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Gallo G, Picciariello A, Tufano A, Camporese G. Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review. Updates Surg 2024; 76:423-434. [PMID: 38356039 PMCID: PMC10995001 DOI: 10.1007/s13304-024-01776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Chronic venous disease (CVD) and hemorrhoidal disease (HD) are among the most common vascular diseases in the world, with CVD affecting 22-41% of the population in Europe and HD having a point prevalence of 11-39%. The burden is substantial in terms of the effect of symptoms on patients' health-related quality of life (HRQoL) and direct/indirect medical costs. Treatment begins with lifestyle changes, compression in CVD and topical therapies in HD, and escalates as needed through oral therapies first and eventually to surgery for severe disease. CVD and HD share etiological features and pathological changes affecting the structure and function of the tissue extracellular matrix. Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate, has been demonstrated to positively impact the underlying causes of CVD and HD, regenerating the glycocalyx and restoring endothelial function, in addition to having antithrombotic, profibrinolytic, anti-inflammatory, antiedema and wound-healing effects. In clinical trials, oral mesoglycan reduced the severity of CVD signs and symptoms, improved HRQoL, and accelerated ulcer healing. In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding. In patients undergoing excisional hemorrhoidectomy, adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone. The clinical effects of mesoglycan in patients with CVD or HD are consistent with the agent's known mechanisms of action.
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Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | | | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Camporese
- Department of Internal Medicine, Padua University Hospital, Padua, Italy
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Casoria A, Miele C, Capasso F, Mormile R, Bisceglia L, Pracella R, Vecchione G, Cirillo F, Frangipane I, Conca P, Cimino E, Di Minno M, Tufano A. A novel mutation in the fibrinogen γ-chain gene c.952G>T, p. (Gly318Cys) leading to hypo dysfibrinogenemia. Thromb Res 2024; 234:59-62. [PMID: 38159325 DOI: 10.1016/j.thromres.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Aniello Casoria
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ciro Miele
- UOC Laboratory Medicine of Hematology and Hemostasis, Federico II University Hospital, Naples, Italy
| | - Filomena Capasso
- UOC Laboratory Medicine of Hematology and Hemostasis, Federico II University Hospital, Naples, Italy
| | - Rosaria Mormile
- Haematology, Department of Translational and precision Medicine, Sapienza University, Rome, Italy
| | - Luigi Bisceglia
- Division of Medical Genetics IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Riccardo Pracella
- Division of Medical Genetics IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Gennaro Vecchione
- Division of Medical Genetics IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Ferdinando Cirillo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ignazio Frangipane
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ernesto Cimino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Matteo Di Minno
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
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Calcaterra I, Tufano A, Strano F, Rufolo P, Donnarumma S, Palermo V, De Ruberto F, Cimino E, Guerrino C, Conca P, Iannuzzo G, Di Minno M. Efficacy and safety of direct oral anticoagulants in splanchnic vein thrombosis: a pooled analysis of literature studies. J Thromb Haemost 2024; 22:534-544. [PMID: 37926192 DOI: 10.1016/j.jtha.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Limited evidence is available on management of splanchnic vein thrombosis (SVT). OBJECTIVES This study aimed to evaluate safety and efficacy of direct oral anticoagulants (DOACs) for SVT treatment. METHODS Studies were systematically searched in the PubMed, Web of Science, and Scopus databases according to PRISMA guidelines. We assessed any recanalization, full recanalization, recurrence, mortality, and major bleeding as outcomes of interest. Results were reported as weighted mean prevalence (WMP) with 95% CI. Subgroup analyses and meta-regressions have been performed to address heterogeneity and adjust for potential confounders. RESULTS We included a total of 16 studies (17 datasets) on 648 patients with SVT treated with DOACs. We found any recanalization in 60.3% (95% CI: 41.8%-76.3%; I2 = 84.9%; P < .001) and full recanalization in 51.7% (95% CI: 36.0%-67.0%; I2 = 87.4%; P < .001). Recurrent venous thromboembolism occurred in 2.8% (95% CI: 1.4%-5.9%; I2 = 0%; P = .787) and death in 3.4% (95% CI: 1.6%-7.3%; I2 = 13.2%; P = .318) of patients. Major bleeding was reported by 5.8% (95% CI: 3.7%-8.9%; I2 = 29.2%; P = .125) of patients. Results were consistent when separately analyzing prospective studies, retrospective studies, studies on cirrhotic patients, and studies enrolling patients with portal vein thrombosis. Meta-regression analyses showed that an increasing age and cancer impacted the rate of recanalization. Cirrhosis was associated with a higher rate of major bleeding and mortality. CONCLUSION The results of the present study, mostly based on observational studies, suggest good safety and efficacy profiles of DOACs in patients with SVT. Randomized studies are needed to corroborate our findings.
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Affiliation(s)
- Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Federica Strano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paola Rufolo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sofia Donnarumma
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Vincenzina Palermo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesca De Ruberto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ernesto Cimino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Cornelia Guerrino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Matteo Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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Tufano A, Brenner B. Prevention of Venous Thromboembolism in Medical Patients with Thrombocytopenia or with Platelet Dysfunction: The Last 10 Years. Semin Thromb Hemost 2024; 50:96-103. [PMID: 37201536 DOI: 10.1055/s-0043-1769013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Current guideline recommendations for primary prophylaxis of venous thromboembolism (VTE) are based on randomized clinical trials that usually exclude subjects at a potentially high risk of bleeding complications. For this reason, no specific guideline is available for thromboprophylaxis in hospitalized patients with thrombocytopenia and/or platelet dysfunction. However, except in patients with absolute contraindications to anticoagulant drugs, antithrombotic prophylaxis should always be considered, for example, in hospitalized cancer patients with thrombocytopenia, especially in those with multiple VTE risk factors. Low platelet number, platelet dysfunction, and clotting abnormalities are also very common in patients with liver cirrhosis, but these patients have a high incidence of portal venous thrombosis, implying that cirrhotic coagulopathy does not fully protect against thrombosis. These patients may benefit from antithrombotic prophylaxis during hospitalization. Patients hospitalized for COVID-19 need prophylaxis, but frequently experience thrombocytopenia or coagulopathy. In patients with antiphospholipid antibodies, a high thrombotic risk is usually present, even in the presence of thrombocytopenia. VTE prophylaxis in high-risk conditions is thus suggested in these patients. At variance with severe thrombocytopenia (< 50,000/mm3), mild/moderate thrombocytopenia (≥ 50,000/mm3) should not interfere with VTE prevention decisions. In patients with severe thrombocytopenia, pharmacological prophylaxis should be considered on an individual basis. Aspirin is not as effective as heparins in lowering the risk of VTE. Studies in patients with ischemic stroke demonstrated that thromboprophylaxis with heparins is safe in these patients also during antiplatelet treatment. The use of direct oral anticoagulants in the prophylaxis of VTE in internal medicine patients has been recently evaluated, but no specific recommendation exists for patients with thrombocytopenia. The need for VTE prophylaxis in patients on chronic treatment with antiplatelet agents should be evaluated after assessing the individual risk of bleeding complications. Finally, the selection of patients who require post-discharge pharmacological prophylaxis remains debated. New molecules currently under development (such as the inhibitors of factor XI) may contribute to improve the risk/benefit ratio of VTE primary prevention in this setting of patients.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, Naples, Italy
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Haifa, Israel
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Pelizza MF, Martinato M, Rosati A, Nosadini M, Saracco P, Giordano P, Luciani M, Ilardi L, Lasagni D, Molinari AC, Bagna R, Palmieri A, Ramenghi LA, Grassi M, Magarotto M, Magnetti F, Francavilla A, Indolfi G, Suppiej A, Gentilomo C, Restelli R, Tufano A, Tormene D, Pin JN, Tona C, Meneghesso D, Rota L, Conti M, Russo G, Lorenzoni G, Gregori D, Sartori S, Simioni P. Corrigendum: The new Italian registry of infantile thrombosis (RITI): a reflection on its journey, challenges and pitfalls. Front Pediatr 2024; 12:1372754. [PMID: 38357512 PMCID: PMC10865093 DOI: 10.3389/fped.2024.1372754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2023.1094246.].
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Affiliation(s)
- Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Statistics, Computer Science, Applications “G. Parenti”, University of Firenze, Firenze, Italy
| | - Anna Rosati
- Neuroscience Center of Excellence, Children’s Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Paola Saracco
- Paediatric Haematology Unit, Department of Paediatrics, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari-Giovanni XXIII Hospital, Bari, Italy
| | - Matteo Luciani
- Department of Paediatric Hemato-Oncology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Roma, Italy
| | - Laura Ilardi
- Neonatal Intensive Care Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
| | - Donatella Lasagni
- Paediatric Unit, Children’s Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Angelo Claudio Molinari
- Regional Reference Center for Hemorrhagic Diseases, IRCCS Giannina Gaslini Children’s Hospital, Genova, Italy
| | - Rossana Bagna
- Neonatal Intensive Care Unit, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Antonella Palmieri
- Department of Paediatric Emergency, IRCCS Giannina Gaslini Children’s Hospital, Genova, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Children’s Hospital, Genova, Italy
| | - Massimo Grassi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari-Giovanni XXIII Hospital, Bari, Italy
| | - Mariella Magarotto
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Federica Magnetti
- Neonatal Intensive Care Unit, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Children’s Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Agnese Suppiej
- Section of Pediatrics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Roberta Restelli
- Neonatal Intensive Care Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
| | - Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | - Daniela Tormene
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, University Hospital of Padova, Padova, Italy
| | - Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Clarissa Tona
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Davide Meneghesso
- Paediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
| | - Lidia Rota
- Cardiovascular Prevention Centre, Humanitas Research Hospital, Milano, Italy
| | - Marta Conti
- Child Neurology Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Giovanna Russo
- Unit of Pediatric Onco-Haematology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, University Hospital of Padova, Padova, Italy
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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Truong P, Mazzolai L, Font C, Ciammaichella M, González-Martínez J, Tufano A, Gavín-Sebastián O, Le Mao R, Monreal M, Hugli O. Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Acad Emerg Med 2023; 30:935-945. [PMID: 37092646 DOI: 10.1111/acem.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The diagnostic strategy for pulmonary embolism (PE) includes a D-dimer test when PE probability is low or intermediate, but false-positive D-dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule-out criteria (PERC) rule excludes PE without D-dimer testing when pretest probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. METHODS This retrospective cohort study used data from the RIETE registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the failure rate of the PERC strategy, represented by the proportion of PERC-negative (PERC-N) patients with a PE included in the registry. Secondary outcomes were a comparison of the clinical characteristics, treatment strategy, and outcome of PERC-N versus PERC-positive (PERC-P) patients at 3 months. RESULTS From 2001 to 2021, a total of 49,793 patients with acute PE were enrolled in the RIETE registry. We included 48,903 in the final analysis after exclusion of 890 patients with an undetermined PERC status. Only 346 patients were PERC-N with a failure rate of 0.7% (95% confidence interval 0.6%-0.8%). PERC-N patients presented more frequently with chest pain but less often with dyspnea, syncope, or hypotension. They also had subsegmental or segmental PE more frequently, were more often treated with direct oral anticoagulants, and received mechanical or pharmacological thrombolysis less often. In addition, PERC-N patients had a lower incidence of recurrent deep vein thrombosis, major bleeding, and death attributed to PE during the 3-month follow-up. CONCLUSIONS A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE.
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Affiliation(s)
- Perrine Truong
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucia Mazzolai
- Department of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | | | - José González-Martínez
- Department of Internal Medicine, Hospital Universitari Sant Joan de Déu, Fundació Althaia, Manresa, Barcelona, Spain
| | - Antonella Tufano
- Regional Reference Centre, Federico II University Hospital, Naples, Italy
| | - Olga Gavín-Sebastián
- Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Raphael Le Mao
- Department of Internal Medicine, CHRU Brest, Brest, France
| | - Manuel Monreal
- Faculty of Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Olivier Hugli
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Abate V, Vergatti A, Casoria A, Zarrella AF, Muscariello R, Nuzzo V, Vargas M, Servillo G, Conca P, D'Elia L, Iannuzzo G, Venetucci P, De Filippo G, Rendina D, Tufano A. Venous thromboembolism and major bleeding in severe and critical COVID-19 hospitalized patients. Monaldi Arch Chest Dis 2023. [PMID: 37403940 DOI: 10.4081/monaldi.2023.2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/07/2023] [Indexed: 07/06/2023] Open
Abstract
Venous thromboembolism (VTE) and major bleeding (MB) are life-threatening complications described in COVID-19 hospitalized patients and they can be considered as two sides of the same coin. This retrospective study aims to evaluate the risk factors for VTE and MB in COVID-19 patients admitted to two Italian hospitals. The medical records of all COVID-19 patients (males 139; 62.3%, mean age 67.2±13.6 years, body weight 88.2±20.6 kg) hospitalized from March 11th to July 31st, 2020 to the Federico II University Hospital and to Sea Hospital, Naples, Italy, were analyzed. The COVID-19 patients were classified into four groups: COVID-19 patients developing VTE and/or MB, COVID-19 patients developing only VTE, COVID-19 patients developing only MB, and COVID-19 patients not developing neither VTE nor MB. During the hospitalization, 53 COVID-19 patients (24.7%; males 40; 75.5%, mean age 67.2±13.6 years, weight 88.2±20.6 kg) developed VTE, 33 COVID-19 patients (15.3 %; males 17; 51.5, mean age 67.3±14.9 years, weight 74.1±14.3 kg) developed MB, and 129 COVID-19 patients not developed neither TVP nor MB. No parameters to identify severe COVID-19 complicated by VTE and/or MB were found. However, some clinical and biochemical parameters can be evaluated to predict the risk of MB in order to modify the treatment and take prompt action to reduce mortality.
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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Anita Vergatti
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | | | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples.
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples.
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples.
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, Federico II University of Naples.
| | - Gianpaolo De Filippo
- Department of Paediatric Endocrinology and Diabetology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris.
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University of Naples.
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Pelizza MF, Martinato M, Rosati A, Nosadini M, Saracco P, Giordano P, Luciani M, Ilardi L, Lasagni D, Molinari AC, Bagna R, Palmieri A, Ramenghi LA, Grassi M, Magarotto M, Magnetti F, Francavilla A, Indolfi G, Suppiej A, Gentilomo C, Restelli R, Tufano A, Tormene D, Pin JN, Tona C, Meneghesso D, Rota L, Conti M, Russo G, Lorenzoni G, Gregori D, Sartori S, Simioni P. The new Italian registry of infantile thrombosis (RITI): A reflection on its journey, challenges and pitfalls. Front Pediatr 2023; 11:1094246. [PMID: 37152311 PMCID: PMC10159054 DOI: 10.3389/fped.2023.1094246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/06/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Thrombotic events in neonates and children represent a rare although severe occurrence in view of the associated risk of mortality and sequelae. Quality evidence is limited in this field, and registry studies provide an essential base for research. The aim of this paper is to present the new Italian Registry of Infantile Thrombosis (RITI), set it into the scene of international thrombosis and stroke registries, and provide some insight on the challenges associated with registry management. Methods We present the detailed structure and content of the new RITI registry, a brief overview of its main data, and a reflection on its features, pitfalls and the main challenges related to its management. Results The RITI, initially started in 2007 and officially re-launched in 2017 after structural modifications, is a non-interventional retrospective and prospective registry study collecting data on neonatal and pediatric patients (0-18 years) who experienced a systemic or cerebral thrombotic event in Italy. The RITI is managed by a multidisciplinary team with expertise in pediatric thrombosis, and participation is open to all Italian physicians, on a voluntary basis. The overall aim of the registry is to acquire new evidence to better characterize the population of children with thrombotic events and improve their management and outcome. 48 Italian pediatric and intensive care units are actively involved in the RITI, including 85 medical doctors from 16 Italian regions. A total of 1,001 neonates and children affected by cerebral or systemic thrombosis have been enrolled. Discussion The RITI is one of the largest available European registries of neonatal and pediatric thrombosis. National registries like the RITI represent a model for the study of rare conditions based on multidisciplinary and multicenter collaboration, aimed at overcoming the limitations due to small populations of patients, and creating a network of experts for patient referral and continuous education. Moreover, registry studies have a pivotal role in the research on pediatric thrombosis, due to the limited feasibility of high-quality studies. In our experience, the main critical stages, pitfalls and challenges in registry management include adequate registry designing, diffusion, data completeness and quality control.
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Affiliation(s)
- Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Statistics, Computer Science, Applications “G. Parenti”, University of Firenze, Firenze, Italy
| | - Anna Rosati
- Neuroscience Center of Excellence, Children's Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Paola Saracco
- Paediatric Haematology Unit, Department of Paediatrics, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari-Giovanni XXIII Hospital, Bari, Italy
| | - Matteo Luciani
- Department of Paediatric Hemato-Oncology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, Roma, Italy
| | - Laura Ilardi
- Neonatal Intensive Care Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
| | - Donatella Lasagni
- Paediatric Unit, Children's Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Angelo Claudio Molinari
- Regional Reference Center for Hemorrhagic Diseases, IRCCS Giannina Gaslini Children's Hospital, Genova, Italy
| | - Rossana Bagna
- Neonatal Intensive Care Unit, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Antonella Palmieri
- Department of Paediatric Emergency, IRCCS Giannina Gaslini Children's Hospital, Genova, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Children's Hospital, Genova, Italy
| | - Massimo Grassi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari-Giovanni XXIII Hospital, Bari, Italy
| | - Mariella Magarotto
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Federica Magnetti
- Neonatal Intensive Care Unit, University Hospital “Città Della Salute e Della Scienza”, Torino, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Indolfi
- NEUROFARBA Department, Children's Hospital Anna Meyer, University of Firenze, Firenze, Italy
| | - Agnese Suppiej
- Section of Pediatrics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Roberta Restelli
- Neonatal Intensive Care Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
| | - Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | - Daniela Tormene
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, University Hospital of Padova, Padova, Italy
| | - Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Clarissa Tona
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Davide Meneghesso
- Paediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Lidia Rota
- Cardiovascular Prevention Centre, Humanitas Research Hospital, Milano, Italy
| | - Marta Conti
- Child Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanna Russo
- Unit of Pediatric Onco-Haematology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, University Hospital of Padova, Padova, Italy
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Anceschi U, Amparore D, Siena G, Cocci A, Checcucci E, Prata F, De Cillis S, Flammia R, Tufano A, Quarà A, Ortenzi M, Brassetti A, Bove A, Tuderti G, D’Annunzio S, Viola L, Sessa F, Spatafora P, Fiori C, Varvello F, Minervini A, Ferrari G, Porpiglia F, Cindolo L, Simone G. A novel outcomes categorization for current minimally invasive ejaculation-sparing treatments of benign prostatic hyperplasia: Results of a multicentric series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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11
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Prata F, Iannuzzi A, Ragusa A, Anceschi U, Flammia R, Tufano A, Bravi C, Brassetti A, Tuderti G, Minervini A, Mari A, Capitanio U, Montorsi F, Autorino R, Veccia A, Fiori C, Porpiglia F, Eun D, Lee J, Deerwesh I, Sundaram C, Steward J, Mottrie A, Leonardo C, Simone G. Analysis of CKD progression for purely Off-Clamp and On-Clamp robotic partial nephrectomy for high nephrometry renal masses: Results of a multicentric series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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12
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Flammia R, Tufano A, Tuderti G, Mastroianni R, Anceschi U, Misuraca L, Bove A, Brassetti A, Ferriero M, Amparone D, Porpiglia F, Mari A, Grasso A, Minervini A, Derweesh I, Autorino R, Larcher A, Capitanio U, Eun D, Bologna E, Leonardo C, Gallucci M, Simone G. Unveil the interplay between baseline renal function, warm ischemia time and tumor complexity when assessing renal functional outcomes of on- vs. off-clamp robot-assisted partial nephrectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Tufano A, Polimeno M, Matani B, Cardillo G, Capasso F, Mormile R, Paladino F, Di Minno G. Validation of PLASMIC score in a cohort of patients with suspected thrombotic microangiopathy in an academic medical centre. Blood Transfus 2022:2022.0082-22. [PMID: 35969133 DOI: 10.2450/2022.0082-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The PLASMIC score is a rapid and inexpensive clinical assessment tool for predicting severe ADAMTS13 deficiency (<10% activity) in patients with suspected thrombotic thrombocytopenic purpura (TTP). The score includes 7 parameters: absence of active cancer, patient not having received stem cell transplant or organ transplant, platelet count <30×109/L, haemolysis, mean corpuscular volume <90 fl, International Normalized Ratio <1.5, and serum creatinine <2 mg/dL. MATERIALS AND METHODS In this retrospective study, we evaluated a cohort of 59 consecutive patients with suspected thrombotic microangiopathy who had been referred to the Hemostasis and Thrombosis Center of the "Federico II" University of Naples, Italy, for measurement of ADAMTS13 activity. Relevant clinical and laboratory information were collected for all patients. RESULTS The PLASMIC score was calculated in 52 of the 59 patients included in the study. In the high-risk group (PLASMIC score 6 or 7), 12 out of 20 patients (60%) had ADAMTS13 <10%. Interestingly, all 6 patients (100%) with PLASMIC score 7 had ADAMTS13 <5%. In the intermediate risk group (score 5), only one case out of 17 (5.9%) had ADAMTS 13 <10%. In the low-risk group (score 0-4), none of the patients had severe ADAMTS13 deficiency. The collected data enabled the sensitivity and specificity of PLASMIC score in TTP to be calculated, achieving 92% (95% CI: 0.80-0.98) and 79% (95% CI: 0.66-0.89), respectively. The PLASMIC score was seen to be a very efficient tool in distinguishing between patients with severe ADAMTS13 deficiency from those without, with an AUC of 0.92 (95% CI: 0.82-1.0; p<0.001). DISCUSSION In our cohort, a high-risk PLASMIC score successfully predicted patients with severe ADAMTS13 deficiency, allowing the clinician to quickly define the best therapeutic approach, especially useful for those clinicians not used to the diagnosis and treatment of thrombotic microangiopathies.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Mariateresa Polimeno
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | - Beniamino Matani
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
| | | | - Filomena Capasso
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
| | - Rosaria Mormile
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
| | | | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy
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14
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini, 5, Naples 80131, Italy.
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, CHU SartTilman, University of Liège Hospital, Avenue de L'Hôpital 1, Liège 4000, Belgium; Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Italy and Anthea Hospital, Cotignola Bari, Via Corriera, 1, 48033 Cotignola RA, Via Camillo Rosalba, 35/37, Bari 70124, Italy
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15
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Tufano A. Optimizing antithrombotic therapy for atrial fibrillation in cancer. Thromb Res 2022; 213 Suppl 1:S103-S106. [DOI: 10.1016/j.thromres.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
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16
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Pezzo MP, Tufano A, Franchini M. Role of New Potential Biomarkers in the Risk of Thromboembolism in Atrial Fibrillation. J Clin Med 2022; 11:jcm11040915. [PMID: 35207188 PMCID: PMC8877602 DOI: 10.3390/jcm11040915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke risk in atrial fibrillation differs from patient to patient, depending on numerous variables. Many attempts have been made to translate this difference into simple numbers and to compare it to the hemorrhagic risk of anticoagulation. Different clinical scores have been studied to define a clear strategy. One score, the CHA2DS2-VASc score, has been extensively and successfully applied worldwide. Nevertheless, it is not yet the “perfect instrument”. Many proposals have been made to integrate its clinical parameters with some biomarkers to improve its predictive power. This short review describes some of these biomarkers and their possible implications in potentiating the efficacy of clinical scores.
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Affiliation(s)
- Mario Piergiulio Pezzo
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantova, Italy
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17
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Lasagni D, Nosadini M, Molinari AC, Saracco P, Pelizza MF, Piersigilli F, Putti MC, Gaffuri M, Giordano P, Lorenzoni G, Francavilla A, Trapani S, Luciani M, Suppiej A, Tufano A, Tormene D, Martinato M, Gregori D, Sartori S, Simioni P. Systemic Catheter-Related Venous Thromboembolism in Children: Data From the Italian Registry of Pediatric Thrombosis. Front Pediatr 2022; 10:843643. [PMID: 35402350 PMCID: PMC8984174 DOI: 10.3389/fped.2022.843643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) represent one of the main risk factors for venous thrombotic events (VTEs) in children. METHODS We studied the Italian Registry of Pediatric Thrombosis (RITI) with regard to systemic radiologically confirmed CVC-related VTEs (CVC-VTEs) occurred during 6.5 years in children aged 29 days to 18 years. RESULTS A total of 78 CVC-VTEs were included, which occurred in 76 patients (40/76, 53% males). CVC-VTEs comprised 67 non-cardiac VTEs (86%) and 11 intracardiac thrombotic events (ICTEs) (14%); the median age at onset was 19 and 17 months, respectively. The most frequent reason for CVC insertion was supportive therapy. The catheters were placed percutaneously in 85% of cases (56/66) and surgically in the remaining 15% (10/66). Peripherally inserted central catheters (PICCs) were used in 47% (31/66) cases, partially implanted catheters in 42% (28/66), non-implantable catheters in 7% (5/66), and totally implanted catheters (Port) in 2% (1/66). CVC-VTEs were symptomatic in 77% of cases (60/78), while in the remaining 23%, they were incidentally detected on the imaging performed for the underlying condition. The median time between CVC insertion and the onset of symptoms was 10 days in non-cardiac VTEs and 39 days in ICTEs. Doppler ultrasound was the diagnostic technique most frequently used. The venous compartment most frequently affected was the veins of the lower extremities (52%, 43/73). Anti-thrombotic treatment was administered in 96% of CVC-VTEs (75/78). About 2.6% (2/76) of patients experienced a second thrombotic event. At discharge, post-thrombotic syndrome was reported in 13.5% (5/37) events with available data, CVC replacement in 10.8% (4/47), and ischemic necrosis with toe finger amputation in 2.7% (1/37). Three patients died due to an underlying condition; no CVC-VTE-related deaths were reported. CONCLUSIONS We have carried out a registry-based study on CVC-VTEs in the children in Italy, providing the data that may help improve the detection and management of this CVC-related complication.
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Affiliation(s)
- Donatella Lasagni
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | | | - Paola Saracco
- Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | | | - Maria Caterina Putti
- Department of Oncology and Hematology, University Hospital of Padua, Padua, Italy
| | | | - Paola Giordano
- Pediatric Hematology and Oncology, University of Bari, Bari, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Sandra Trapani
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Matteo Luciani
- Department of Hematology and Oncology and Transfusional Medicine, IRCCS Pediatric Hospital Bambin Gesù, Rome, Italy
| | - Agnese Suppiej
- Department of Medical Sciences-Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Daniela Tormene
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy
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Tufano A, Coppola A, Franchini M. Cardiovascular and Thromboembolic Diseases in Oncology: Novel Aspects and Revisited Issues. Semin Thromb Hemost 2021; 47:895. [PMID: 34719008 DOI: 10.1055/s-0041-1736476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders, Department of General and Specialist Medicine, University Hospital of Parma, Parma, Italy
| | - Massimo Franchini
- Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
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Franchini M, Tufano A, Coppola A. Cardiovascular and Thromboembolic Diseases in Oncology: Novel Aspects and Revisited Issues. Semin Thromb Hemost 2021; 47:896-898. [PMID: 34719009 DOI: 10.1055/s-0041-1733926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Massimo Franchini
- Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Antonio Coppola
- Department of General and Specialist Medicine, Hub Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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20
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Tufano A, Rendina D, Abate V, Casoria A, Marra A, Buonanno P, Galletti F, Di Minno G, Servillo G, Vargas M. Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10214925. [PMID: 34768445 PMCID: PMC8584903 DOI: 10.3390/jcm10214925] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background: A high incidence of venous thromboembolism (VTE) is reported in hospitalized COVID-19 patients, in particular in patients admitted to the intensive care unit (ICU). In patients with respiratory tract infections, including influenza A (H1N1), many studies have demonstrated an increased incidence of thromboses, but evidence is lacking regarding the risk difference (RD) of the occurrence of VTE between COVID-19 and non-COVID-19 patients. Methods: In this systematic review with meta-analysis, we evaluated the RD of the occurrence of VTE, pulmonary embolism (PE), and deep venous thrombosis (DVT) between COVID-19 and other pulmonary infection cohorts, in particular H1N1, and in an ICU setting. We searched for all studies comparing COVID-19 vs. non-COVID-19 regarding VTE, PE, and DVT. Results: The systematic review included 12 studies and 1,013,495 patients. The RD for VTE in COVID-19 compared to non-COVID-19 patients was 0.06 (95% CI 0.11–0.25, p = 0.011, I2 = 97%), and 0.16 in ICU (95% CI 0.045–0.27, p = 0.006, I2 = 80%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.03 (95% CI, 0.006–0.045, p = 0.01, I2 = 89%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.021 in retrospective studies (95% CI 0.00–0.04, p = 0.048, I2 = 92%) and 0.11 in ICU studies (95% CI 0.06–0.16, p < 0.001, I2 = 0%). Conclusions: The growing awareness and understanding of a massive inflammatory response combined with a hypercoagulable state that predisposes patients to thrombosis in COVID-19, in particular in the ICU, may contribute to a more appropriate strategy of prevention and earlier detection of the thrombotic events.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Veronica Abate
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.T.); (D.R.); (V.A.); (A.C.); (F.G.); (G.D.M.)
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.M.); (P.B.); (G.S.)
- Correspondence:
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Cicione A, De Nunzio C, Mancini E, Guarnotta G, Lombardo R, Nacchia A, D’Annunzio S, Flammia R, Tufano A, Leonardo C, Esperto F, Papalia R, Mastroianni R, Anceschi U, Simone G, Brassetti A, Misuraca L, Tuzzolo P, Cantiani A, Signore S, Scarpa R, Tubaro A. Role of inflammatory markers and frailty index as predictors of adverse pathological stage andcomplications in patients with upper urinary tract urothelial cancer: a multicenter analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Guarnotta G, De Nunzio C, Mancini E, Lombardo R, Nacchia A, Cicione A, D’Annunzio S, Flammia R, Tufano A, Leonardo C, Al Sahli Y, Fuschi A, Mastroianni R, Anceschi U, Simone G, Brassetti A, Tuderti G, Cantiani A, Signore S, Pastore A, Carbone A, Tubaro A. Role of inflammatory markers and frailty index as predictors of adverse pathological stage in patients with kidney cancer: a multicenter analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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23
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Proietti F, Palombi V, Flammia R, Tufano A, Bologna E, Gerolimetto C, Franco G, Leonardo C. Is tutoring radical cystectomy safetely performed by residents? Impact on perioperative outcomes from high-volume center. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Tufano A, Flammia R, Gerolimetto C, Proietti F, Canale V, Gallucci M, Leonardo C. Multiparametric prospective contrast-enhanced ultrasound evaluation of kidney lesions: comparison with histological examination. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Anceschi U, Mattevi D, Puglisi M, Flammia R, Tufano A, Cai T, Vattovani V, Brassetti A, Tuderti G, Ferriero M, Misuraca L, Bove A, Leonardo C, Guaglianone S, Mastroianni R, Malossini G, Gallucci M, Luciani L, Simone G. External validation of a novel trifecta system in predicting oncologic and functional outcomes of partial nephrectomy: results of a multicentric series. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00750-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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26
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Chiurazzi F, Tufano A, Esposito M, D'Agostino F, Casoria A, Capasso F, Minno GD. Acquired Factor V Inhibitor after Coronavirus Disease 2019 (COVID-19). Semin Thromb Hemost 2021; 48:124-126. [PMID: 34560795 DOI: 10.1055/s-0041-1735452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Federico Chiurazzi
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Maria Esposito
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Francesco D'Agostino
- Department of Hematology and Bone Marrow Transplantation, University of Naples "Federico II," Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Filomena Capasso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II," Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
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Abstract
Cancer is associated with an increased incidence of both venous thromboembolism (VTE) and arterial thrombosis (cardiovascular events and ischemic stroke). Cancer-associated arterial thrombotic events are less well studied than VTE, but increasingly recognized, particularly in specific malignancies and in association with specific anticancer therapies. The pathogenesis of arterial thrombotic events in cancer is complex and involves generation of tumor-associated procoagulant factors and a variety of alterations in platelet function as well as in the coagulation and fibrinolytic systems, and endothelial injury and dysfunction, that combine to produce hypercoagulability. The multifactorial interaction between this prothrombotic state, the individual cardiovascular risk, advanced age and presence of comorbidities, and the specific neoplasm characteristics and therapy, may induce the vascular events. Recent studies based on population databases and prospective or retrospective analyses with prolonged follow-up highlight that cancer patients experience an increased (approximately 1.5-2-fold) risk of both cerebrovascular and cardiovascular events compared with noncancer individuals, which peaks in the time period of the diagnosis of cancer but may persist for years. Beyond the type of cancer, the risk reflects the tumor burden, being higher in advanced stages and metastatic cancers. The occurrence of arterial thromboembolic events is also associated with increased overall mortality. We here present an update of the pathophysiology, risk factors, clinical evidence, and treatment considerations on cancer-associated arterial thrombosis, in the light of the need for specific multidisciplinary prevention and surveillance strategies in this setting, in the frame of cardio-oncology approaches.
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Affiliation(s)
- Massimo Franchini
- Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Antonio Coppola
- Department of General and Specialist Medicine, Hub Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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28
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Di Micco P, Tufano A, Cardillo G, Imbalzano E, Amitrano M, Lodigiani C, Bellizzi A, Camporese G, Cavalli A, De Stefano C, Russo V, Voza A, Perrella A, Prandoni P. The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study. Viruses 2021; 13:v13091720. [PMID: 34578301 PMCID: PMC8473366 DOI: 10.3390/v13091720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones.
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Affiliation(s)
- Pierpaolo Di Micco
- Department of Medicine, Ospedale Buon Consiglio Fatebenefratelli di Napoli, 80122 Naples, Italy
- Correspondence:
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy;
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
| | - Maria Amitrano
- Department of Medicine, AO Moscati, 83100 Avellino, Italy; (M.A.); (C.D.S.)
| | - Corrado Lodigiani
- Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy; (C.L.); (A.V.)
| | - Annamaria Bellizzi
- Unit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, Italy; (A.B.); (A.C.)
| | - Giuseppe Camporese
- Unit of Angiology, Department of Cardiac, Thoracic and Vascular Sciences, Padua University, 35100 Padua, Italy;
| | - Antonella Cavalli
- Unit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, Italy; (A.B.); (A.C.)
| | - Carmela De Stefano
- Department of Medicine, AO Moscati, 83100 Avellino, Italy; (M.A.); (C.D.S.)
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Antonio Voza
- Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy; (C.L.); (A.V.)
| | | | - Paolo Prandoni
- Arianna Foundation on Anticoagulation, 40138 Bologna, Italy;
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29
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Abate V, Casoria A, Rendina D, Muscariello R, Nuzzo V, Vargas M, Servillo G, Venetucci P, Conca P, Tufano A, Galletti F, Di Minno G. Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series. Semin Thromb Hemost 2021; 48:100-108. [PMID: 34388842 DOI: 10.1055/s-0041-1732370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, University of Naples "Federico II," Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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Abstract
Progress in the treatment of cancer has significantly improved survival of oncologic patients in recent decades. However, anticancer therapies, particularly some new, more potent and targeted agents, are potentially cardiotoxic. As a consequence, cardiovascular complications, including heart failure, arterial hypertension, coronary artery disease, venous thromboembolism, peripheral vascular disease, arrhythmias, pericardial disease, and pulmonary hypertension, as related to cancer itself or to anticancer treatments, are increasingly observed and may adversely affect prognosis in oncologic patients. Cardiovascular oncology is an emerging field in cardiology and internal medicine, which is rapidly growing, dealing with the prevention, the early detection, and the management of cardiovascular disease, in all stages of anticancer therapy and during the survivorship period, now crucial for reducing cardiovascular morbidity and mortality in cancer patients. In this narrative review, the existing literature regarding the epidemiology of cardiovascular oncology, the mechanisms of cardiovascular complications in cancer, and the pathophysiology of cardiotoxicity related to chemotherapeutic agents, targeted therapies, immunotherapies, and radiotherapy will be analyzed and summarized.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Antonio Coppola
- Hub Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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31
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Abstract
Splanchnic vein thrombosis (SVT), which includes portal, mesenteric, and splenic vein thrombosis and the Budd-Chiari syndrome, is an infrequent manifestation of venous thromboembolism (VTE). Like typical site VTE, SVT is also frequently associated with cancer, particularly intra-abdominal solid malignancies and myeloproliferative neoplasms (MPNs). The clinical presentation of SVT is nonspecific. Symptoms may be related to the underlying malignancy, and thrombosis is incidentally diagnosed by imaging studies for cancer staging or follow-up in a substantial proportion of cases. The occurrence of SVT predicts worse prognosis in patients with liver or pancreatic cancer and, not uncommonly, SVT may precede the diagnosis of cancer. Therefore, the occurrence of an apparently unprovoked SVT should prompt careful patient evaluation for the presence of an underlying malignancy or MPN. Cancer patients carry a high risk of VTE extension and recurrence and long-term anticoagulant treatment is suggested in the absence of high risk of bleeding. Either LMWH or direct oral anticoagulants (DOACs) are suggested for the treatment of patients with cancer-related SVT, although limited experience is available on the use of DOACs in these settings. Vitamin K antagonists (VKAs) are suggested for the short and long-term treatment of SVT associated with MPN. This review outlines the epidemiological aspects, pathogenesis, risk factors, and diagnosis of cancer-associated SVT, and addresses questions regarding the management of this challenging condition.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis and the Amalia Biron Research Institute, Sheba Medical Center, Tel-HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Maria Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Gerolimetto C, Flammia R, Tufano A, Antonelli L, Bologna E, Palombi V, Gallucci M, Leonardo C. Robot-assisted single knot-single running suture vesico-urethral anastomosis with posterior musculofascial reconstruction. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Tufano A, Canale V, Flammia R, Gerolimetto C, Proietti F, Cantisani V, Gallucci M, Leonardo C. Multiparametric prospective contrast enhanced ultrasound evaluation of kidney lesions: Comparison with histological examination. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Limongelli G, Iucolano S, Monda E, Elefante P, De Stasio C, Lubrano I, Caiazza M, Mazzella M, Fimiani F, Galdo M, De Marchi G, Esposito M, Rubino M, Cirillo A, Fusco A, Esposito A, Trama U, Esposito S, Scarano G, Sepe J, Andria G, Orlando V, Menditto E, Chiodini P, Iolascon A, Franzese A, Sanduzzi Zamparelli A, Tessitore A, Romano A, Venosa A, Nunzia Olivieri A, Bianco A, La Manna A, Cerbone AM, Spasiano A, Agnese Stanziola A, Colao A, De Bellis A, Gambale A, Toriello A, Tufano A, Ciampa A, Maria Risitano A, Pisani A, Russo A, Volpe A, De Martino B, Amato B, De Fusco C, Piscopo C, Selleri C, Tucci C, Pignata C, Cioffi D, Melis D, Pasquali D, De Brasi D, Spitaleri D, De Brasi D, Russo D, Martellotta D, De Michele E, Varricchio E, Miraglia Del Giudice E, Coscioni E, Cimino E, Pane F, Tranfa F, Pollio F, Lonardo F, Nuzzi F, Simonelli F, Trojsi F, Habetswallner F, Valentini G, Cerbone G, Parenti G, Tedeschi G, Capasso G, Battista Rossi G, Gaglione G, Sarnelli G, Argenziano G, Bellastella G, De Michele G, Fiorentino G, Spadaro G, Scala I, Santoro L, Zeppa L, Auricchio L, Elio Adinolfi L, Alessio M, Amitrano M, Savanelli MC, Russo MG, Ferrucci MG, Carbone MT, Pellecchia MT, Salerno M, Melone M, Del Donno M, Vitale M, Triggiani M, Della Monica M, Lo Presti M, Tenuta M, Mignogna MD, Schiavulli M, Zacchia M, Brunetti-Pierri N, Iovino P, Moscato P, Iandoli R, Scarpa R, Russo R, Troisi S, Sbordone S, Perrotta S, Fecarotta S, Sampaolo S, Cicalese V. Diagnostic issues faced by a rare disease healthcare network during Covid-19 outbreak: data from the Campania Rare Disease Registry. J Public Health (Oxf) 2021; 44:586-594. [PMID: 33982102 PMCID: PMC8194710 DOI: 10.1093/pubmed/fdab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background The aims of this study were: to investigate the capacity of the rare disease healthcare network in Campania to diagnose patients with rare diseases during the outbreak of Covid-19; and to shed light on problematic diagnoses during this period. Methods To describe the impact of the Covid-19 pandemic on the diagnosis of patients with rare diseases, a retrospective analysis of the Campania Region Rare Disease Registry was performed. A tailored questionnaire was sent to rare disease experts to investigate major issues during the emergency period. Results Prevalence of new diagnoses of rare disease in March and April 2020 was significantly lower than in 2019 (117 versus 317, P < 0.001 and 37 versus 349, P < 0.001, respectively) and 2018 (117 versus 389, P < 0.001 and 37 versus 282, P < 0.001, respectively). Eighty-two among 98 rare disease experts completed the questionnaire. Diagnostic success (95%), access to diagnosis (80%) and follow-up (72%), lack of Personal Protective Equipment (60%), lack of Covid-19 guidelines (50%) and the need for home therapy (78%) were the most important issues raised during Covid-19 outbreak. Conclusions This study describes the effects of the Covid-19 outbreak on the diagnosis of rare disease in a single Italian region and investigates potential issues of diagnosis and management during this period.
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Affiliation(s)
| | - Stefano Iucolano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Emanuele Monda
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Pasquale Elefante
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Chiara De Stasio
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Imma Lubrano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Caiazza
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | | | - Fabio Fimiani
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Maria Galdo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Giulia De Marchi
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Marta Rubino
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Annapaola Cirillo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Adelaide Fusco
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Augusto Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Ugo Trama
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Salvatore Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Gioacchino Scarano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Joseph Sepe
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Generoso Andria
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Valentina Orlando
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Enrica Menditto
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Paolo Chiodini
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
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Fazio S, Tufano A, de Simone G. Sustained High D-Dimer in Outpatients Who Have Recovered from Mild to Moderate Coronavirus Disease 2019 (COVID-19). Semin Thromb Hemost 2021; 48:115-117. [PMID: 33962473 DOI: 10.1055/s-0041-1729857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Serafino Fazio
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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Mancini I, Giacomini E, Pontiggia S, Artoni A, Ferrari B, Pappalardo E, Gualtierotti R, Trisolini SM, Capria S, Facchini L, Codeluppi K, Rinaldi E, Pastore D, Campus S, Caria C, Caddori A, Nicolosi D, Giuffrida G, Agostini V, Roncarati U, Mannarella C, Fragasso A, Podda GM, Birocchi S, Cerbone AM, Tufano A, Menna G, Pizzuti M, Ronchi M, De Fanti A, Amarri S, Defina M, Bocchia M, Cerù S, Gattillo S, Rosendaal FR, Peyvandi F. The HLA Variant rs6903608 Is Associated with Disease Onset and Relapse of Immune-Mediated Thrombotic Thrombocytopenic Purpura in Caucasians. J Clin Med 2020; 9:jcm9103379. [PMID: 33096882 PMCID: PMC7589625 DOI: 10.3390/jcm9103379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) deficiency, recurring in 30–50% of patients. The common human leukocyte antigen (HLA) variant rs6903608 was found to be associated with prevalent iTTP, but whether this variant is associated with disease relapse is unknown. To estimate the impact of rs6903608 on iTTP onset and relapse, we performed a case-control and cohort study in 161 Italian patients with a first iTTP episode between 2002 and 2018, and in 456 Italian controls. Variation in rs6903608 was strongly associated with iTTP onset (homozygotes odds ratio (OR) 4.68 (95% confidence interval (CI) 2.67 to 8.23); heterozygotes OR 1.64 (95%CI 0.95 to 2.83)), which occurred over three years earlier for each extra risk allele (β −3.34, 95%CI −6.69 to 0.02). Of 153 survivors (median follow-up 4.9 years (95%CI 3.7 to 6.1)), 44 (29%) relapsed. The risk allele homozygotes had a 46% (95%CI 36 to 57%) absolute risk of relapse by year 6, which was significantly higher than both heterozygotes (22% (95%CI 16 to 29%)) and reference allele homozygotes (30% (95%CI 23 to 39%)). In conclusion, HLA variant rs6903608 is a risk factor for both iTTP onset and relapse. This newly identified biomarker may help with recognizing patients at high risk of relapse, who would benefit from close monitoring or intensified immunosuppressive therapy.
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Affiliation(s)
- Ilaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Elisa Giacomini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Silvia Pontiggia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Andrea Artoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Barbara Ferrari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Emanuela Pappalardo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Saveria Capria
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Luca Facchini
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Katia Codeluppi
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Erminia Rinaldi
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Domenico Pastore
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Simona Campus
- Pediatric Unit, Ospedale Microcitemico, 09121 Cagliari, Italy;
| | - Cinzia Caria
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Aldo Caddori
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Daniela Nicolosi
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Gaetano Giuffrida
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Vanessa Agostini
- U.O. Medicina Trasfusionale, IRCCS—Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Umberto Roncarati
- U.O. Immunoematologia e Medicina Trasfusionale/Officina Trasfusionale, Cesena e Forlì, 47521 Cesena, Italy;
| | - Clara Mannarella
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Alberto Fragasso
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Gian Marco Podda
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Simone Birocchi
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Giuseppe Menna
- Department of Oncology, AORN Santobono-Pausilipon, 80122 Naples, Italy;
| | | | - Michela Ronchi
- Internal Medicine Unit, Department of Medicine, Lugo Hospital, Lugo, 48022 Ravenna, Italy;
| | - Alessandro De Fanti
- Departmental Simple Unit of Pediatric Rheumatology, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Sergio Amarri
- Paediatrics Unit, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Marzia Defina
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Monica Bocchia
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Silvia Cerù
- Hematology Unit, Santa Chiara Hospital, 38122 Trento, Italy;
| | - Salvatore Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, 20132 Milan, Italy;
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
- Correspondence: ; Tel.: +39-02-5503-5414
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Flammia R, Gerolimetto C, Tufano A, Proietti F, Bologna E, Franco G, Gallucci M, Leonardo C. Indocyanine green guided off – Clamp robot assisted partial nephrectomy for endophytic masses. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tufano A, Galderisi M. Can echocardiography improve the prediction of thromboembolic risk in atrial fibrillation? Evidences and perspectives. Intern Emerg Med 2020; 15:935-943. [PMID: 32124208 DOI: 10.1007/s11739-020-02303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/20/2020] [Indexed: 01/28/2023]
Abstract
Atrial fibrillation is the most common arrhythmia and its prevalence is expected to further increase. Patients with atrial fibrillation have an increased risk of stroke (fivefold increased risk), heart failure, and death. In patients with non-valvular atrial fibrillation, the most recent guidelines recommend the use of the CHA2DS2-VASc (congestive heart failure, arterial hypertension, age > 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category) scoring system to identify those who may benefit from oral anticoagulant treatment. Guidelines recommend initiation of oral anticoagulation with vitamin K antagonists or direct oral anticoagulants in men with a score ≥ 2 and in women with a score ≥ 3, while oral anticoagulation in individuals with a score of 0 is not recommended. Accordingly, men with CHA2DS2VASc score = 1 (and women with CHA2DS2VASc = 2) represent a grey zone where guidelines do not provide a definite oral anticoagulant indication. Implementation of risk stratification with transthoracic echocardiography could be extremely useful. Both prospective and observational studies using transthoracic echocardiography prediction of events and studies utilizing transesophageal echocardiographic parameters as surrogate markers of thromboembolic events make sustainable the hypothesis that echocardiography could improve thromboembolism prediction in non-valvular atrial fibrillation. However, because of some controversial results of different studies, determination of the best echocardiographic parameter predicting thromboembolic events in atrial fibrillation remains uncertain. The combination of left atrial enlargement with left atrial function (in particular assessing left atrial strain) appears to be very valuable, but needs to be confirmed in large-scale multi-center trials.
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Affiliation(s)
- Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Del-Toro-Cervera J, Demelo-Rodriguez P, Galeano-Valle F, Fidalgo Á, Sampériz Á, Muñoz-Torrero JFS, Lima J, Sigüenza P, Tufano A, Monreal M. Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in patients with venous thromboembolism treated with vitamin K antagonists: Findings from the RIETE registry. Thromb Res 2020; 194:178-182. [PMID: 32788113 DOI: 10.1016/j.thromres.2020.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The time in therapeutic range (TTR) of patients with venous thromboembolism (VTE) treated with vitamin K antagonists (VKA) is usually below recommended, leading to higher frequency of vascular events, bleeding and mortality. The SAMe-TT2R2 prediction score discriminates those patients with high or low probability of obtaining poor INR control and its use is recommended in patients with atrial fibrillation. Its usefulness has been evaluated in patients with VTE, with conflicting results. METHOD We included consecutive patients enrolled in Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective multicenter VTE registry, treated with VKA for >90 days and a minimum of 3 INR determinations. We analyzed the relationship between the SAMe-TT2R2 score and TTR, determined by the Rosendaal method and by the percentage of INR determinations (after excluding the first month). A ROC curve was calculated considering a cut-off point of TTR ≥65% for good anticoagulation control. RESULTS 3893 patients were included and classified in high (1411 patients) or low (2482 patients) probability of obtaining poor INR control according to the total score obtained (0-1 points versus 2 points, respectively). TTR, calculated by direct method and Rosendaal method, was 51.2 (±23.4) and 55.4 (±25.9) in the high probability group; and 54.4 (±23.0) and 58.2 (±25.6) in the low probability group, respectively (p < 0.001 for both comparisons). The outcomes were similar between groups. The predictive capacity of the SAMe-TT2R2 score showed an area under the ROC curve of 0.54 (CI 95% 0.52-0.56) and 0.53 (CI 95% 0.51-0.55). CONCLUSIONS In patients with VTE treated with VKA, the SAMe-TT2R2 score discriminated those patients with high probability of obtaining poor INR control, but with a low predictive capacity. Further studies are required to assess the usefulness of the score in clinical decision-making.
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Affiliation(s)
- Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain; Universidad Complutense de Madrid, Spain
| | - Pablo Demelo-Rodriguez
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain; Universidad Complutense de Madrid, Spain.
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain; Universidad Complutense de Madrid, Spain
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ángel Sampériz
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain
| | | | - Jorge Lima
- Department of Pneumonology, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Patricia Sigüenza
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
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41
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Calcaterra I, Tufano A, Lupoli R, Iannuzzo G, Emmi G, Di Minno MND. Cardiovascular disease and antiphospholipid syndrome: how to predict and how to treat? Pol Arch Intern Med 2020; 131:161-170. [PMID: 32491304 DOI: 10.20452/pamw.15415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune systemic disease characterized by a hyperco‑ agulable state secondary to the presence of antiphospholipid antibodies and associated with vascular thromboses and / or pregnancy complications. Although venous thrombosis represents approximately 60% of thrombotic manifestations, also cardiovascular events can occur in patients with APS, including coronary and / or noncoronary complications. Moreover, several studies consistently showed a more significant atherosclerosis in patients with APS than controls. Thus, a stratification of thrombotic and cardiovascular risk according to clinical and immunologic features is mandatory in order to prevent APS‑related vascular events. The most appropriate antithrombotic treatment of patients with arterial APS still represents an open issue, mainly in primary prevention settings. After a thrombotic event, in the absence of an adequate antithrombotic treatment, a 50% recurrence rate is reported in APS patients over a 5‑year follow‑up. Vitamin K antagonists still remain the mainstay treatment to prevent a recurrent event in patients with APS. The use of non-vitamin K oral anticoagulants in those with APS is still contro‑ versial, and identification of patients who could benefit from this therapy is still an open issue. Low‑dose aspirin should be considered in arterial APS in addition to vitamin K antagonists in a high‑risk subset, or alone for primary prophylaxis in high‑risk antiphospholipid antibodies carriers. Furthermore, statins and immunomodulation therapies have an emerging role in the treatment of APS. Overall, ad hoc designed high‑quality studies are needed to definitely determine optimal therapeutic strategies for arterial APS.
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Affiliation(s)
- Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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42
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Pilato E, Pinna GB, Grande L, Cirillo V, Izzo R, Tufano A, Guida M, Sarno L, Browning R, Comentale G. Challenging report of cardiopulmonary bypass in 16th week pregnant patient with endoventricular mass. Heart Lung 2020; 50:174-176. [PMID: 32473746 DOI: 10.1016/j.hrtlng.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy usually represents a risk factor for aortic dissection or thrombotic events, but therapeutic options are very scarce because the foetus limits the common approaches especially in the early stages of pregnancy. CASE PRESENTATION We present a challenging case of a young woman in her 16th week of gestation with an history of multiple abortions associated with autoimmune thrombophilia. A strictly designed perioperative management protocol was required to remove a huge right endoventricular mass, due to her decision to not terminate the pregnancy. CONCLUSIONS Nowadays the mother, completely healthy, gived birth to her baby so it demonstrates how cardiac surgery, even in complicated circumstances, can be feasible during pregnancy through a multidisciplinary approach.
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Affiliation(s)
- Emanuele Pilato
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy
| | | | - Loredana Grande
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy
| | - Vera Cirillo
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy
| | - Raffaele Izzo
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy
| | - Antonella Tufano
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy
| | - Maurizio Guida
- Division of Obstetrics and Gynaecology, University of Napoli "Federico II", Italy
| | - Laura Sarno
- Division of Obstetrics and Gynaecology, University of Napoli "Federico II", Italy
| | - Rosie Browning
- Division of Cardiovascular Perfusion, The Royal Brompton, London, UK
| | - Giuseppe Comentale
- Division of Cardiovascular Emergencies, University of Napoli "Federico II", Italy.
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43
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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Galderisi M, Esposito R, Sorrentino R, Mura LL, Santoro C, Tufano A. Atrial Fibrillation, Cancer and Echocardiography. J Cardiovasc Echogr 2020; 30:S33-S37. [PMID: 32566464 PMCID: PMC7293868 DOI: 10.4103/jcecho.jcecho_8_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/23/2019] [Accepted: 10/03/2019] [Indexed: 01/05/2023] Open
Abstract
Nonvalvular atrial fibrillation (AF) is a relatively frequent arrhythmia in cancer patients; it is possibly due to direct effect of cancer or consequence of cancer therapies. AF creates important problems for both therapeutic management and prognosis in cancer patients. The anticoagulation of cancer patients presenting AF is a main issue because of the difficult balance between thromboembolic and bleeding risks, both elevated in this clinical setting. A comprehensive echo Doppler examination is mandatory to identify the eventual sources of emboli in left atrial (LA) cavity, mainly the transesophageal echocardiography (TEE), but also to predict the subsequent development of heart failure. This evaluation is particularly important to graduate anticoagulation and to prevent and manage symptoms/signs of heart failure. The performance of a TEE precardioversion is highly encouraged to detect possible thrombi in LA appendage. A careful assessment of LA size (LA volume index) and function (LA emptying fraction and/or LA strain) should always be planned to predict the possible recurrence of AF paroxysmal episodes. This is in fact a key action, not only from the cardiologic point of view but also for the oncologic perspectives in individual situations. Patients with larger left atrium and more impaired LA function should be addressed toward a less aggressive cancer treatment, with drugs which are not associated or are poorly related with the risk of AF development. A correct and comprehensive echocardiographic assessment could even induce the oncologist to change the cancer management balancing the oncologic and the cardiac risk.
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Affiliation(s)
- Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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45
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Tufano A, López-Jiménez L, Bikdeli B, García-Bragado F, Mazzolai L, Amitrano M, Gómez-Cuervo C, Marchena PJ, Madridano O, Monreal M, Di Micco P. Inferior vena cava agenesis in patients with lower limb deep vein thrombosis in the RIETE registry. When and why to suspect. Int J Cardiol 2020; 305:115-119. [DOI: 10.1016/j.ijcard.2020.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
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46
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Di Minno MND, Forte F, Tufano A, Buonauro A, Rossi FW, De Paulis A, Galderisi M. Speckle tracking echocardiography in patients with systemic lupus erythematosus: A meta-analysis. Eur J Intern Med 2020; 73:16-22. [PMID: 31911023 DOI: 10.1016/j.ejim.2019.12.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE), is characterized by a systemic involvement including myocardial dysfunction. Being standard echocardiography not able at fully detecting subclinical alterations, speckle tracking echocardiography (STE) has recently emerged as a quantitative ultrasound technique to accurately estimate myocardial function. METHODS We conducted a systematic review with meta-analysis of studies reporting STE parameters in patients with SLE. RESULTS A total of 9 studies were included in the analysis. Left ventricle global longitudinal strain (GLS) was significantly lower in SLE patients than in non-SLE controls (MD: -2.331, 95% CI: -3.083, -1.580, p < 0.001). In addition, we found significant differences between SLE patients and non-SLE controls in left ventricle GLS rate (MD: -0.115, 95% CI: -0.177 to 0.063, p < 0.001), left ventricle circumferential strain(MD: -1.841, 95% CI: -3.160 to 0.521, p = 0.006) and left ventricle radial strain(MD: -11.03, 95% CI: -13.819 to 8.241, p < 0.001). Right ventricle strain was significantly lower in SLE patients than in non-SLE controls (MD: -5.814, 95% CI: -7.347, -4.281, p < 0.001). Meta-regression models showed a lower difference in left ventricle GLS between SLE cases and controls for studies with a higher prevalence of female gender and higher prevalence of hypertension. CONCLUSIONS SLE patients have lower STE parameters than controls, thus suggesting the presence of an impaired myocardial function involving both left and right ventricle.
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Affiliation(s)
| | - Francesco Forte
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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47
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Majmudar K, Golemi I, Tafur AJ, Toro JD, Visonà A, Falgá C, Sahuquillo JC, Lorente MA, Tufano A, Weinberg I, Di Micco P, Monreal M. Outcomes after venous thromboembolism in patients with gastric cancer: Analysis of the RIETE Registry. Vasc Med 2020; 25:210-217. [PMID: 32000631 DOI: 10.1177/1358863x19893432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric cancer is the fifth most common malignancy worldwide. Venous thromboembolism is an independent predictor of death among patients with gastric cancer. We aimed to describe the factors associated with mortality, thrombosis recurrence, and bleeding complications in patients with gastric cancer who develop venous thromboembolism. We included 612 patients with gastric cancer and venous thromboembolism in the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry from 2001 to 2018. We used Cox proportional hazard ratios and a Fine-Gray model to define factors associated with outcomes. The overall mortality at 6 months was 44.4%. Factors associated with increased 6-month mortality included immobility (HR 1.8, 95% CI 1.3-2.4; p < 0.001), anemia (HR 1.4, 95% CI 1.1-1.8; p < 0.02), and leukocytosis (HR 1.8, 95% CI 1.4-2.3; p < 0.001). Recurrent thrombosis occurred in 6.5% of patients and major bleeding complications in 8.5% of the cohort. Male sex was the main factor associated with thrombosis recurrence (HR 2.1, 95% CI 1.1-4.0; p < 0.02) and hemoglobin below 10 g/dL (HR 1.6, 95% CI 1.05-2.50; p = 0.03) the main factor associated with bleeding. In conclusion, patients with gastric cancer who develop venous thrombosis have a very high likelihood of death. Low hemoglobin in this population is associated with poor outcomes.
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Affiliation(s)
- Kaushal Majmudar
- Department of Medicine, Division of Internal Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Iva Golemi
- Department of Medicine, Division of Internal Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alfonso J Tafur
- Department of Medicine, Division of Vascular Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jorge Del Toro
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Conxita Falgá
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | | | | | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy
| | - Ido Weinberg
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pierpaolo Di Micco
- Department of Medicine, UOC Medicina, Fatebenefratelli Hospital of Napoli, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain
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48
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Avnery O, Martin M, Bura-Riviere A, Barillari G, Mazzolai L, Mahé I, Marchena PJ, Verhamme P, Monreal M, Ellis MH, Aibar MA, Aibar J, Amado C, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón‐Andrés B, Bascuñana J, ina A, Camon AM, Cañas I, Carrasco C, Castro J, Ancos C, Toro J, Demelo P, Díaz‐Peromingo JA, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Criado MC, Fernández‐Núñez S, Fidalgo MA, Font C, Font L, Freire M, Gallego M, García MA, García‐Bragado F, García‐Morillo M, García‐Raso A, Gavín O, Gayol MC, Gil‐Díaz A, Gómez V, Gómez‐Cuervo C, González‐Martínez J, Grau E, Gutiérrez J, Hernández‐Blasco LM, Iglesias M, Jara‐Palomares L, Jaras MJ, Jiménez R, Jiménez‐Castro D, Jiménez‐López J, Joya MD, Lima J, Llamas P, Lobo JL, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Martín del Pozo M, Martín‐Guerra JM, Martín‐Romero M, Mellado M, Morales MV, Muñoz N, Nieto‐Cabrera MA, Nieto‐Rodríguez JA, Núñez‐Ares A, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez‐Rus G, Peris ML, Porras JA, Rivas A, Rodríguez‐Dávila MA, Rodríguez‐Hernández A, Rubio CM, Ruiz‐Artacho P, Ruiz‐Ruiz J, Ruiz‐Torregrosa P, Ruiz‐Sada P, Sahuquillo JC, Salazar V, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Soler S, Sopeña B, Suriñach JM, Tolosa C, Torres MI, Trujillo‐Santos J, Uresandi F, Valle R, Vidal G, Villares P, Gutiérrez P, Vázquez FJ, Vilaseca A, Vanassche T, Vandenbriele C, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Debourdeau P, Farge‐Bancel D, Hij A, Moustafa F, Schellong S, Braester A, Brenner B, Tzoran I, Sharif‐Kashani B, Bilora F, Bortoluzzi C, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Di Pangrazio M, Maida R, Mastroiacovo D, Pace F, Pallotti G, Parisi R, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Gibietis V, Skride A, Strautmane S, Bosevski M, Zdraveska M, Bounameaux H, Fresa M, Ney B, Caprini J, Bui HM, Pham KQ. D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry. J Intern Med 2020; 287:32-41. [PMID: 31394000 DOI: 10.1111/joim.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). RESULTS In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. CONCLUSIONS Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.
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Affiliation(s)
- O Avnery
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Martin
- Hospital Infanta Sofia San Sebastian de los Reyes and Universidad Europea de Madrid, Madrid, Spain
| | - A Bura-Riviere
- Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
| | - G Barillari
- Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy
| | - L Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - I Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, Colombes, France
| | - P J Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
| | - P Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - M Monreal
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M H Ellis
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Esposito L, Sorrentino R, Capone V, Santoro C, Lembo M, Esposito R, Lo Iudice F, De Roberto AM, Tufano A, Galderisi M. P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF.
Purpose
To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF.
Methods
In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile <25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile > 29.3 Kg/m² (n = 130).
Results
No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p < 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p < 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p < 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p < 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p < 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p < 0.02) (cumulative R² =0.41, SEE = 8.5%, p < 0.0001).
Conclusions
In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF.
Abstract P814 Figure. Relation between BMI and PALS
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Affiliation(s)
- L Esposito
- University Hospital Federico II, Naples, Italy
| | | | - V Capone
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Lo Iudice
- University Hospital Federico II, Naples, Italy
| | | | - A Tufano
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Bikdeli B, Jiménez D, Garcia-Tsao G, Barba R, Font C, Díaz-Pedroche MDC, Mazzolai L, Little DHW, Tufano A, Tafur AJ, Siegal D, Lip GYH, Monreal M. Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry. Semin Thromb Hemost 2019; 45:793-801. [PMID: 31614388 DOI: 10.1055/s-0039-1697682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43-201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38-2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03-5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65-37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03-6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69-4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91-4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5-20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00-4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.,Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, Connecticut.,Cardiovascular Research Foundation, New York, New York
| | - David Jiménez
- Department of Respiratory, Hospital Ramón y Cajal, Madrid, Spain.,Department of Medicine, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Raquel Barba
- Department of Internal Medicine, Fundación Hospital Alcorcón, Madrid, Spain
| | - Carme Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | | | - Lucia Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II, University Hospital, Naples, Italy
| | - Alfonso J Tafur
- Department of Medicine, Vascular Medicine, NorthShore University HealthSystem, University of Chicago, Chicago, Illinois
| | - Deborah Siegal
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Manuel Monreal
- Department of Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Universidad Católica de Murcia, Murcia, Spain
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