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Lu BW, Li JC, Wen MT, Luo D, Guo YQ, Li G. Safety comparisons among different subcutaneous anticoagulants for venous thromboembolism using FDA adverse event reporting system. Sci Rep 2025; 15:17070. [PMID: 40379814 PMCID: PMC12084613 DOI: 10.1038/s41598-025-01527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 05/06/2025] [Indexed: 05/19/2025] Open
Abstract
Venous thromboembolism (VTE) remains a significant global health burden, particularly in older adults. While fondaparinux sodium, enoxaparin sodium, and dalteparin sodium are commonly used anticoagulants, their safety profiles require further evaluation. This study analyzes their adverse drug events (ADEs) using data from the FDA Adverse Event Reporting System (FAERS). A retrospective pharmacovigilance study was conducted using FAERS data from Q1 2004 to Q2 2024. Reports identifying fondaparinux sodium, enoxaparin sodium, or dalteparin sodium as the primary suspect drug were extracted. ADEs were classified using MedDRA 23.0 at the System Organ Class (SOC) and Preferred Term (PT) levels. Disproportionality analysis was performed with Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). FAERS contained 470 reports for fondaparinux sodium, 1,375 for enoxaparin sodium, and 344 for dalteparin sodium. Most cases involved patients aged ≥ 60, with a female predominance. Hospitalization was the most frequent outcome. Fondaparinux showed the strongest signals for intra-abdominal haematoma (ROR = 374.14, PRR = 371.14), muscle haemorrhage (ROR = 354.91, PRR = 347.04), and retroperitoneal haematoma (ROR = 214.97, PRR = 213.25). Enoxaparin demonstrated notable signals for heparin-induced thrombocytopenia (HIT) (ROR = 149.42, PRR = 147.53) and retroperitoneal haemorrhage (ROR = 287.68, PRR = 284.03). Dalteparin showed notable signals for HIT (ROR = 127.88, PRR = 126.49) and retroperitoneal haemorrhage (ROR = 103.23, PRR = 102.75). Distinct ADE profiles were identified among the three anticoagulants, underscoring the need for individualized risk assessment. These findings highlight the importance of close monitoring, particularly in high-risk patients, to optimize anticoagulation safety.
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Affiliation(s)
- Bo-Wen Lu
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Jia-Cheng Li
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Ming-Tao Wen
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Di Luo
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Yu-Qi Guo
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Gang Li
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
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Hjalmarsson C, Lindgren M, Bergh N, Hornestam B, Smith JG, Adiels M, Rosengren A. Atrial Fibrillation, Venous Thromboembolism, and Risk of Pulmonary Hypertension: A Swedish Nationwide Register Study. J Am Heart Assoc 2025; 14:e037418. [PMID: 40314359 DOI: 10.1161/jaha.124.037418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 03/31/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Atrial fibrillation (AF) is suggested to be associated with venous thromboembolism (VTE) and might thereby play a role in the development of chronic thromboembolic pulmonary hypertension (PH). By elevating left-sided filling pressure and promoting atrial myopathy, AF may also play a role in the development of postcapillary PH. We aimed to investigate the association between AF, with or without incident VTE, and the occurrence of PH. METHODS A total of 521 988 patients diagnosed with AF between 1987 and 2013, without a previous diagnosis of VTE or PH, were identified from the Swedish National Patient Register and matched for age, sex, and county with 1 017 277 population controls without AF, VTE, or PH. RESULTS The mean age of the patients with AF was 71.1 (SD ±10.1) years and 42.8% were women. During a median follow-up period of 11 (interquartile range 5.1-17) years, 4454 (0.9%) patients with AF, and 1855 (0.2%) controls were diagnosed with PH, hazard ratio 4.7 (4.4-5.0). The AF group had a significantly higher comorbidity burden at baseline, with a mean CHA2DS2-VASc of 2.9 compared with 2.1 in controls. In the absence of intercurrent VTE, the hazard ratio of PH was 4.2 (3.9-4.5) among patients with AF compared with controls. Intercurrent VTE increased the hazard ratio of PH a further 1.9-fold (1.7-2.1) and 3.5 (3.1-4.0), among patients with AF and controls, respectively. The hazard ratio for PH in patients with AF with incident VTE was 8.1 (7.3-9.1). CONCLUSIONS AF was associated with a markedly increased risk of developing incident PH, and this risk was further increased by incident VTE.
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Affiliation(s)
- Clara Hjalmarsson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Niklas Bergh
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Björn Hornestam
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - J G Smith
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology, Clinical Sciences Lund University and Skåne University Hospital Lund Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center Lund University Lund Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- School of Public Health and Community Medicine, Health Metrics Unit University of Gothenburg Gothenburg Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Medicine, Geriatrics and Emergency Medicine Sahlgrenska University Hospital/Östra Gothenburg Sweden
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Abbasi A, Li C, Dekle M, Bermudez CA, Brodie D, Sellke FW, Sodha NR, Ventetuolo CE, Eickhoff C. Interpretable machine learning-based predictive modeling of patient outcomes following cardiac surgery. J Thorac Cardiovasc Surg 2025; 169:114-123.e28. [PMID: 38040328 PMCID: PMC11133766 DOI: 10.1016/j.jtcvs.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The clinical applicability of machine learning predictions of patient outcomes following cardiac surgery remains unclear. We applied machine learning to predict patient outcomes associated with high morbidity and mortality after cardiac surgery and identified the importance of variables to the derived model's performance. METHODS We applied machine learning to the Society of Thoracic Surgeons Adult Cardiac Surgery Database to predict postoperative hemorrhage requiring reoperation, venous thromboembolism (VTE), and stroke. We used permutation feature importance to identify variables important to model performance and a misclassification analysis to study the limitations of the model. RESULTS The study dataset included 662,772 subjects who underwent cardiac surgery between 2015 and 2017 and 240 variables. Hemorrhage requiring reoperation, VTE, and stroke occurred in 2.9%, 1.2%, and 2.0% of subjects, respectively. The model performed remarkably well at predicting all 3 complications (area under the receiver operating characteristic curve, 0.92-0.97). Preoperative and intraoperative variables were not important to model performance; instead, performance for the prediction of all 3 outcomes was driven primarily by several postoperative variables, including known risk factors for the complications, such as mechanical ventilation and new onset of postoperative arrhythmias. Many of the postoperative variables important to model performance also increased the risk of subject misclassification, indicating internal validity. CONCLUSIONS A machine learning model accurately and reliably predicts patient outcomes following cardiac surgery. Postoperative, as opposed to preoperative or intraoperative variables, are important to model performance. Interventions targeting this period, including minimizing the duration of mechanical ventilation and early treatment of new-onset postoperative arrhythmias, may help lower the risk of these complications.
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Affiliation(s)
- Adeel Abbasi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI.
| | - Cindy Li
- Brown University, Providence, RI
| | | | - Christian A Bermudez
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Daniel Brodie
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI
| | - Neel R Sodha
- Division of Cardiothoracic Surgery, Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, RI
| | - Corey E Ventetuolo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI; Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, RI
| | - Carsten Eickhoff
- Department of Computer Science, Brown University, Providence, RI; Faculty of Medicine, University of Tübingen, Tübingen, Germany; Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
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Dang C, Liao W, Xu L, Zhao W, Lu Y. Association between venous thromboembolism and atrial fibrillation: a Mendelian randomization study. BMC Med Genomics 2024; 17:258. [PMID: 39472885 PMCID: PMC11523904 DOI: 10.1186/s12920-024-02034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 10/21/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Although previous observational studies have shown an association between venous thromboembolism (VTE) and atrial fibrillation (AF), the underlying causal relationship between them remains uncertain. METHODS AND RESULTS This two-sample bidirectional Mendelian randomization (MR) analysis was performed to investigate the causal relationship between VTE and AF. The VTE dataset were obtained from FinnGen, including 9,176 cases and 209,616 controls. Meanwhile a genome-wide association study (GWAS) of 60,620 individuals with AF and 970,216 control subjects identified genetic variations associated with AF. The principal MR analytic approach used in this study is the inverse-variance weighting (IVW) method. Furthermore, we performed complementary MR analyses, including the MR-Egger, Weighted median (WM), and Weighted Mode. MR pleiotropy residual sum was applied to identify pleiotropy. The MR analysis showed suggestive causal associations between VTE and the risk of AF (p = 0.0245, OR [95%CI]: 1.027 [1.003, 1.051]). The reverse MR analysis found that genetic susceptibility to AF was not significantly associated with VTE, as determined by the IVW method (p = 0.7773). The robustness of these findings was corroborated through MR sensitivity analyses. CONCLUSIONS There is a unidirectional causal relationship between VTE and AF, meaning that VTE is a causal risk factor for AF, whereas no effect of AF on VTE was identified.
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Affiliation(s)
- Caijing Dang
- Department of Infectious Diseases, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Wenkai Liao
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Xu
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenshu Zhao
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuxia Lu
- Department of Infectious Diseases, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Wenzler E, Dalton K, Andrews L, Benken ST. Edoxaban pharmacokinetics during in vitro continuous renal replacement therapy. BMC Nephrol 2024; 25:341. [PMID: 39390394 PMCID: PMC11468074 DOI: 10.1186/s12882-024-03777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND To evaluate the clearance of edoxaban during modeled in vitro continuous renal replacement therapy (CRRT), assess protein binding and circuit adsorption, and provide initial dosing recommendations. METHODS Edoxaban was added to the CRRT circuit and serial pre-filter bovine blood samples were collected along with post-filter blood and effluent samples. All experiments were performed in duplicate using continuous veno-venous hemofiltration (CVVH) and hemodialysis (CVVHD) modes, with varying filter types, flow rates, and point of CVVH replacement fluid dilution. Concentrations of edoxaban and urea were quantified via liquid chromatography-tandem mass spectrometry. Plasma pharmacokinetic parameters for edoxaban were estimated via noncompartmental analysis. Two and three-way analysis of variance (ANOVA) models were built to assess the effects of mode, filter type, flow rate, and point of dilution on CLCRRT. Linear regression was utilized to provide dosing estimations across CRRT effluent flow rates from 0.5 to 5 L/h. Optimal edoxaban doses were suggested using CLCRRT and population non-renal clearance (CLNR) to estimate total clearance and match the systemic AUC associated with efficacy in the treatment of venous thromboembolism. RESULTS Edoxaban clearance from the CRRT circuit occurred primarily via hemofilter adsorption to the HF1400 and M150 filters at 74% and 65%, respectively, while mean percent protein binding was 41%. Multivariate analyses confirmed the lack of influence of CRRT mode, filter type, and point of dilution on the CLCRRT of edoxaban allowing dosing recommendations to be made based on effluent flow rate. Edoxaban doses of 30-45 mg once daily were estimated to achieve target the AUC threshold for flow rates from 0.5 to 5 L/h. CONCLUSION For CRRT flow rates most employed in clinical practice, an edoxaban dose of 45 mg once daily is predicted to achieve target systemic exposure thresholds for venous thromboembolism treatment. The safety and efficacy of this proposed dosing warrants further investigation in clinical studies.
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Affiliation(s)
- Eric Wenzler
- Department of Pharmacy Practice, College of Pharmacy, MHPE, BCPS - AQ Cardiology, FCCM, FCCP, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA
| | - Kaitlyn Dalton
- Department of Pharmacy Practice, College of Pharmacy, MHPE, BCPS - AQ Cardiology, FCCM, FCCP, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA
- St. David's HealthCare, Austin, TX, USA
| | - Lauren Andrews
- Department of Pharmacy Practice, College of Pharmacy, MHPE, BCPS - AQ Cardiology, FCCM, FCCP, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA
- University of Colorado Health, Aurora, CO, USA
| | - Scott T Benken
- Department of Pharmacy Practice, College of Pharmacy, MHPE, BCPS - AQ Cardiology, FCCM, FCCP, University of Illinois at Chicago, 833 South Wood Street, Room 164 (M/C 886), Chicago, IL, 60612, USA.
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Risni HW, Khan A, Insani WN, Wei L, Brauer R. Cardiovascular risk of hormone replacement therapy in menopausal women with diabetes: a systematic review and meta-analysis of clinical trials and observational studies. Expert Opin Pharmacother 2024; 25:2089-2105. [PMID: 39387240 DOI: 10.1080/14656566.2024.2411442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/20/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION Studies have shown the relative cardiovascular safety of hormone replacement therapy (HRT) for women in the general population. Evidence on women with diabetes remains scarce. We aimed to investigate the risk of cardiovascular disease (CVD) in menopausal women with diabetes who use HRT compared to non-users. METHODS Search across Medline, Embase, Web of Sciences, and Cochrane databases up to November 2023 was conducted. We combined keywords of menopause, diabetes, HRT, and various CVD outcomes. Non-English studies, observational studies other than cohort and case-control, reviews, and conference abstracts were excluded. Bias was checked using validated risk-of-bias tools. Random-effects model was used to calculate pooled relative risks (RR) for similar outcomes. RESULTS Out of 7625 identified articles, 19 (6 clinical trials and 13 observational studies) were included, primarily from Europe and the U.S.A. Most studies had moderate risk of bias. Meta-analysis of myocardial infarction (MI) risk from nine observational studies (n = ~34,626) showed a pooled RR of 0.83 (95% CI 0.62-1.12). Limited data precluded meta-analysis for the clinical trials and other outcomes from observational studies. CONCLUSIONS Observational studies do not suggest an increased risk of MI in menopausal women with diabetes prescribed HRT. Further research with a more robust method is warranted to validate this finding. PROSPERO REGISTRATION NUMBER CRD42023479335.
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Affiliation(s)
- Hindun Wilda Risni
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Aaman Khan
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | | | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 441] [Impact Index Per Article: 441.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Noumegni SR, Tromeur C, Hoffmann C, Mao RL, Moigne EL, Moreuil CD, Mansourati V, Nasr B, Gentric JC, Guegan M, Poulhazan E, Bressollette L, Lacut K, Didier R, Couturaud F. Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous Thromboembolism. Semin Thromb Hemost 2023; 49:688-701. [PMID: 36252603 DOI: 10.1055/s-0042-1757899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
After first episodes of venous thromboembolism (VTE), patients are at increased risk of recurrent VTE and arterial thrombotic events (ATE) compared with the general population, two disorders that are influenced by anticoagulation. However, risk factors of these conditions occurring during and after anticoagulation are little described. Using cause-specific hazard regression models, we aimed to determine risk factors of the composite outcome recurrent VTE/ATE, and separately recurrent VTE or ATE, during and after anticoagulation in patients with first episodes of VTE from a prospective cohort. Hazard ratios (HRs) are given with 95% confidence intervals (CIs). A total of 2,011 patients treated for at least 3 months were included. A total of 647 patients had recurrent VTE/ATE (incidence: 4.69% per patient-years) during overall follow-up (median: 92 months). Of these events, 173 occurred during anticoagulation (incidence: 3.67% per patient-years). Among patients free of events at the end of anticoagulation, 801 had a post-anticoagulation follow-up ≥3 months; and 95 had recurrent VTE/ATE (incidence: 1.27% per patient-years). After adjustment for confounders, cancer-associated VTE (HR: 2.64, 95% CI: 1.70-4.11) and unprovoked VTE (HR: 1.95, 95% CI: 1.35-2.81) were the identified risk factors of recurrent VTE/ATE during anticoagulation (vs. transient risk factor-related VTE). Risk factors of recurrent VTE/ATE after anticoagulation included 50 to 65 years of age (vs. < 50, HR: 1.99, 95% CI: 1.04-3.81), older than 65 years (vs. < 50, HR: 5.28, 95% CI: 3.03-9.21), and unprovoked VTE (vs. transient risk factor-related VTE, HR: 2.06, 95% CI: 1.27-3.34). Cancer-associated VTE and unprovoked VTE are the main risk factors of recurrent VTE/ATE during anticoagulation, while older age and unprovoked VTE mainly predict the risk of these events after anticoagulation.
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Affiliation(s)
- Steve Raoul Noumegni
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Cécile Tromeur
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Clément Hoffmann
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Raphael Le Mao
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Emmanuelle Le Moigne
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Claire de Moreuil
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Vincent Mansourati
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
- Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
| | - Jean-Christophe Gentric
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
- Department of Neuroradiology, Brest Teaching Hospital, Brest, France
| | - Marie Guegan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Elise Poulhazan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Luc Bressollette
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Karine Lacut
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Romain Didier
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
- Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Francis Couturaud
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
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Miao L, Shi J, Yu H, Song L, Zhu C, Shi D, Gao J. Studies on Atrial Fibrillation and Venous Thromboembolism in the Past 20 Years: A Bibliometric Analysis Via CiteSpace and VOSviewer. J Am Heart Assoc 2023; 12:e029810. [PMID: 37586071 PMCID: PMC10547310 DOI: 10.1161/jaha.123.029810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The conjunction of atrial fibrillation (AF) and venous thromboembolism (VTE) is common in clinical practice. Over the last 2 decades, a significant number of articles (2500) have been published about AF and VTE. To effectively analyze and present these vast amounts of information, this study uses bibliometric research methods to categorize and consolidate these publications. The number of publications has increased yearly, especially since 2012. The United States was the most prolific country, with 1054 studies published. The most productive institution was McMaster University. Gregory Y.H. Lip was the most prolific author. The keyword analysis identified that the research focuses from 2003 to 2014 were factor Xa inhibitor, dabigatran etexilate, direct thrombin inhibitor, double-blind, deep vein thrombosis, molecular weight heparin, stroke prevention, etc. From 2015 to 2016, research mainly focused on venous thromboembolism, antithrombotic therapy, anticoagulant, warfarin, atrial fibrillation, stroke, and pulmonary embolism. Studies during 2017 to 2022 focused on apixaban, direct oral anticoagulant, rivaroxaban, dabigatran, hemorrhage, edoxaban, medicine efficacy and safety, risk factors, clinical management, and vitamin K antagonists. Since 2018, novel oral anticoagulants have been the most commonly used keywords. On the whole, most studies of AF and VTE focus on pathogenesis and therapeutic drugs. The causal relationship between AF and VTE, the effectiveness and safety of novel oral anticoagulants in the treatments, the anticoagulant regimen of AF and VTE co-disease, and the treatment regimen for vulnerable populations such as the elderly or obese people were the focus of current research and will continue to be the central point of future research.
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Affiliation(s)
- Lina Miao
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Junhe Shi
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Haixu Yu
- Beijing Jishuitan HospitalBeijingChina
| | - Lei Song
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Chunlin Zhu
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Dazhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Jie Gao
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
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Pastori D, Gazzaniga G, Farcomeni A, Bucci T, Menichelli D, Franchino G, Pani A, Violi F, Pignatelli P, Fauchier L, Lip GY. Venous Thromboembolism in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of 4,170,027 Patients. JACC. ADVANCES 2023; 2:100555. [PMID: 38939492 PMCID: PMC11198539 DOI: 10.1016/j.jacadv.2023.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2024]
Abstract
Background Data on the association between atrial fibrillation (AF) and venous thromboembolism (VTE) are controversial. Objectives The purpose of this study was to investigate the risk of VTE in patients with AF according to the time from AF diagnosis. Methods Systematic review of MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature (EBSCO host), Cochrane Central Register of Controlled Trials (2020) in the Cochrane Library, and World Health Organization Global Index Medicus databases and meta-analysis of observational studies. The risk of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) was analyzed according to the time of AF onset: 1) short (≤3 months); 2) medium (≤6 months); and 3) long (>6 months) time groups. Results Eight studies were included with 4,170,027 patients, of whom 650,828 with AF. In the short-term group, AF was associated with the highest risk of either PE (HR: 9.62; 95% CI: 7.07-13.09; I2 = 0%) or DVT (HR: 6.18; 95% CI: 4.51-8.49, I2 = 0%). Even if to a lesser extent, AF was associated with a higher risk of VTE (HR: 3.69; 95% CI: 1.65-8.27; I2 = 79%), DVT (HR: 1.75; 95% CI: 1.43-2.14; I2 = 0%), and PE (HR: 4.3; 95% CI: 1.61-11.47; I2 = 68%) in the up to 6 months and long-term risk group >6 months groups (HR: 1.39; 95% CI: 1.00-1.92; I2 = 72%) and PE (HR: 1.08; 95% CI: 1.00-1.16; I2 = 0%). Conclusions The risk of VTE is highest in the first 3 to 6 months after AF diagnosis and decreases over time. The early initiation of anticoagulation in patients with AF may reduce the risk of VTE.
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Affiliation(s)
- Daniele Pastori
- Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Gianluca Gazzaniga
- Oncology and Hemato-Oncology Department, Università degli Studi di Milano, Milan, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome “Tor Vergata”, Rome, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Sapienza University of Rome, Rome, Italy
| | - Danilo Menichelli
- Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Sapienza University of Rome, Rome, Italy
| | - Giovanni Franchino
- Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Arianna Pani
- Oncology and Hemato-Oncology Department, Università degli Studi di Milano, Milan, Italy
| | - Francesco Violi
- Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Vijan A, Daha IC, Delcea C, Dan GA. The complex interplay between right ventricular dysfunction and atrial fibrillation - a narrative review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:77-83. [PMID: 36762789 DOI: 10.2478/rjim-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 05/10/2023]
Abstract
Atrial fibrillation (AF) is one of the most common sustained arrhythmias in clinical practice, associated with multiple comorbidities and complication. The potential predictors of AF onset and perpetuation or specific drivers of complications need future investigation. Right ventricular (RV) dysfunction plays an important role in the development of new-onset AF warranting in-depth analysis in relation to AF. RV may play a significant role in a better characterization of the cardiac substrate of AF patients. The relation between RV dysfunction and AF is bidirectional as AF may be one of the causes of RV dysfunction and their coexistence worsens the overall patient prognosis. Our aim is to present in a narrative review the most relevant data regarding the complex relationship between AF and RV dysfunction.
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Affiliation(s)
- Ancuta Vijan
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Ioana Cristina Daha
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Caterina Delcea
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
| | - Gheorghe-Andrei Dan
- 1Carol Davila University of Medicine and Pharmacy, Bucharest
- 2Colentina Clinical Hospital, Bucharest, Romania
- 3Joint senior author
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12
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Chang Y, Lee H, Song TJ. Association of gamma-glutamyl transferase variability with risk of venous thrombosis. Sci Rep 2023; 13:7402. [PMID: 37149666 PMCID: PMC10164162 DOI: 10.1038/s41598-023-34368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/28/2023] [Indexed: 05/08/2023] Open
Abstract
Gamma-glutamyl transferase (GGT) is a biomarker of inflammation, and is known to be associated with stroke and atrial fibrillation. Venous thromboembolism (VT), a not uncommon thrombotic disorder, shares similar mechanisms with other thrombotic disorders including these stroke and atrial fibrillation. Given these associations, we intended to investigate the potential association between variability in GGT and VT. The study included data from the National Health Insurance Service-Health Screening Cohort, comprising 1,085,105 participants with health examinations 3 or more times from 2003 to 2008. Variability indexes were the coefficient of variation, standard deviation, and variability independent of the mean. The occurrence of venous thromboembolism (VT) was defined with more than one claim of the following ICD-10 codes: deep VT (I80.2-80.3), pulmonary thromboembolism (I26), intraabdominal venous thrombosis (I81, I82.2, I82.3), or other VT (I82.8, I82.9). To determine the relationship of quartiles of GGT with incident VT risk, Kaplan-Meier survival curve and logrank test were used. Cox's proportional hazard regression was used to investigate the risk of VT occurrence by GGT quartile (Q1-Q4). A total of 1,085,105 subjects were incorporated in the analysis, and the average follow-up was 12.4 years (interquartile range 12.2-12.6). VT occurred in 11,769 (1.08%) patients. The GGT level was measured 5,707,768 times in this stud. Multivariable analysis showed that GGT variability were positively associated with the occurrence of VT. Compared to the Q1, the Q4 showed an adjusted HR of 1.15 (95% CI 1.09-1.21, p < 0.001) when using coefficient of variation, 1.24 (95% CI 1.17-1.31, p < 0.001) when using standard deviation, and 1.10 (95% CI 1.05-1.16, p < 0.001) when using variability independent of the mean. Increased variability of GGT may be related to an increased risk of VT. Maintaining a stable GGT level would be beneficial in reducing the risk of VT.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Heajung Lee
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, Republic of Korea.
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13
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Kanuri SH, Jayesh Sirrkay P, Ulucay AS. COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research. Egypt Heart J 2023; 75:36. [PMID: 37120772 PMCID: PMC10149046 DOI: 10.1186/s43044-023-00359-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. MAIN BODY In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. CONCLUSIONS Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.
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14
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Abstract
Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Neil A Zakai
- Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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15
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Savaie M, Sheikhi Y, Baghbanian R, Soltani F, Amiri F, Hesam S. Epidemiology, Risk Factors, and Outcome of Cardiac Dysrhythmias in a
Noncardiac Intensive Care Unit. SAGE Open Nurs 2023; 9:23779608231160932. [PMID: 36969363 PMCID: PMC10034271 DOI: 10.1177/23779608231160932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Introduction Several extrinsic factors contribute to the development of cardiac
dysrhythmias. In intensive care unit (ICU) settings and among critically ill
patients who are exposed to a large number of risk factors, cardiac
disturbances are more common. Objectives This study aimed to examine the epidemiology, risk factors, and outcome of
cardiac dysrhythmias in a non-cardiac ICU. Methods This is a retrospective, single-center, observational study conducted in a
tertiary noncardiac ICU at Imam Khomeini Hospital in Ahvaz, Iran. Out of the
360 adult patients aged 18 years and older who were admitted to ICU for
longer than 24 h, 340 cases who met the study inclusion criteria were
recruited between March 2018 until October 2018. Results The most common nonsinus dysrhythmias were new-onset atrial fibrillation
(NOAF) (12.9%) and ventricular tachycardia (21 patients—6.2%). According to
our results, previous percutaneous coronary instrumentation, acute kidney
injury, sepsis, and hyperkalemia act as risk factors in the development of
cardiac dysrhythmias. Additionally, we found out that thyroid dysfunction
and pneumonia can predict the development of NOAF in critically ill
patients. The estimated mortality rate among patients with NOAF in this
study was 15.7% (p < .05). Conclusion Cardiac dysrhythmias are common in ICU patients and treating the risk factors
can help to prevent their development and improve patient management and
outcome.
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Affiliation(s)
- Mohsen Savaie
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
- Mohsen Savaie, Post code 6155689768, No.
15, East Motahhari Street, Kianpars, Ahvaz, Iran.
| | - Yasaman Sheikhi
- School of Medicine, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Reza Baghbanian
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Farhad Soltani
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Fereshteh Amiri
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Ahvaz
Jundishapur University of Medical Sciences,
Ahvaz, Iran
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16
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 2289] [Impact Index Per Article: 1144.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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17
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Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Similarities and differences in systemic risk factors for retinal artery occlusion and retinal vein occlusion: A nationwide case-control study. Int Ophthalmol 2022; 43:817-824. [PMID: 36056288 DOI: 10.1007/s10792-022-02483-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To investigate the relationship between risk factors for retinal artery occlusion (RAO) and retinal vein occlusion (RVO) and thereby identify similarities and differences between the two types of retinal vascular occlusions. METHODS In this case-control study, 5708 patients with RAO were included and matched with three patients with RVO each. The patients with RVO were matched on sex and age at index date. All patients, personal information, diagnoses, and prescriptions were obtained from the Danish nationwide registries. Adjusted conditional logistic regression was used to investigate the association of RAO and RVO with the included risk factors. RESULTS RAO was stronger associated with arterial hypertension, heart failure, ischemic heart disease, peripheral artery disease, and stroke than RVO, with effect measures ranging from 1.10 to 2.21. RVO was associated with cataract and glaucoma with effect measures of 0.80 (95% CI 0.73-0.87) and 0.65 (95% CI 0.56-0.76), respectively. CONCLUSION Differences in the level of associations with the included risk factors suggests differences in the pathophysiologies of the two diseases. The main pathophysiology associated with RAO was atherosclerosis, whereas the main pathophysiology associated with RVO was changes in the pressure gradients of the eyes.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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18
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Smartphone-based screening for atrial fibrillation: a pragmatic randomized clinical trial. Nat Med 2022; 28:1823-1830. [PMID: 36031651 DOI: 10.1038/s41591-022-01979-w] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/28/2022] [Indexed: 12/16/2022]
Abstract
Digital smart devices have the capability of detecting atrial fibrillation (AF), but the efficacy of this type of digital screening has not been directly compared to usual care for detection of treatment-relevant AF. In the eBRAVE-AF trial ( NCT04250220 ), we randomly assigned 5,551 policyholders of a German health insurance company who were free of AF at baseline (age 65 years (median; interquartile range (11) years, 31% females)) to digital screening (n = 2,860) or usual care (n = 2,691). In this siteless trial, for digital screening, participants used a certified app on their own smartphones to screen for irregularities in their pulse waves. Abnormal findings were evaluated by 14-day external electrocardiogram (ECG) loop recorders. The primary endpoint was newly diagnosed AF within 6 months treated with oral anti-coagulation by an independent physician not involved in the study. After 6 months, participants were invited to cross-over for a second study phase with reverse assignment for secondary analyses. The primary endpoint of the trial was met, as digital screening more than doubled the detection rate of treatment-relevant AF in both phases of the trial, with odds ratios of 2.12 (95% confidence interval (CI), 1.19-3.76; P = 0.010) and 2.75 (95% CI, 1.42-5.34; P = 0.003) in the first and second phases, respectively. This digital screening technology provides substantial benefits in detecting AF compared to usual care and has the potential for broad applicability due to its wide availability on ordinary smartphones. Future studies are needed to test whether digital screening for AF leads to better treatment outcomes.
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19
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Louis DW, Kennedy KF, Saad M, Salber G, Imran H, Wark T, Soares C, Ghosalkar D, Cherala R, Poppas A, Abbott JD, Aronow HD. Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission. Am J Cardiol 2022; 181:38-44. [PMID: 35970632 PMCID: PMC9374502 DOI: 10.1016/j.amjcard.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, p <0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, p <0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, p <0.001), intubation (6.4% vs 18.6%, p <0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, p <0.001) in patients on than those not on preadmission OAC. A higher CHA2DS2-VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19.
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Affiliation(s)
- David W Louis
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Marwan Saad
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Greg Salber
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hafiz Imran
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tyler Wark
- Department of Cardiology, University of Vermont, Burlington, Vermont
| | - Cullen Soares
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dhairyasheel Ghosalkar
- Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rasan Cherala
- Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Athena Poppas
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Herbert D Aronow
- Division of Cardiology, Henry Ford Heart & Vascular Institute, Detroit, Michigan.
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20
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Sokolova AA, Kudriavtseva AA, Kostokova NV, Zaikina MP, Gebekova ZA, Napalkov DA, Zolotukhin IA. Risk of Venous Thromboembolic Complications in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this meta-analysis and systematic review was to evaluate the possible connection between AF and VTE.Material and methods. Atrial fibrillation (AF) and atrial flutter (AFL) contribute to intra-atrial blood stasis which leads to thrombus formation with its embolization. There is some evidence that AF can be a risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE). The following databases were searched: PubMed (MEDLINE), EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials. The time frame for conducting a systematic literature search ranged from January 1, 1990 to November 1, 2021. The diagnosis of atrial fibrillation had to be confirmed by using ECG. The diagnosis of VTE could be made with Doppler imaging, ventilation/perfusion scan, CT angiography, venography, angiography or autopsy. Only the three studies with 102192 patients meeting the requirement were included in the meta-analysis.Results. The prevalence of DVT and PE were assessed using incidence rate ratios (IRR) method of the inverse variance random effects model and its 95% confidence interval (CI). The significant association between atrial fibrillation and pulmonary embolism was found (IRR, 4.18 95% Cl 1.958.98). Also there is obvious association between DVT and AF (IRR, 2.97 95% Cl 2.18-4.03).Conclusion. It can be concluded that the increased risk of developing VTE is associatedwith concomitant AF.
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Affiliation(s)
- A. A. Sokolova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Kudriavtseva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. V. Kostokova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. P. Zaikina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Z. A. Gebekova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. A. Napalkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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21
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Noumegni SR, Mansourati V, Tromeur C, Mao RL, Hoffmann C, Moigne EL, Nasr B, Gentric JC, Guegan M, Poulhazan E, Bressollette L, Lacut K, Couturaud F, Didier R. Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study. Thromb Haemost 2022; 122:1744-1756. [PMID: 35716659 DOI: 10.1055/s-0042-1748889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiovascular deaths (CVDTs) are more frequent in patients with venous thromboembolism (VTE) than in the general population; however, risk factors associated with this increased risk of CVDT in patients with VTE are not described. METHODS To determine the risk factors of CVDT in patients with VTE from a multicenter prospective cohort study, Fine and Gray subdistribution hazard models were conducted. RESULTS Of the 3,988 included patients, 426 (10.7%) died of CVDT during a median follow-up of 5 years. The risk factors of CVDT after multivariate analyses were: age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 3.22, 95% confidence interval [CI]: 1.67-6.62), age >65 years (vs. <50 years, HR: 7.60, 95% CI: 3.73-15.52), cancer-associated VTE (vs. transient risk factor-related VTE, HR: 1.73, 95% CI: 1.15-2.61), unprovoked VTE (vs. transient risk factor-related VTE, HR: 1.42, 95% CI: 1.02-2.00), past tobacco use (vs. never, HR: 1.43, 95% CI: 1.06-1.94), current tobacco use (vs. never, HR: 1.87, 95% CI: 1.15-3.01), hypertension (HR: 2.11, 95% CI: 1.51-2.96), chronic heart failure (HR: 2.28, 95% CI: 1.37-3.79), chronic respiratory failure (HR: 1.72, 95% CI: 1.02-2.89), and atrial fibrillation (HR: 1.67, 95% CI: 1.06-2.60). The risk of CVDT was significantly reduced with direct oral anticoagulants (vs. vitamin-K antagonists) and with longer duration of treatment (>3 months). CONCLUSION Risk factors of CVDT after VTE include some traditional cardiovascular risk factors and other risk factors that are related to characteristics of VTE, and patients' comorbidities.
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Affiliation(s)
- Steve Raoul Noumegni
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Vincent Mansourati
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Cécile Tromeur
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Raphael Le Mao
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Clément Hoffmann
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Emmanuelle Le Moigne
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
| | - Jean-Christophe Gentric
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Neuroradiology, Brest Teaching Hospital, Brest, France
| | - Marie Guegan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Elise Poulhazan
- Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Luc Bressollette
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Karine Lacut
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Francis Couturaud
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Romain Didier
- Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
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22
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Glise Sandblad K, Rosengren A, Sörbo J, Jern S, Hansson P. Pulmonary embolism and deep vein thrombosis—comorbidities and temporary provoking factors in a register‐based study of 1.48 million people. Res Pract Thromb Haemost 2022; 6:e12714. [PMID: 35677029 PMCID: PMC9166387 DOI: 10.1002/rth2.12714] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knowledge on differences in patients who present with deep vein thrombosis (DVT) and those with pulmonary embolism (PE) is incomplete. Objective To determine comorbidities and temporary provoking factors in patients with a first‐time PE or DVT. Methods This was a nationwide Swedish registry‐based, retrospective, case‐control study including 298 172 patients with first‐time venous thromboembolism (VTE) and 1 185 079 controls matched for age, sex, and county of residence, free of VTE at the time of matching. Results Patients with PE were older than those with DVT (mean age, 69 vs 66 years) and included slightly more women (PE, 53.4% vs DVT, 52.1%). After multivariable adjustment for comorbidities (within 7 years) and temporary provoking factors (within 3 months), heart failure (PE: adjusted odds ratio [aOR], 2.64 [99% confidence interval [CI], 2.55‐2.73]; DVT: aOR, 1.66 [99% CI, 1.60‐1.72]), ischemic heart disease (PE: aOR, 1.51 [99% CI, 1.47‐1.56]; DVT: aOR, 1.01 [99% CI, 0.98‐1.04]), and chronic obstructive pulmonary disease (PE: aOR, 2.51 [99% CI, 2.40‐2.63]; DVT, 1.54 [99% CI, 1.47‐1.62]) were among diseases that showed higher odds ratios in patients with PE than in those with DVT, compared with controls. Comorbidities registered within 6 months were associated with higher aORs than those within 7 years. The highest population attributable risks for PE were for cancer (13.0%) and heart failure (11.7%). Conclusion Cardiopulmonary diseases, particularly with recent onset, imply a higher risk for PE, whereas orthopedic surgery and lower‐extremity fractures carry a higher risk of DVT.
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Affiliation(s)
- Katarina Glise Sandblad
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Annika Rosengren
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Jan Sörbo
- Department of Clinical Physiology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Sverker Jern
- The Wallenberg Laboratory for Cardiovascular Research Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per‐Olof Hansson
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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23
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Noumegni SR, Didier R, Mansourati V, Moigne EL, Mao RL, Hoffmann C, Moreuil CD, Tromeur C, Roux PYL, Nasr B, Gentric JC, Guegan M, Poulhazan E, Lacut K, Bressollette L, Couturaud F. Risk Factors for Major Adverse Cardiovascular Events and Major Adverse Limb Events after Venous Thromboembolism: A Large Prospective Cohort Study. Semin Thromb Hemost 2022; 48:465-480. [PMID: 35772402 DOI: 10.1055/s-0042-1748152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is an increased risk of arterial events including major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after venous thromboembolism (VTE). However, their risk factors remain little explored. METHODS We aimed to determine the risk factors for MACE (acute coronary syndrome/stroke/cardiovascular death) and MALE (limb ischemia/critical limb ischemia/non-traumatic amputation/any limb revascularization) after VTE. Competing risk models (Fine-Gray) were used in a multicenter prospective cohort of 4,940 patients (mean age: 64.6 years and median follow-up: 64 months). RESULTS MACE occurred in 17.3% of participants (2.35% per patient-years) and MALE in 1.7% (0.27% per patient-years). In multivariable analysis, the identified risk factors for MACE were the age of 50 to 65 years (vs. <50 years, hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.38-2.91), age >65 years (vs. <50 years, HR 4.85, 95% CI: 3.35-7.02), pulmonary embolism + deep vein thrombosis (DVT) (vs. isolated-DVT, HR: 1.25, 95% CI: 1.02-1.55), unprovoked-VTE (vs. transient risk factor associated-VTE, HR: 1.29, 95% CI: 1.04-1.59), current tobacco use (vs. never, HR: 1.45, 95% CI: 1.07-1.98), hypertension (HR: 1.61, 95% CI: 1.30-1.98), past history of symptomatic atherosclerosis (HR: 1.52, 95% CI: 1.17-1.98), heart failure (HR: 1.71, 95% CI: 1.21-2.42), atrial fibrillation (HR: 1.55, 95% CI: 1.15-2.08), and vena cava filter insertion (HR: 1.46, 95% CI: 1.03-2.08). The identified risk factors for MALE were the age of 50-65 years (vs. <50 years, HR: 3.49, 95% CI: 1.26-9.65) and atrial fibrillation (HR: 2.37, 95% CI: 1.15-4.89). CONCLUSIONS Risk factors for MACE and MALE after VTE included some traditional cardiovascular risk factors, patient's comorbidities, and some characteristics of VTE.
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Affiliation(s)
- Steve Raoul Noumegni
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Romain Didier
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Vincent Mansourati
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Cardiology, Brest Teaching Hospital, Brest, France
| | - Emmanuelle Le Moigne
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Raphael Le Mao
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Clément Hoffmann
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Claire De Moreuil
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Cécile Tromeur
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Pierre-Yves Le Roux
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Nuclear Medicine, Brest Teaching Hospital, Brest, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
| | - Jean-Christophe Gentric
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France.,Department of Neuroradiology, Brest Teaching Hospital, Brest, France
| | - Marie Guegan
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Elise Poulhazan
- Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Karine Lacut
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Luc Bressollette
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
| | - Francis Couturaud
- Departments of Internal Medicine, Vascular Medicine and Pneumology, Brest University Teaching Hospital, Brest Teaching Hospital, Brest, France.,Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
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24
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Terrier J, Gaspar F, Guidi M, Fontana P, Daali Y, Csajka C, Reny JL. Population Pharmacokinetic Models for Direct Oral Anticoagulants: A Systematic Review and Clinical Appraisal Using Exposure Simulation. Clin Pharmacol Ther 2022; 112:353-363. [PMID: 35593020 PMCID: PMC9540501 DOI: 10.1002/cpt.2649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/13/2022] [Indexed: 01/22/2023]
Abstract
Available data have shown an association between direct oral anticoagulant (DOAC) plasma concentration and clinical, particularly bleeding, events. Factors that may influence DOAC plasma concentration are therefore the focus of particular attention. Population pharmacokinetic (PopPK) analyses can help in identifying such factors while providing predictive models. The main aim of the present study was to identify all the PopPK models to date for the four most frequently used DOACs (dabigatran, apixaban, rivaroxaban, and edoxaban). The secondary aim was to use these models to simulate different DOAC plasma concentration–time profiles in relevant clinical scenarios. The results of our model‐based simulations confirm the clinical relevance of the known major factors influencing DOAC exposure and support the current approved dose adaptation, at least for atrial fibrillation. They also highlight how the accumulation of covariates, not currently considered for dose adaptation due to their seemingly minor influence on DOAC exposure, lead to supratherapeutic blood concentrations and could thus enhance the risk of major bleeding. The present results therefore question DOAC dose adaptation in the presence of these covariates, such as drug–drug interaction or genotypes, alongside the known existing covariates. As the overall effect of accumulation of several covariates could be difficult to apprehend for the clinicians, PopPK modeling could represent an interesting approach for informed precision dosing and to improve personalized prescription of DOACs.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Gaspar
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.,Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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25
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Lin MS, Chung CM, Chen MY, Chu PH, Chang ST, Yang TY, Wu VCC, Lin WY, Lin YS. Venous Thromboembolism and Critical Limb Events in Patients with Atrial Fibrillation: A Nationwide Population-Based Cohort Study. Angiology 2022; 73:413-421. [PMID: 34284641 DOI: 10.1177/00033197211033747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about whether venous thromboembolism (VTE) causes worse critical limb events in populations with atrial fibrillation (AF). A retrospective cohort study using claims data from Taiwan's National Health Insurance program between 2001 and 2013 compared AF patients with or without VTE. Outcomes were percutaneous transluminal angioplasty (PTA), amputation, systemic thromboembolism, all-cause mortality, cardiovascular death, ischemic stroke, and acute myocardial infarction. Patients (n = 316,817) with newly diagnosed AF were analyzed; of those, 2514 (0.79%) had VTE history. After inverse probability of treatment weighting, a history of VTE was significantly associated with higher risks of PTA (3.3 vs 2.2%; subdistribution hazard ratio [SHR] 1.47; 95% confidence interval [CI] 1.17-1.84); above knee amputation (0.7 vs 0.3%; HR 2.15; 95% CI 1.10-4.21); systemic thromboembolism (5.8 vs 3.9%; SHR 1.48; 95% CI 1.21-1.80); all-cause mortality (53 vs 46.4%; HR 1.20, 95% CI 1.12-1.29); and cardiovascular death (34.8 vs 29.4%; HR 1.25, 95% CI 1.14-1.36). In conclusion, VTE might increase the risk of critical lower limb events (PTA and above-knee amputation), systemic thromboembolism, and mortality in the AF population. However, current data cannot confirm a causal relationship between VTE and clinical outcomes in this population.
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Affiliation(s)
- Ming-Shyan Lin
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Chang-Min Chung
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Shih-Tai Chang
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Teng-Yao Yang
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Victor C-C Wu
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Wey-Yil Lin
- Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, 38014Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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26
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Gangaraju R, Davis ES, Bhatia S, Kenzik KM. Venous-thromboembolism and associated health care utilization in elderly patients with diffuse large B cell lymphoma. Cancer 2022; 128:2348-2357. [PMID: 35363373 DOI: 10.1002/cncr.34210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with lymphoma have an increased risk of venous thromboembolism (VTE). The authors examined the risk of VTE and subsequent health care utilization in elderly patients with diffuse large B cell lymphoma (DLBCL). METHODS A total of 5537 DLBCL patients ≥66 years old enrolled in Medicare from the Surveillance, Epidemiology, and End Results registry and a noncancer control group of Medicare beneficiaries (n = 5537) were identified. Cumulative incidence function to examine the risk of VTE 12 months after DLBCL diagnosis was used. Fine and Gray method was used to examine the risk factors associated with VTE risk in multivariable models. Total number of hospitalizations, outpatient visits, and Medicare spending were compared in DLBCL patients with and without VTE. RESULTS VTE was diagnosed in 8.3% DLBCL patients and 1.5% controls, yielding an 8.6-fold higher risk of VTE in DLBCL in adjusted analysis (95% confidence interval [CI], 6.62-11.20; P < .001). Multivariable regression analysis showed that precancer VTE history was associated with an increased risk of developing VTE after a DLBCL diagnosis (hazard ratio [HR], 5.39; 95% CI, 4.39-6.63), and Asian individuals were associated with a lower risk (HR, 0.54; 95% CI, 0.29-1.00). Patients newly diagnosed with VTE after lymphoma had a 1.7-fold higher rate of hospitalization and a 1.2-fold higher rate of outpatient visits compared to those without, resulting in excess Medicare spending of $22,208 in the first year after DLBCL diagnosis. CONCLUSIONS Elderly patients with DLBCL have an elevated risk of VTE resulting in excess health care utilization. VTE history before DLBCL was associated with increased risk of post-DLBCL VTE, and Asian individuals were associated with a lower risk of VTE.
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Affiliation(s)
- Radhika Gangaraju
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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27
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Risk factors of arterial thrombotic events after unprovoked venous thromboembolism, and after cancer associated venous thromboembolism: A prospective cohort study. Thromb Res 2022; 214:93-105. [DOI: 10.1016/j.thromres.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
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28
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Dudziñska-Szczerba K, Kułakowski P, Michałowska I, Baran J. Association Between Left Atrial Appendage Morphology and Function and the Risk of Ischaemic Stroke in Patients with Atrial Fibrillation. Arrhythm Electrophysiol Rev 2022; 11:e09. [PMID: 35846423 PMCID: PMC9272406 DOI: 10.15420/aer.2022.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022] Open
Abstract
AF is the most common cardiac arrhythmia and has been identified as an independent risk factor for stroke. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA2DS2-VASc score. However, stroke also occurs in some patients with a low CHA2DS2-VASc score. Therefore, it is necessary to find new factors to improve thromboembolic risk stratification in AF patients. Over 90% of embolic strokes are caused by thrombi originating from the left atrial appendage (LAA). Thus, certain anatomical or functional parameters of the LAA could potentially be used to predict cardioembolic stroke. Studies have suggested that some of these factors, such as LAA morphology, number of LAA lobes, LAA dimensions, LAA volume, distance from the LAA ostium to the first bend of LAA, LAA orifice diameter, extent of LAA trabeculations, LAA takeoff, LAA flow velocity and LAA strain rate, are independently associated with a higher risk of stroke in a population of patients with AF and improve the performance of the CHA2DS2-VASc score. However, the results are conflicting and, so far, no new parameter has been added to the CHA2DS2-VASc score.
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Affiliation(s)
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | | | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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29
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 3167] [Impact Index Per Article: 1055.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Characteristics and management of patients with stroke and major hemorrhagic episodes with atrial fibrillation under vitamin K antagonist therapy. EVENTHO study. Med Clin (Barc) 2022; 159:366-371. [DOI: 10.1016/j.medcli.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022]
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Lin YS, Lin MS, Wu VCC, Chen YL, Chang JJ, Chu PH, Lip GYH, Chen MC. Differential Presentations of Arterial Thromboembolic Events Between Venous Thromboembolism and Atrial Fibrillation Patients. Front Cardiovasc Med 2021; 8:775564. [PMID: 34938791 PMCID: PMC8685417 DOI: 10.3389/fcvm.2021.775564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Atrial fibrillation (AF) and venous thromboembolism (VTE) share several risk factors related to arterial thromboembolism. No study has reported the differential contribution to arterial thromboembolic events and mortality between these two conditions in the same population. We therefore assessed the differential arterial thromboembolic events between AF and VTE. Methods: We included AF and VTE national cohorts derived from Taiwan National Health Insurance Research Database between 2001 and 2013. The eligible population was 314,861 patients in the AF cohort and 41,102 patients in the VTE cohort. The primary outcome was arterial thromboembolic events, including ischemic stroke, extracranial arterial thromboembolism (ECATE) and myocardial infarction (MI). Secondary outcomes were all-cause mortality and cardiovascular death. Results: After a 1:1 propensity matching, 32,688 patients in either group were analyzed. The risk of arterial thromboembolic events was lower in the VTE cohort than that in the AF cohort (subdistribution hazard ratio [SHR], 0.60; 95% confidence interval [CI], 0.57-0.62). The risk of ischemic stroke (SHR, 0.44; 95% CI, 0.42-0.46) and MI (SHR, 0.80; 95% CI, 0.72-0.89) were lower in the VTE cohort, while the risk of ECATE (SHR, 1.23; 95% CI, 1.14-1.33; particularly lower extremities) was higher in the VTE cohort. All-cause mortality rate was higher in the VTE cohort (HR, 1.18; 95% CI, 1.15-1.21) while the risk of cardiovascular death was lower in the VTE cohort (HR, 0.96; 95% CI, 0.93-0.995). Conclusions: Patients with AF had higher risks of arterial thromboembolic events compared to patients with VTE, despite having risk factors in common. The VTE cohort had higher risks of all-cause mortality and ECATE, particularly lower extremity events, compared to AF patients. The differential manifestations of thromboembolism sequelae and mortality between AF and VTE patients merit further investigation.
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Affiliation(s)
- Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3534] [Impact Index Per Article: 883.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Go AS, Desvigne-Nickens P, Anderson CD, Casadei B, Chen LY, Crijns HJ, Freedman B, Hills MT, Healey JS, Kamel H, Kim DY, Link MS, Lopes RD, Lubitz SA, McManus DD, Noseworthy PA, Perez MV, Piccini JP, Schnabel RB, Singer DE, Tieleman R, Turakhia MP, Van Gelder IC, Cooper LS, Al-Khatib SM. Research Priorities in Atrial Fibrillation Screening: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop. Circulation 2021; 143:372-388. [PMID: 33493033 PMCID: PMC8776506 DOI: 10.1161/circulationaha.120.047633] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop focused on identifying key research priorities related to AF screening. Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: (1) role of opportunistic screening; (2) AF as a risk factor, risk marker, or both; (3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; (4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and (5) role of AF screening after ischemic stroke. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.
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Affiliation(s)
- Emelia J. Benjamin
- Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 (E.J.B.)
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612. Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA 94143. Departments of Medicine, Health Research and Policy, Stanford University, Stanford, CA 94305 (A.S.G.)
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (P.D.N., L.S.C.)
| | - Christopher D. Anderson
- Department of Neurology, Center for Genomic Medicine, and McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114 (C.D.A.)
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX39DU, UK (B.C.)
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455 (L.Y.C.)
| | - Harry J.G.M. Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands (H.J.G.M.C.)
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, and Concord Hospital Department of Cardiology, Concord Clinical School, University of Sydney, Sydney, Australia (B.F.)
| | - Mellanie True Hills
- StopAfib.org, American Foundation for Women’s Health, Decatur, TX 76234 (M.T.H.)
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021 (H.K.)
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (D.Y.K.)
| | - Mark S. Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390 (M.S.L.)
| | - Renato D. Lopes
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
| | - Steven A. Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (S.A.L.)
| | - David D. McManus
- Department of Medicine, Division of Cardiology, University of MA Medical School, Worcester, MA 01655 (D.D.M.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902 (P.A.N.)
| | - Marco V. Perez
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 95125 (M.V.P.)
| | - Jonathan P. Piccini
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
| | - Renate B. Schnabel
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck (R.B.S.)
| | - Daniel E. Singer
- Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, 02114 (D.E.S.)
| | - Robert Tieleman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (I.C.V.G, R.T.)
- Department of Cardiology, Martini Hospital, Groningen, The Netherlands (R.T.)
| | - Mintu P. Turakhia
- Veterans Affairs Palo Alto Health Care System, Palo Alto CA; Center for Digital Health, Stanford University, Stanford, CA (M.P.T.)
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (I.C.V.G, R.T.)
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (P.D.N., L.S.C.)
| | - Sana M. Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
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Bai Y, Yue QM, Sun H, Guo SD, Wang ZZ, Zhong P, Wei XY, Sun L, Liu Y, Shi XB, Liu YT. Prevalence and sex- and age-related risk of pulmonary embolism in in-hospital patients with atrial fibrillation: a multicenter retrospective study from China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 8:1558. [PMID: 33437757 PMCID: PMC7791195 DOI: 10.21037/atm-20-2718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study was designed to explore the prevalence of pulmonary embolism (PE) and sex and age-related risk of incident PE in in-hospital patients with atrial fibrillation (AF) in China. Methods A retrospective cohort of 15,688 AF patients (mean age: 72.56 years; 55.7% male) was identified from 2008 to 2018 in our hospitals. The prevalence and incidence of PE over a 2.28-year follow-up were studied. Unadjusted, age or sex-adjusted, and multivariate Cox regression were used to explore the risk of PE in the studied patients. Results One hundred eighty-two AF patients (1.2%) had PE at their first hospitalizations. Over a mean follow-up of 2.28 years, 85 patients developed PE, with an incidence of 0.24% per person-year. PE was more likely to occur in female and older patients with AF according to the unadjusted, age or sex-adjusted, and multivariate Cox regression analysis (all P<0.05). Moreover, a significant higher risk of PE was seen in female and older patients in AF using Kaplan-Meier analysis, respectively (log-rank: both P<0.001). Conclusions In the current AF cohort, the prevalence of PE was 1.2% and the incidence of PE was 0.24% per person-year during a mean follow-up of 2.28 years. Female and older patients were more likely to experience PE compared to male and younger patients.
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Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiao-Min Yue
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - He Sun
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shi-Dong Guo
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Zhou Wang
- Trauma Medicine Center, Peking University People's Hospital, China
| | - Peng Zhong
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue-Yao Wei
- Information Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Neurologic Department, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yue Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu-Bo Shi
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan-Ting Liu
- Information Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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35
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Kim JE, Chang JH, Jeong MJ, Choi J, Park J, Baek C, Shin A, Park SM, Kang D, Choi JY. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases. Sci Rep 2020; 10:20631. [PMID: 33244065 PMCID: PMC7691511 DOI: 10.1038/s41598-020-77534-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies was conducted to assess the association between menopausal hormone therapy and cardiovascular disease. The PubMed and EMBASE databases were searched for articles published from 2000 to 2019, using review methods based on a previous Cochrane review. Quality assessment of RCTs and observational studies was conducted using the Jadad scale and the Newcastle-Ottawa Scale, respectively. A total of 26 RCTs and 47 observational studies were identified. The study populations in the RCTs were older and had more underlying diseases than those in the observational studies. Increased risks of venous thromboembolism [summary estimate (SE), 95% confidence interval (CI): RCTs, 1.70, 1.33-2.16; observational studies, 1.32, 1.13-1.54] were consistently identified in both study types, whereas an increased risk of stroke in RCTs (SE: 1.14, 95% CI: 1.04-1.25) and a decreased risk of myocardial infarction in observational studies (SE: 0.79, 95% CI: 0.75-0.84) were observed. Differential clinical effects depending on timing of initiation, underlying disease, regimen type, and route of administration were identified through subgroup analyses. These findings suggest that underlying disease and timing of initiation should be carefully considered before starting therapy in postmenopausal women.
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Affiliation(s)
- Ji-Eun Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hyuck Chang
- Northeastern University Bouve College of Health Sciences School of Pharmacy, Boston, MA, USA
| | - Min-Ji Jeong
- Northeastern University Bouve College of Health Sciences School of Pharmacy, Boston, MA, USA
| | - Jaesung Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea
| | - JooYong Park
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea
| | - Chaewon Baek
- Northeastern University Bouve College of Health Sciences School of Pharmacy, Boston, MA, USA
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- BK21plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Korea.
- Cancer Research Institute, Seoul National University, Seoul, Korea.
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 874] [Impact Index Per Article: 174.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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Awotoye J, Fashanu OE, Lutsey PL, Zhao D, O'Neal WT, Michos ED. Resting heart rate and incident venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis. Open Heart 2020; 7:e001080. [PMID: 32153786 PMCID: PMC7046973 DOI: 10.1136/openhrt-2019-001080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/07/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Resting heart rate (RHR), which may be modifiable through lifestyle changes, has been shown to be associated with cardiovascular disease risk and with inflammatory markers that have been predictive of VTE incidence. Methods We examined whether RHR is also associated with VTE incidence independent of these risk factors. We studied 6479 Multi-Ethnic Study of Atherosclerosis participants free from clinical VTE at baseline who had baseline RHR ascertained by 12-lead ECG. VTE events were recorded from hospital records and death certificates using International Classification of Diseases (ICD)-9 and ICD-10 codes. We categorised RHR as <60, 60-69, 70-79 and ≥80 bpm. We used Cox hazard models to determine the association of incident VTE by RHR. Results Participants had mean (SD) age of 62 (10) years and RHR of 63 (10) bpm. RHR was cross-sectionally correlated with multiple inflammatory and coagulation factors. There were 236 VTE cases after a median follow-up of 14 years. Compared with those with RHR<60 bpm, the HR (95% CI) for incident VTE for RHR≥80 bpm was 2.08 (1.31 to 3.30), after adjusting for demographics, physical activity, smoking, diabetes and use of atrioventricular (AV)-nodal blockers, aspirin and anticoagulants, and remained significant after further adjustment for inflammatory markers (2.05 (1.29 to 3.26)). Results were similar after excluding those taking AV-nodal blocker medications. There was no effect modification of these associations by sex or age. Conclusion Elevated RHR was positively associated with VTE incidence after a median of 14 years; this association was independent of several traditional VTE and inflammatory markers.
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Affiliation(s)
- Josephine Awotoye
- Department of Biology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oluwaseun E Fashanu
- Department of Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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38
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Prandoni P. Is there a link between venous and arterial thrombosis? A reappraisal. Intern Emerg Med 2020; 15:33-36. [PMID: 31773560 DOI: 10.1007/s11739-019-02238-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and obesity. Endothelial dysfunction and inflammation are likely to play a role in determining the simultaneous involvement of the two vascular compartments. Unlike subclinical atherosclerosis, symptomatic complications of atherosclerosis such as myocardial infarction, ischemic stroke and atrial fibrillation are likely to predict the subsequent development of venous thromboembolic (VTE) complications. Patients with VTE, especially those with apparently unprovoked episodes, have a definitely increased risk of subsequent arterial thrombotic disorders. Drugs that reduce the risk of arterial thrombosis are likely to reduce the risk of venous thrombosis and vice versa. In particular, the direct oral anticoagulants have recently been shown to reduce the risk of both vascular disorders. In conclusion, recent evidence provides compelling evidence in support of the link between venous and arterial thrombosis. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.
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Affiliation(s)
- Paolo Prandoni
- Arianna Foundation On Anticoagulation, Via P. Fabbri 1/3, 40138, Bologna, Italy.
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39
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Bikdeli B, Jiménez D. Atrial fibrillation in the course of pulmonary embolism: just a little smoke, or fuel to the fire? J Intern Med 2020; 287:114-116. [PMID: 31637791 DOI: 10.1111/joim.12999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA.,Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA.,Cardiovascular Research Foundation (CRF), New York, NY, USA
| | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.,Medicine Department, Universidad de Alcala, IRYCIS, Madrid, Spain
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40
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Wang Y, Bromberg Y. Identifying mutation-driven changes in gene functionality that lead to venous thromboembolism. Hum Mutat 2019; 40:1321-1329. [PMID: 31144782 PMCID: PMC6745089 DOI: 10.1002/humu.23824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/26/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Abstract
Venous thromboembolism (VTE) is a common hematological disorder. VTE affects millions of people around the world each year and can be fatal. Earlier studies have revealed the possible VTE genetic risk factors in Europeans. The 2018 Critical Assessment of Genome Interpretation (CAGI) challenge had asked participants to distinguish between 66 VTE and 37 non-VTE African American (AA) individuals based on their exome sequencing data. We used variants from AA VTE association studies and VTE genes from DisGeNET database to evaluate VTE risk via four different approaches; two of these methods were most successful at the task. Our best performing method represented each exome as a vector of predicted functional effect scores of variants within the known genes. These exome vectors were then clustered with k-means. This approach achieved 70.8% precision and 69.7% recall in identifying VTE patients. Our second-best ranked method had collapsed the variant effect scores into gene-level function changes, using the same vector clustering approach for patient/control identification. These results show predictability of VTE risk in AA population and highlight the importance of variant-driven gene functional changes in judging disease status. Of course, more in-depth understanding of AA VTE pathogenicity is still needed for more precise predictions.
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Affiliation(s)
- Yanran Wang
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey
| | - Yana Bromberg
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey
- Department of Genetics, Rutgers University, New Brunswick, New Jersey
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Ptaszynska-Kopczynska K, Kiluk I, Sobkowicz B. Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7846291. [PMID: 31531368 PMCID: PMC6720355 DOI: 10.1155/2019/7846291] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022]
Abstract
Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.
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Affiliation(s)
| | - Izabela Kiluk
- Department of Cardiology, Medical University of Bialystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Poland
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Malavasi VL, Marietta M, Lip GYH, Boriani G. Cancer and atrial fibrillation. Author's reply. Eur J Intern Med 2019; 62:e24-e25. [PMID: 30661827 DOI: 10.1016/j.ejim.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/08/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Marietta
- Hematology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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Folsom AR, Lutsey PL, Heckbert SR, Poudel K, Basu S, Hoogeveen RC, Cushman M, Ballantyne CM. Longitudinal increases in blood biomarkers of inflammation or cardiovascular disease and the incidence of venous thromboembolism. J Thromb Haemost 2018; 16:1964-1972. [PMID: 30007116 PMCID: PMC6173641 DOI: 10.1111/jth.14241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 12/23/2022]
Abstract
Essentials Inflammatory and cardiac diseases are associated with increased venous thromboembolism (VTE) risk. Our prospective study assessed rise in inflammatory or cardiac biomarkers and VTE risk. A greater 6-year rise in N-terminal natriuretic peptide is associated with increased VTE incidence. Volume overload or impending cardiac disease may contribute to VTE occurrence. SUMMARY Background We previously showed that participants in the population-based Atherosclerosis Risk in Communities (ARIC) cohort with elevated levels of blood biomarkers of inflammation or cardiac disease were at increased risk of venous thromboembolism (VTE). Objective We hypothesized that ARIC participants with larger 6-year increases in the levels of three biomarkers - C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin T - would also have an increased subsequent risk of VTE. Methods We measured changes in the levels of these biomarkers in 9844 participants from 1990-1992 to 1996-1998, and then identified VTEs through 2015. Results A greater 6-year rise in the level of NT-proBNP, but not in that of CRP or troponin T, was significantly associated with increased VTE incidence over a median of 17.6 years of follow-up. After adjustment for other VTE risk factors, those whose NT-proBNP level rose from < 100 pg mL-1 to ≥ 100 pg mL-1 had a hazard ratio for VTE of 1.44 (95% confidence interval [CI] 1.15-1.80), as compared with the reference group with an NT-proBNP level of < 100 pg mL-1 at both times. This hazard ratio was slightly higher (1.66, 95% CI 1.19-2.31) during the first 10 years of follow-up, but was attenuated (1.24, 95% CI 0.99-1.56) after adjustment for prevalent and incident coronary heart disease, heart failure, and atrial fibrillation. Conclusions The two most likely explanations for our results are that: (i) an increasing NT-proBNP level reflects increasing subclinical volume overload and potentially increased venous stasis or subclinical PE that had gone unrecognized over time; or (ii) an increasing NT-proBNP level is a risk marker for impending cardiac disease that places patients at risk of VTE.
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Affiliation(s)
- Aaron R. Folsom
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Kripa Poudel
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Saonli Basu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ron C. Hoogeveen
- Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Pathology, University of Vermont, Burlington, Vermont, USA
| | - Christie M. Ballantyne
- Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Marcatto LR, Sacilotto L, Tavares LC, Facin M, Olivetti N, Strunz CMC, Darrieux FCC, Scanavacca MI, Krieger JE, Pereira AC, Santos PCJL. Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin. Front Pharmacol 2018; 9:1052. [PMID: 30298004 PMCID: PMC6160801 DOI: 10.3389/fphar.2018.01052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/31/2018] [Indexed: 12/26/2022] Open
Abstract
Thromboembolic events are associated with high mortality and morbidity indexes. In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics. Some studies on the literature about oral anticoagulant management showed that pharmacists could improve the efficiency of anticoagulant therapy. However, the majority of these studies included general patients retrospectively. The aim of this study was to prospectively evaluate a pharmacist’s warfarin management in patients with poor quality of anticoagulation therapy (Time in the Therapeutic Range- TTR < 50%). We included 268 patients with atrial fibrillation (AF) and without stable dose of warfarin (TTR < 50%, based on the last three values of International Normalized Ratio-INR). We followed them up for 12 weeks, INR values were evaluated and, when necessary, the dose adjustments were performed. During the first four visits, patient’s INR was measured every 7 days. Then, if INR was within the target therapeutic range (INR: 2–3), the patient was asked to return in 30 days. However, if INR was out the therapeutic target, the patient was asked to return in 7 days. Adherence evaluation was measured through questionnaires and by counting the pills taken. Comparison between basal TTR (which was calculated based on the three last INR values before prospective phase) and TTR of 4 weeks (calculated by considering the INR tests from visits 0 to 4, in the prospective phase of the study) and basal TTR and TTR of 12 weeks (calculated based on the INR tests from visits 0 to 12, in the prospective phase of the study) revealed significant statistical differences (0.144 ± 0.010 vs. 0.382 ± 0.016; and 0.144 ± 0.010 vs. 0.543 ± 0.014, p < 0.001, respectively). We also observed that the mean TTR of 1 year before (retrospective phase) was lower than TTR value after 12 weeks of pharmacist-driven treatment (prospective phase) (0.320 ± 0.015; 0.540 ± 0.015, p < 0.001). In conclusion, pharmaceutical care was able to improve TTR values in patients with AF and poor quality of anticoagulation with warfarin.
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Affiliation(s)
- Leiliane Rodrigues Marcatto
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Sacilotto
- Arrythmia Unit, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Letícia Camargo Tavares
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Mirella Facin
- Arrythmia Unit, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Natália Olivetti
- Arrythmia Unit, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Celia Maria Cassaro Strunz
- Clinical Laboratory, Heart Institute (InCor), Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | | | - Maurício Ibrahim Scanavacca
- Arrythmia Unit, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Jose Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina FMUSP, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil.,Department of Pharmacology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
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