Multivariate analysis, Anemia, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Internal medicine, Neoplasms, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Registries, risk, Aged, Aged, 80 and over, Thrombocytosis, Venous Thrombosis, Framingham Risk Score, business.industry, screening, Case-control study, Age Factors, Cancer, Reproducibility of Results, Venous Thromboembolism, Middle Aged, medicine.disease, Pulmonary embolism, Surgery, Spain, Case-Control Studies, Surgical Procedures, Operative, Cohort, Multivariate Analysis, Female, Cardiology and Cardiovascular Medicine, Risk assessment, business, Pulmonary Embolism, neoplasm
Abstract: Background The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. Methods We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. Results Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. Conclusions This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.
Published: 2016

10. DVT Management and Outcome Trends, 2001 to 2014

Author: Raquel Morillo, David Jiménez, Miguel Ángel Aibar, Daniela Mastroiacovo, Philip S. Wells, Ángel Sampériz, Marta Saraiva de Sousa, Alfonso Muriel, Roger D. Yusen, Manuel Monreal, Hervè Decousus, Paolo Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, Manolis Papadakis, P. Agudo, M.A. Aibar, M. Akasbi, M. Alcalde-Manero, V. Andújar, J.I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, I. Cañas, I. Casado, J. de Miguel, J. del Toro, S. Díaz, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, C. Font, L. Font, P. Gallego, F. García-Bragado, M. García-Rodenas, V. Gómez, C.J. González, E. Grau, L. Guirado, J. Gutiérrez, G. Hernández, L. Hernández-Blasco, V. Isern, L. Jara-Palomares, M.J. Jaras, D. Jiménez, J.L. Lobo, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, M. Martín, J.M. Martín-Antorán, F. Martín-Martos, M. Monreal, M.V. Morales, D. Nauffal, J.A. Nieto, S. Nieto, M.J. Núñez, C. Orbegoso, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, C. Pérez, G. Pérez, M.L. Peris, I. Pons, J.A. Porras, O. Reig, A. Riera-Mestre, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, A.S. Rosa-Murillo, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala, A. Sampériz, R. Sánchez, O. Sanz, S. Soler, J.M. Suriñach, C. Tolosa, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, G. Vidal, C. Vilar, J. Villalta, B. Xifre, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. Celis, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahé, A. Merah, I. Quere, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, A. Apollonio, G. Barillari, A. Bertone, F. Bilora, E. Bucherini, M. Ciammaichella, P. De Ciantis, F. Dentali, P. Di Micco, R. Duce, P. Ferrazzi, E. Grandone, G. Lessiani, C. Lodigiani, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, M. Rosa, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, U. Venturelli, A. Visonà, B. Zalunardo, E. Drucka, D. Kigitovica, A. Skride, A. Mafalda, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Mazzolai, Morillo, R., Jimenez, D., Aibar, M. A., Mastroiacovo, D., Wells, P. S., Samperiz, A., Saraiva de Sousa, M., Muriel, A., Yusen, R. D., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Papadakis, M., Agudo, P., Akasbi, M., Alcalde-Manero, M., Andujar, V., Arcelus, J. I., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Canas, I., Casado, I., de Miguel, J., del Toro, J., Diaz, S., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Font, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Rodenas, M., Gomez, V., Gonzalez, C. J., Grau, E., Guirado, L., Gutierrez, J., Hernandez, G., Hernandez-Blasco, L., Isern, V., Jara-Palomares, L., Jaras, M. J., Lobo, J. L., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin, M., Martin-Antoran, J. M., Martin-Martos, F., Morales, M. V., Nauffal, D., Nieto, J. A., Nieto, S., Nunez, M. J., Orbegoso, C., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Perez, C., Perez, G., Peris, M. L., Pons, I., Porras, J. A., Reig, O., Riera-Mestre, A., Rivas, A., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Rosa-Murillo, A. S., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala, M. C., Sanchez, R., Sanz, O., Soler, S., Surinach, J. M., Tolosa, C., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vidal, G., Vilar, C., Villalta, J., Xifre, B., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., Celis, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Farge-Bancel, D., Hij, A., Mahe, I., Merah, A., Quere, I., Braester, A., Apollonio, A., Barillari, G., Bertone, A., Bilora, F., Bucherini, E., Ciammaichella, M., De Ciantis, P., Dentali, F., Duce, R., Ferrazzi, P., Grandone, E., Lessiani, G., Lodigiani, C., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rosa, M., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Venturelli, U., Visona, A., Zalunardo, B., Drucka, E., Kigitovica, D., Skride, A., Mafalda, A., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., and Mazzolai, L.
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Vena Cava Filters, Hemorrhage, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Rate ratio, survival, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, medicine, Humans, Thrombolytic Therapy, Registries, 030212 general & internal medicine, Mortality, Population Growth, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Venous Thrombosis, business.industry, Anticoagulants, Disease Management, Heparin, Low-Molecular-Weight, Length of Stay, Middle Aged, Prognosis, medicine.disease, Pulmonary embolism, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Venous thromboembolism, Hospital stay, DVT, prognosi
Abstract: Background A comprehensive evaluation of temporal trends in the treatment of patients who have DVT may assist with identification of modifiable factors that contribute to short-term outcomes. Methods We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, pulmonary embolism-related, and bleeding-related death to 30 days after diagnosis. Results The mean length of hospital stay decreased from 9.0 days in 2001 to 2005 to 7.6 days in 2010 to 2014 (P
Published: 2016

11. Alcance de los últimos subestudios del RE-LY: implicaciones clínicas

Author: N. Ruiz-Giménez Arrieta
Subjects: business.industry, Medicine, General Medicine, business, Humanities
Abstract: Resumen La aprobacion de etexilato de dabigatran en la prevencion del ictus en pacientes con fibrilacion auricular no valvular (FANV) se fundamenta en los resultados del ensayo RE-LY, uno de los mayores estudios realizados hasta la fecha en esta patologia. En este estudio, dabigatran ha demostrado ser una alternativa eficaz y segura a la warfarina para la prevencion primaria y secundaria del ictus en pacientes con FA. Dabigatran en dosis de 150 mg 2 veces al dia resulto superior a la warfarina en la prevencion de ictus o embolias sistemicas y la dosis de 110 mg 2 veces al dia demostro similar eficacia con mayor seguridad, dada la menor incidencia de hemorragia. Dichos resultados se mantienen consistentes en los diferentes subanalisis con algunos matices de interes para la practica clinica. Los candidatos ideales para dabigatran serian los pacientes con FANV subsidiarios de cardioversion, que requieren periodos cortos de anticoagulacion, pacientes en zonas geograficas alejadas con dificultad para acceder a un buen control de la anticoagulacion o dificiles de controlar con AVK por fluctuacion del cociente internacional normalizado (INR), y pacientes con bajo riesgo de hemorragias, con score de CHADS ≥ 3 o/y con ictus previo, siempre que logicamente no exista contraindicacion. La eleccion de dosis de dabigatran sera valorada en funcion de las caracteristicas individuales (precaucion con los ancianos y en insuficiencia renal) y del riesgo embolico y/o hemorragico en cada paciente. Aspectos relacionados con la seguridad a largo plazo, estudios de farmacoeconomia en Espana y datos de farmacovigilancia poscomercializacion son necesarios para posicionar definitivamente este farmaco.
Published: 2012

12. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity

Author: V. Rosa‐Salazar, J. Trujillo‐Santos, J.A. Díaz Peromingo, A. Apollonio, O. Sanz, R. Malý, F.J. Muñoz‐Rodriguez, J.C. Serrano, S. Soler, M. Monreal, H. Decousus, P. Prandoni, B. Brenner, R. Barba, P. Di Micco, L. Bertoletti, S. Schellong, I. Tzoran, A. Reis, M. Bosevski, H. Bounameaux, P. Wells, M. Papadakis, M.D. Adarraga, A. Alibalic, A. Alvarado‐Faria, J.I. Arcelus, T. Auguet, A. Ballaz, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, J.F. Benítez, A. Blanco‐Molina, T. Bueso, A. Cañas, A. Casado, N. Castejón‐Pina, E.L. Chaves, F del Molino, J del Toro, C. Falgá, C. Fernández‐Capitán, L. Font, P. Gallego, F. García‐Bragado, A. García‐Ortega, V. Gómez, J. González, D. González‐Marcano, E. Grau, R. Guijarro, M. Guil, L. Guirado, J. Gutiérrez‐Guisado, L. Hernández‐Blasco, L. Jara‐Palomares, M.J. Jaras, D. Jiménez, R. Jiménez, B. Lacruz, R. Lecumberri, J.L. Lobo, L. López‐Jiménez, L. López‐Montes, R. López‐Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P.J. Marchena, J.M. Martín‐Antorán, F. Martín‐Martos, M.V. Morales, D. Nauffal, J.A. Nieto, M.J. Núñez, S. Otalora, R. Otero, B. Pagán, J.M. Pedrajas, M.L. Peris, I. Pons, J.A. Porras, A. Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, N. Ruiz‐Giménez, P. Sabio, A. Sampériz, R. Sánchez, M.J. Soto, J.M. Suriñach, G. Tiberio, R. Tirado, C. Tolosa, F. Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, J. Villalta, P. Malfante, P. Verhamme, T. Vanassche, T. Tomko, J. Hirmerova, A. Bura‐Riviere, D. Farge‐Bancel, A. Hij, I. Mahe, A. Merah, F. Moustafa, I. Quere, D. Babalis, I. Tzinieris, A. Braester, G. Barillari, E. Bucherini, J. Campodomico, M. Ciammaichella, P. Ferrazzi, R. Maida, F. Pace, S. Pasca, R. Pesavento, C. Piovella, L. Rota, E. Tiraferri, A. Tufano, A. Visonà, A. Skride, A. Belovs, M. Moreira, J.L. Ribeiro, M.S. Sousa, A. Alatri, L. Calanca, L. Mazzolai, Rosa-Salazar, V., Trujillo-Santos, J., Diaz Peromingo, J. A., Apollonio, A., Sanz, O., Maly, R., Munoz-Rodriguez, F. J., Serrano, J. C., Soler, S., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., Bosevski, M., Bounameaux, H., Wells, P., Papadakis, M., Adarraga, M. D., Alibalic, A., Alvarado-Faria, A., Arcelus, J. I., Auguet, T., Ballaz, A., Barron, M., Barron-Andres, B., Bascunana, J., Benitez, J. F., Blanco-Molina, A., Bueso, T., Canas, A., Casado, A., Castejon-Pina, N., Chaves, E. L., del Molino, F., del Toro, J., Diaz, J. A., Falga, C., Fernandez-Capitan, C., Font, L., Gallego, P., Garcia-Bragado, F., Garcia-Ortega, A., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Guijarro, R., Guil, M., Guirado, L., Gutierrez-Guisado, J., Hernandez-Blasco, L., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Lacruz, B., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Montes, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Madridano, O., Maestre, A., Marchena, P. J., Martin-Antoran, J. M., Martin-Martos, F., Montreal, M., Morales, M. V., Nauffal, D., Nieto, J. A., Nunez, M. J., Otalora, S., Otero, R., Pagan, B., Pedrajas, J. M., Peris, M. L., Pons, I., Porras, J. A., Riera-Mestre, A., Rivas, A., Rodriguez-Davila, M. A., Ruiz-Gimenez, N., Sabio, P., Samperiz, A., Sanchez, R., Soto, M. J., Surinach, J. M., Tiberio, G., Tirado, R., Tolosa, C., Uresandi, F., Valero, B., Valle, R., Vela, J., Villalobos, A., Verhamme, P., Tomko, T., Villalta, J., Malfante, P., Mahe, I., Vanassche, T., Moustafa, F., Babalis, D., Hirmerova, J., Barillari, G., Bucherini, E., Farge-Bance, D., Ciammaichella, M., Ferrazzi, P., Maida, R., Pace, F., Quere, I., Pesavento, R., Piovella, C., Rota, L., Tzinieris, I., Tufano, A., Skride, A., Moreira, M., Ribeiro, J. L., Alatri, A., Calanca, L., Visona, A., Belovs, A., Sousa, M. S., Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
Subjects: Adult, Male, Canada, medicine.medical_specialty, Time Factors, Upper extremity, Deep vein, Renal function, Hemorrhage, Risk Assessment, deep vein thrombosis, Decision Support Techniques, Hospital, Predictive Value of Tests, Risk Factors, Deep vein thrombosi, Upper Extremity Deep Vein Thrombosis, Humans, Medicine, Registries, Israel, Adverse effect, Anticoagulant therapy, Aged, Outcome, Deep vein thrombosis, Outpatients, Anticoagulants, Europe, Female, Middle Aged, Pulmonary Embolism, South America, Treatment Outcome, business.industry, Cancer, Outpatient, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, medicine.disease, Thrombosis, Confidence interval, 3. Good health, Pulmonary embolism, Surgery, outpatients, medicine.anatomical_structure, Heart failure, business
Abstract: International audience; BACKGROUND:No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy.METHODS:We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week.RESULTS:As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055.CONCLUSIONS:Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.
Published: 2015

13. Usefulness of Fast ELISA Determination of D-Dimer Levels for Diagnosing Pulmonary Embolism in an Emergency Room

Author: Paloma Caballero, C. Suárez, E. Pérez-Amor, L. Domínguez, N. Ruiz-Giménez, P. Artieda, and A. Friera-Reyes
Subjects: Male, medicine.medical_specialty, Enzyme-Linked Immunosorbent Assay, Sensitivity and Specificity, Gastroenterology, Fibrin Fibrinogen Degradation Products, Predictive Value of Tests, Internal medicine, D-dimer, medicine, Humans, Prospective cohort study, Aged, business.industry, General Medicine, Plasma levels, Middle Aged, medicine.disease, Predictive value, Confidence interval, Pulmonary embolism, Surgery, Embolism, Predictive value of tests, Female, Emergency Service, Hospital, Pulmonary Embolism, business
Abstract: Objective To determine the sensitivity and negative predictive value of D-dimer levels measured by fast enzyme-linked immunoabsorbent assay (ELISA) in pulmonary embolism. Patients and methods Prospective study of consecutive patients with suspicion of pulmonary embolism attended in the Emergency Room of the Hospital de la Princesa in Madrid, Spain. Thromboembolism was diagnosed with an algorithm established in the hospital, and D-dimer levels were determined by fast ELISA (VIDAS D-dimer Assay) in each patient suspected of pulmonary embolism. Patients with negative findings from a test not considered a reference method for thromboembolism were followed for 3 months. Results Of 132 patients with clinical suspicion, 28 (21.2%) were positive and 104 (78.7%) were negative for embolism. D-dimer levels were below 0.5 μg/mL in 31 patients, 30 of whom did not have pulmonary thromboembolism whereas 1 did. D-dimer levels were abowe 0.5 μg/mL in 101 patients; thromboembolism did not occur in 74 of these but was reported in the remaining 27. For a value of 1 μg/mL, 66 patients had values below the cut off, 3 of whom presented pulmonary embolism. The remaining 66 patients had D-dimer levels above or equal to 1 μg/mL; 25 of them had a positive diagnosis for embolism and 41 had a negative diagnosis. Sensitivity and negative predictive values were 96.4% (95% confidence interval [CI], 79.8%-99.9%) and 96.8% (95% CI, 81.5%-98.8%), respectively, at a cut off of 0.5 μg/mL; and 89.2% (95% CI, 70.6%-97.2%) and 95.45% (95% CI, 86.4%-98.8 %), respectively, at a cut off of 1 μg/mL. Conclusions In an emergency room, thromboembolism can be excluded if plasma levels of D-dimer measured by fast ELISA are below 0.5 μg/mL because of the high negative predictive value at this cut off.
Published: 2005

14. Utilidad del dímero-D por ELISA rápido en el diagnóstico de la embolia pulmonar en un servicio de urgencias

Author: E. Pérez-Amor, Paloma Caballero, N. Ruiz-Giménez, P. Artieda, C. Suárez, A. Friera-Reyes, and L. Domínguez
Subjects: Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, Medicine, business
Abstract: Objetivo Determinar la sensibilidad y el valor predictivo negativo del dimero-D, por enzimoinmunoanalisis (ELISA) rapido, en la embolia pulmonar. Pacientes y metodos Estudio prospectivo de pacientes atendidos consecutivamente por sospecha clinica de embolia en el Servicio de Urgencias del Hospital de La Princesa de Madrid. El diagnostico de tromboembolia se baso en el algoritmo establecido en el hospital, y se determino el dimero-D por ELISA (VIDAS) en cada paciente con sospecha de embolia pulmonar. A los pacientes con resultado negativo para tromboembolia, establecido por una prueba no considerada de referencia, se les realizo seguimiento clinico a los 3 meses. Resultados De 132 pacientes con sospecha clinica, 28 (21,2%) fueron positivos y 104 (78,7%) negativos para embolia. El dimero-D fue 0,5 μg/ml, en 74 no se produjo tromboembolia y en 27 si. Si se considera como punto de corte 1 μg/ml, hubo 66 pacientes con valores inferiores, de los que 3 presentaron embolia pulmonar. Otros 66 pacientes mostraron un dimero-D ≥ 1 μg/ml; de ellos, 25 tuvieron un diagnostico positivo para embolia y 41 negativo. La sensibilidad y el valor predictivo negativo para 0,5 μg/ml fue de 96,4 (intervalo de confianza [IC] del 95%, 79,8-99,9) y 96,8 (IC del 95%, 81,5-98,8), respectivamente; para 1 μg/ml fue de 89,2 (IC del 95%, 70,6-97,2) y 95,45 (IC del 95%, 86,4-98,8), respectivamente. Conclusiones Los valores de dimero-D plasmatico, determinados por la tecnica de ELISA rapido (VIDAS)
Published: 2005

15. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

Author: Inna Tzoran, Manolis Papadakis, Benjamin Brenner, Ángeles Fidalgo, Agustina Rivas, Philip S. Wells, Olga Gavín, María Dolores Adarraga, Farès Moustafa, Manuel Monreal, Hervé Decousus, Paolo Prandoni, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Philip Wells, M.D. Adarraga, M.A. Aibar, M. Alfonso, J.I. Arcelus, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, G. Cañada, I. Cañas, N. Chic, R. del Pozo, J. del Toro, M.C. Díaz-Pedroche, J.A. Díaz-Peromingo, C. Falgá, C. Fernández-Capitán, M.A. Fidalgo, C. Font, L. Font, P. Gallego, A. García, M.A. García, F. García-Bragado, P. García-Brotons, O. Gavín, C. Gómez, V. Gómez, J. González, D. González-Marcano, E. Grau, A. Grimón, R. Guijarro, J. Gutiérrez, G. Hernández-Comes, L. Hernández-Blasco, M.J. Hermosa-Los Arcos, L. Jara-Palomares, M.J. Jaras, D. Jiménez, M.D. Joya, P. Llamas, R. Lecumberri, J.L. Lobo, P. López, L. López-Jiménez, R. López-Reyes, J.B. López-Sáez, M.A. Lorente, A. Lorenzo, A. Maestre, P.J. Marchena, F. Martín-Martos, M. Monreal, J.A. Nieto, S. Nieto, A. Núñez, M.J. Núñez, M. Odriozola, R. Otero, J.M. Pedrajas, G. Pérez, C. Pérez-Ductor, M.L. Peris, J.A. Porras, O. Reig, A. Riera-Mestre, D. Riesco, A. Rivas, C. Rodríguez, M.A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, J.C. Sahuquillo, M.C. Sala-Sainz, A. Sampériz, R. Sánchez-Martínez, R. Sánchez Simón-Talero, O. Sanz, S. Soler, J.M. Suriñach, M.I. Torres, J. Trujillo-Santos, F. Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, A. Villalobos, T. Vanassche, P. Verhamme, P. Wells, J. Hirmerova, R. Malý, T. Tomko, G. del Pozo, E. Salgado, G.T. Sánchez, L. Bertoletti, A. Bura-Riviere, I. Mahé, A. Merah, F. Moustafa, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, G. Antonucci, G. Barillari, F. Bilora, C. Bortoluzzi, C. Cattabiani, M. Ciammaichella, J. Di Biase, P. Di Micco, R. Duce, P. Ferrazzi, M. Giorgi-Pierfranceschi, E. Grandone, E. Imbalzano, C. Lodigiani, R. Maida, D. Mastroiacovo, F. Pace, R. Pesavento, M. Pinelli, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, V. Gibietis, A. Skride, B. Vitola, P. Monteiro, J.L. Ribeiro, M.S. Sousa, M. Bosevski, M. Zdraveska, H. Bounameaux, L. Calanca, A. Erdmann, L. Mazzolai, Tzoran, I., Papadakis, M., Brenner, B., Fidalgo, A., Rivas, A., Wells, P. S., Gavin, O., Adarraga, M. D., Moustafa, F., Monreal, M., Decousus, H., Prandoni, P., Barba, R., Di Micco, P., Bertoletti, L., Reis, A., Bosevski, M., Bounameaux, H., Maly, R., Wells, P., Aibar, M. A., Alfonso, M., Arcelus, J. I., Barron, M., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Canada, G., Canas, I., Chic, N., del Pozo, R., del Toro, J., Diaz-Pedroche, M. C., Diaz-Peromingo, J. A., Falga, C., Fernandez-Capitan, C., Fidalgo, M. A., Font, C., Font, L., Gallego, P., Garcia, A., Garcia, M. A., Garcia-Bragado, F., Garcia-Brotons, P., Gomez, C., Gomez, V., Gonzalez, J., Gonzalez-Marcano, D., Grau, E., Grimon, A., Guijarro, R., Gutierrez, J., Hernandez-Comes, G., Hernandez-Blasco, L., Hermosa-Los Arcos, M. J., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Joya, M. D., Llamas, P., Lecumberri, R., Lobo, J. L., Lopez, P., Lopez-Jimenez, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorente, M. A., Lorenzo, A., Maestre, A., Marchena, P. J., Martin-Martos, F., Nieto, J. A., Nieto, S., Nunez, A., Nunez, M. J., Odriozola, M., Otero, R., Pedrajas, J. M., Perez, G., Perez-Ductor, C., Peris, M. L., Porras, J. A., Reig, O., Riera-Mestre, A., Riesco, D., Rodriguez, C., Rodriguez-Davila, M. A., Rosa, V., Ruiz-Gimenez, N., Sahuquillo, J. C., Sala-Sainz, M. C., Samperiz, A., Sanchez-Martinez, R., Sanchez Simon-Talero, R., Sanz, O., Soler, S., Surinach, J. M., Torres, M. I., Trujillo-Santos, J., Uresandi, F., Valero, B., Valle, R., Vela, J., Vicente, M. P., Villalobos, A., Vanassche, T., Verhamme, P., Hirmerova, J., Tomko, T., del Pozo, G., Salgado, E., Sanchez, G. T., Bura-Riviere, A., Mahe, I., Merah, A., Braester, A., Antonucci, G., Barillari, G., Bilora, F., Bortoluzzi, C., Cattabiani, C., Ciammaichella, M., Di Biase, J., Duce, R., Ferrazzi, P., Giorgi-Pierfranceschi, M., Grandone, E., Imbalzano, E., Lodigiani, C., Maida, R., Mastroiacovo, D., Pace, F., Pesavento, R., Pinelli, M., Poggio, R., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Gibietis, V., Skride, A., Vitola, B., Monteiro, P., Ribeiro, J. L., Sousa, M. S., Zdraveska, M., Calanca, L., Erdmann, A., and Mazzolai, L.
Subjects: Male, Heterozygote, medicine.medical_specialty, medicine.drug_class, Low molecular weight heparin, Hemorrhage, 030204 cardiovascular system & hematology, Gene mutation, Thrombophilia, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Factor V Leiden, Humans, Anticoagulant therapy, Activated Protein C Resistance, Rivaroxaban, biology, business.industry, Bleeding, Factor V, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Mutation, biology.protein, Prothrombin G20210A, Female, Prothrombin, Activated protein C resistance, business, Venous thromboembolism, 030215 immunology, medicine.drug
Abstract: Background Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. Methods We used the Registro Informatizado de Enfermedad TromboEmbolica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. Results Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). Conclusions During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
Published: 2017

16. Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism

Author: S. Hernández-Huerta, J. del Toro, J.L. Ogea, I. Tzinieris, Juan I. Arcelus, Fernando Uresandi, Rita Duce, M. Monreal, Laurent Bertoletti, Diego Tonello, Mar Martín, Alicia Lorenzo, J. Villalta, M. Ciammaichella, C. Piovella, María Teresa Martín, Jorge Gómez Cerezo, José María Pedrajas, Inna Tzoran, O. Madridano, F. del Molino, Luca Calanca, N. Ruiz-Giménez, A. Alatri, M.J. Núñez, Daniel Mosquera, L. Hernández, Ángeles Blanco-Molina, Adriana Visonà, R.M. Tilvan, F.J. Muñoz, A. Braester, Isabelle Mahé, Ángel Sampériz, B. Valero, B. Barrón-Andrés, M.D. Nauffal, P. Prandoni, M. Macià, Jorge Del Toro, R. Maida, J. Bascuñana, Agustina Rivas, P. Gallego, Antonella Tufano, Barry M. Brenner, Ana Maestre, Silvia Soler, Paolo Prandoni, M. Saraiva, F. Gonçalves, L. Rota, J. Ruiz, P. Bedate, T. Bueso, M. Valdés, D. Kovacevic, Henri Bounameaux, P. Di Micco, J. Trujillo, Luis Hernández, A. Schenone, Vladimir Rosa, E. Salgado, David Jiménez, E. Grau, M. Fernandes, J.F. Sánchez Muñoz-Torrero, David Zeltser, Giovanni Barillari, P. Román, I. Casado, Pablo Javier Marchena, M.A. Lorente, M.L. Peris, M.A. Rodríguez-Dávila, B. Zalunardo, M.I. Fuentes, G. Vidal, J.A. Nieto, E. Tiraferri, Carme Font, D. Aujeski, M. Guil, Antoni Riera-Mestre, C. Vilar, G. Tiberio, D. Farge-Bancel, Manolis Papadakis, R. Guijarro, Remedios Otero, Raquel Barba, A. Lorenzo, E. González-Bachs, Luis Jara-Palomares, J. Hirmerova, D. Babalis, R. Poggio, Isabelle Quéré, Lucia Mazzolai, F. Dalla Valle, R. Valle, Conxita Falga, M. Arroyo, J.M. Mora, A. Merah, M. Santos, J.B. López-Sáez, O. Gavín, V. Gómez, C. Tolosa, J. Vela, Ramón Lecumberri, Radovan Malý, Olga Madridano, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, J.M. Luque, Sebastian Schellong, Roberto Quintavalla, José Luis Lobo, R. Sousa, Aitor Ballaz, Marijan Bosevski, Luciano López-Jiménez, F. García-Bragado, Carmen Fernández-Capitán, M. Barrón, Aurora Villalobos, J.C. Sahuquillo, J.M. Suriñach, A. Ruiz-Gamietea, J.J. Martín-Villasclaras, J. González, J. Gutiérrez, M. Miklo sová, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
Subjects: medicine.medical_specialty, Anemia, Myocardial Infarction, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Diabetes mellitus, Internal medicine, medicine, Humans, Myocardial infarction, Stroke, business.industry, Hazard ratio, Anticoagulants, Venous Thromboembolism, Cardiology and Cardiovascular Medicine, Surgery, medicine.disease, 3. Good health, Pulmonary embolism, Venous thrombosis, Mesenteric ischemia, Cardiology, business, Pulmonary Embolism
Abstract: International audience; OBJECTIVE:Patients with acute venous thromboembolism (VTE) are at increased risk for the development of subsequent arterial ischemic events unrelated to the diagnosis of VTE. Accurate identification of VTE patients at increased risk for ischemic events during the course of anticoagulation may help to select those who would potentially benefit from concomitant therapy with anticoagulants and antiplatelets.METHODS:We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry to assess the rate and severity of subsequent ischemic events (ie, stroke, myocardial infarction, lower limb amputation, or mesenteric ischemia) appearing during the course of anticoagulant therapy and tried to identify risk factors for these events.RESULTS:From February 2009 to March 2014, 23,370 patients were recruited: 12,397 initially presenting with pulmonary embolism (PE) and 10,973 with deep venous thrombosis. During the course of anticoagulation (mean, 9.2 months), 597 patients developed recurrent VTE, 652 bled, 162 had ischemic events (stroke, 86; myocardial infarction, 53; limb amputation, 13; mesenteric ischemia, 11), and 2063 died. Of these, 29 patients died of recurrent PE, 83 of bleeding, and 53 of the ischemic events. On multivariable analysis, cancer (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.21-2.61), chronic lung disease (HR, 1.54; 95% CI, 1.05-2.26), renal insufficiency (HR, 1.72; 95% CI, 1.25-2.36), anemia (HR, 1.54; 95% CI, 1.11-2.14), prior artery disease (HR, 1.84; 95% CI, 1.29-2.64), and diabetes (HR, 1.58; 95% CI, 1.10-2.27) independently predicted the risk for ischemic events. Most of these variables also predicted major bleeding (cancer, chronic lung disease, renal insufficiency, anemia, and prior artery disease) or recurrent PE (cancer, chronic lung disease, anemia, and prior artery disease).CONCLUSIONS:In patients receiving anticoagulation for VTE, the mortality due to PE recurrences was lower than the mortality due to ischemic events. Most independent predictors for ischemic events were also predictors for major bleeding and for recurrent PE.
Published: 2014

17. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs

Author: S. Pasca, M.D. Adarraga, Manuel Monreal, M.J. Jaras, Sebastian Schellong, R. Maida, C. Piovella, Dolores Adarraga, F. García-Bragado, Ramón Lecumberri, J.A. Nieto, M. Mellado, Remedios Otero, Isabelle Quéré, Lucia Mazzolai, Radovan Malý, P. Malfante, V. Rosa, M. Farès, M. Alcalde, M. Kaletova, L. López-Jiménez, R. Pesavento, S. Almeida, R. Duce, F. Conget, M.L. Peris, J.M. Luque, B. Pagán, M.A. Rodríguez-Dávila, E. González-Bachs, I. Casado, T. Tomko, Peter Verhamme, J. Ruiz, A. Alatri, A. Apollonio, D. Zeltser, J.A. Porras, Olga Madridano, J.B. López-Sáez, Henri Bounameaux, Giovanni Barillari, Laurent Bertoletti, David Jiménez, A. Merah, N. Ruiz-Giménez, J. Gutiérrez, R. Guijarro, J.M. Suriñach, L. López-Montes, R. Jiménez, Jorge Del Toro, V. Andújar, J. del Toro, I. Pons, J. Trujillo-Santos, Alicia Lorenzo, P. Gallego, Jana Hirmerova, G. Pérez-Rus, E. Grau, M. Guil, M. Monreal, Manuel Alejandro Lorente, J.L. Ogea, Dolores Nauffal, Barry M. Brenner, J. González, L. Calanca, L. Mazzolai, A. Bura-Riviere, M.A. Lorente, Antoni Riera-Mestre, Inna Tzoran, G. Tiberio, J. Hirmerova, Silvia Soler, Paolo Prandoni, C. Grange, V. Gómez, Francisco Lozano, J.M. Martín-Antorán, F. Leal-Seabra, Adriana Visonà, A. Braester, Juan I. Arcelus, Luis Jara-Palomares, J.M. Pedrajas, F. del Molino, A. Blanco-Molina, J.C. Serrano, P.J. Marchena, A. Tufano, J. Vela, B. Valero, R. Poggio, Diego Tonello, M.J. Núñez, L. Rota, Agustina Rivas, José Luis Lobo, T. Bueso, Raquel López-Reyes, Javier Trujillo-Santos, P. Di Micco, Marijan Bosevski, Raúl Sánchez, J. Bascuñana, Isabelle Mahé, M. Barrón, Fernando Uresandi, L. Font, Philip S. Wells, A. Guida, E. Tiraferri, G. Barillari, P. Román, M. Ciammaichella, B. Zalunardo, Ángel Sampériz, Carmen Fernández-Capitán, F. Pace, Manolis Papadakis, R. Valle, M.S. Sousa, P. Sabio, Conxita Falga, A. Climent, A. Villalobos, Raquel Barba, M.V. Morales, K. Peerlinck, B. Barrón-Andrés, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Trujillo-Santos, J., Lozano, F., Lorente, M. A., Adarraga, D., Hirmerova, J., Toro, J. D., Mazzolai, L., Barillari, G., Barron, M., Monreal, M., Alcalde, M., Andujar, V., Arcelus, J. I., Barba, R., Barron-Andres, B., Bascunana, J., Blanco-Molina, A., Bueso, T., Casado, I., Climent, A., Conget, F., Del, M. F., Falga, C., Fernandez-Capitan, C., Font, L., Gallego, P., Garcia-Bragado, F., Gomez, V., Gonzalez, J., Gonzalez-Bachs, E., Grau, E., Guijarro, R., Guil, M., Gutierrez, J., Jara-Palomares, L., Jaras, M. J., Jimenez, D., Jimenez, R., Lecumberri, R., Lobo, J. L., Lopez-Jimenez, L., Lopez-Montes, L., Lopez-Reyes, R., Lopez-Saez, J. B., Lorenzo, A., Luque, J. M., Madridano, O., Marchena, P. J., Martin-Antoran, J. M., Mellado, M., Morales, M. V., Nauffal, D., Nieto, J. A., Nunez, M. J., Ogea, J. L., Otero, R., Pagan, B., Pedrajas, J. M., Perez-Rus, G., Peris, M. L., Porras, J. A., Pons, I., Riera-Mestre, A., Rivas, A., Rodriguez-Davila, M. A., Roman, P., Rosa, V., Ruiz-Gimenez, N., Ruiz, J., Sabio, P., Samperiz, A., Sanchez, R., Soler, S., Surinach, J. M., Tiberio, G., Uresandi, F., Valero, B., Valle, R., Vela, J., Villalobos, A., Malfante, P., Verhamme, P., Peerlinck, K., Wells, P., Maly, R., Kaletova, M., Tomko, T., Bertoletti, L., Bura-Riviere, A., Fares, M., Grange, C., Mahe, I., Merah, A., Quere, I., Schellong, S., Papadakis, M., Braester, A., Brenner, B., Tzoran, I., Zeltser, D., Apollonio, A., Ciammaichella, M., Di, M. P., Duce, R., Guida, A., Maida, R., Pace, F., Pasca, S., Piovella, C., Pesavento, R., Poggio, R., Prandoni, P., Rota, L., Tiraferri, E., Tonello, D., Tufano, A., Visona, A., Zalunardo, B., Almeida, S., Leal-Seabra, F., Sousa, M. S., Bosevski, M., Alatri, A., Bounameaux, H., Calanca, L., and Serrano, J. C.
Subjects: Adult, Male, medicine.medical_specialty, Deep vein, Anticoagulant therapy, Deep venous thrombosis, Home, Hospital, Outcome, Aged, Aged, 80 and over, Ambulatory Care, Anticoagulants, Female, Humans, Lower Extremity, Middle Aged, Outpatients, Prognosis, Risk Assessment, Venous Thrombosis, Prognostic score, 80 and over, medicine, Adverse effect, Deep venous thrombosi, business.industry, Cancer, General Medicine, medicine.disease, Thrombosis, Confidence interval, 3. Good health, Surgery, Pulmonary embolism, medicine.anatomical_structure, Heart failure, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; BACKGROUND:No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy.METHODS:We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home.RESULTS:As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001).CONCLUSIONS:Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
Published: 2014

18. Anticoagulación preventiva: ejemplo de análisis de riesgo/beneficio

Author: Carmen Suárez and N. Ruiz-Giménez
Subjects: business.industry, Medicine, General Medicine, business, Humanities
Published: 2009

19. Carcinoma suprarrenal. Presentación de un caso y revisión de la literatura

Author: C. Zapata Syro, B. Rodríguez Rodríguez, C. Suárez Fernández, M. Mir Montero, N. Ruiz-Giménez Arrieta, and V. Vílchez Aparicio
Subjects: Gynecology, medicine.medical_specialty, business.industry, Carcinoma, medicine, MEDLINE, Mitotane, General Medicine, medicine.disease, business, medicine.drug, Metastasis
Published: 2009

20. A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis

Author: A. Hij, C. Piovella, Ramón Lecumberri, José Luis Lobo, M. Zdraveska, F.J. Muñoz, F. Valle, Marijan Bosevski, P. Verhamme, N. Ruiz-Giménez, Olga Madridano, Steven Greenberg, A. Apollonio, J.F. Benítez, J.A. Porras, R. Maida, L. Bertoletti, G. Pérez-Rus, P. Román, R. Malý, M.J. Soto, J.M. Suriñach, H. Bounameaux, S. Pasca, J. González, B. Zalunardo, A. Merah, J. Caprini, J. Gutiérrez, I. Tzoran, M. Ciammaichella, A. García, Alicia Lorenzo, Manuel Monreal Bosch, R. Re, Abílio Reis, R. Valle, Lucia Mazzolai, M. Alcalde, Laurent Bertoletti, Peter Verhamme, Diego Tonello, J.B. López-Sáez, Juan I. Arcelus, Vladimir Rosa, D. Farge-Bancel, Isabelle Quéré, V. Vilella-Tomas, R. Jiménez, José María Pedrajas, J.M. Martín-Antorán, O. Sanz, P. Malfante, David Jiménez, L. López-Montes, B. Pagán, Inna Tzoran, J. Bascuñana, Beatriz Valero, E. Grau, Adriana Visonà, Francisco José Muñoz, M. Gómez-Durán, R. Guijarro, Antonella Tufano, A. Guida, J. Villalta, Luca Calanca, M.A. Lorente, M.J. Núñez, F. Conget, Lauren Cote, F. del Molino, M. Barrón, L. Rota, P. Prandoni, A. Braester, Raquel Barba, Radovan Malý, Ajla Alibalic, J. del Toro, I. Pons, Luis Jara-Palomares, B. Barrón-Andrés, Javier Trujillo-Santos, Fernando Uresandi, F. García-Bragado, P. Gallego, J. Malheiro, J. Vela, Henri Bounameaux, S. Hernández-Huerta, L. Hernández, P. Ferrazzi, Thomas Vanassche, Agustina Rivas, Giovanni Barillari, Farès Moustafa, J.A. Díaz, Ángeles Blanco-Molina, Pablo Javier Marchena, Benjamin Brenner, J. Hirmerova, M. Monreal, Raúl Sánchez, Aurora Villalobos, M.V. Morales, P. Di Micco, V. Gómez, Bernardo Sopeña, Ángel Sampériz, Antoni Riera-Mestre, Raquel López-Reyes, L. Font, M. Bosevski, Philip S. Wells, Joseph A. Caprini, I. Casado, R. Tirado, R. Barba, M.S. Sousa, Conxita Falga, J.A. Nieto, Remedios Otero, Lisa Baumann Kreuziger, Hervé Decousus, J.L. Ribeiro, G. Tiberio, M.L. Peris, M.A. Rodríguez-Dávila, A. Alatri, Isabelle Mahé, F. Pace, Luciano López-Jiménez, Sebastian Schellong, Carmen Fernández-Capitán, P. Sabio, Manuel Monreal, M.J. Jaras, Alessandra Bura-Rivière, F. Martín-Martos, S. Jiménez, Teresa Auguet, M. Macià, Dolores Nauffal, Barry M. Brenner, Silvia Soler, Paolo Prandoni, Pierpaolo Di Micco, J.C. Serrano, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), and Université Montpellier 1 (UM1)-Université de Montpellier (UM)
Subjects: medicine.medical_specialty, Catheters, Hemorrhage, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Recurrent thromboembolism, medicine, Humans, Registries, Risk factor, Venous Thrombosis, business.industry, Thrombosis, Odds ratio, medicine.disease, 3. Good health, Surgery, Pulmonary embolism, Catheter, Venous thrombosis, 030220 oncology & carcinogenesis, Concomitant, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; BACKGROUND:Few studies have investigated the treatment and the outcomes of patients with catheter-related thrombosis (CRT).METHODS:The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of consecutive patients with objectively confirmed venous thromboembolism (VTE). We analyzed the characteristics, treatment, and outcomes of patients with CRT.RESULTS:Of 558 patients with CRT, 45 (8%) presented with a pulmonary embolism (PE) concomitantly. More patients had central line-associated thrombosis compared with port systems, but catheter type did not influence the risk of presenting with a PE. Patients with only CRT were more often prescribed low-molecular-weight heparin for the duration of their anticoagulant treatment compared with patients presenting with concomitant PE. VTE recurrences and major bleeding events occurred frequently during treatment with anticoagulation (7 per 100 patient-years and 8.9 per 100 patient years, respectively). The rates of fatal PE recurrences (1.85 per 100 patient-years) and fatal bleeding (2.32 per 100 patient-years) were similar. Patients with an additional transient risk factor for VTE had the lowest risk for VTE recurrences (odds ratio [OR], 0.07; 90% confidence interval [CI], 0.01-0.45) compared with patients with CRT and no additional transient risk factors. PE at presentation increased the risk of recurrent thrombosis by 2.4 times. Renal insufficiency was also an independent predictor of recurrent thrombosis (OR, 3.93; 90% CI, 2.0-7.7). The odds of recurrent thrombosis was decreased by 77% in patients who received anticoagulation therapy for >90 days compared with patients with a shorter treatment (OR, 0.23; 90% CI, 0.1-0.56).CONCLUSIONS:Concomitant PE occurs less frequently in CRT than lower extremity deep venous thrombosis, but it is associated with a worse outcome. CRT occurs in high-risk patients, and duration of anticoagulation must be predicated on balancing these risks.
Published: 2015

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20 results on '"N. Ruiz-Giménez"'

1. Assessment of bleeding events in patients receiving DOACs with or without statins to treat venous thromboembolism: insights from the RIETE registry

2. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study

3. Timing and characteristics of venous thromboembolism after noncancer surgery

4. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site

5. Pharmacogenetic algorithm for acenocoumarol dosing improve anticoagulation control: a multicenter randomized clinical trial

6. Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

7. Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

8. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry

9. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE

10. DVT Management and Outcome Trends, 2001 to 2014

11. Alcance de los últimos subestudios del RE-LY: implicaciones clínicas

12. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity

13. Usefulness of Fast ELISA Determination of D-Dimer Levels for Diagnosing Pulmonary Embolism in an Emergency Room

14. Utilidad del dímero-D por ELISA rápido en el diagnóstico de la embolia pulmonar en un servicio de urgencias

15. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

16. Subsequent arterial ischemic events in patients receiving anticoagulant therapy for venous thromboembolism

17. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs

18. Anticoagulación preventiva: ejemplo de análisis de riesgo/beneficio

19. Carcinoma suprarrenal. Presentación de un caso y revisión de la literatura

20. A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis

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