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di Gennaro C, Galdiero M, Scherillo G, Parlamento S, Poggiano MR, Arturo C, Vasta A, Giordano B, Pisano V, Lobasso A, Camporese G, Di Micco P. Editorial COVID-19 and Thrombosis 2023: New Waves of SARS-CoV-2 Infection, Triage Organization in Emergency Department and the Association of VOCs/VOI with Pulmonary Embolism. Viruses 2022; 14:v14112453. [PMID: 36366551 PMCID: PMC9692792 DOI: 10.3390/v14112453] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Nearly two years ago, the SARS-CoV-2 outbreak began, and our lives have changed significantly since then [...]
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Affiliation(s)
- Ciro di Gennaro
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Mariano Galdiero
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Giovanna Scherillo
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Stefano Parlamento
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Maria Rita Poggiano
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Claudia Arturo
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Antonio Vasta
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Beniamino Giordano
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Viviana Pisano
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Antonio Lobasso
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
| | - Giuseppe Camporese
- UO Internal Medicine, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Pierpaolo Di Micco
- Department of Medicine PO A Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy
- Correspondence:
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Cella CA, Di Minno G, Carlomagno C, Arcopinto M, Cerbone AM, Matano E, Tufano A, Lordick F, De Simone B, Muehlberg KS, Bruzzese D, Attademo L, Arturo C, Sodano M, Moretto R, La Fata E, De Placido S. Preventing Venous Thromboembolism in Ambulatory Cancer Patients: The ONKOTEV Study. Oncologist 2017; 22:601-608. [PMID: 28424324 DOI: 10.1634/theoncologist.2016-0246] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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: 06/09/2016] [Accepted: 12/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The efficacy of risk model scores to predict venous thromboembolism (VTE) in ambulatory cancer patients is under investigation, aiming to stratify on an individual risk basis the subset of the cancer population that could mostly benefit from primary thromboprophylaxis. MATERIALS AND METHODS We prospectively assessed 843 patients with active cancers, collecting clinical and laboratory data. We screened all the patients with a duplex ultrasound (B-mode imaging and Doppler waveform analysis) of the upper and lower limbs to evaluate the right incidence of VTE (both asymptomatic and symptomatic). The efficacy of the existing Khorana risk model in preventing VTE was also explored in our population. Several risk factors associated with VTE were analyzed, leading to the construction of a risk model. The Fine and Gray model was used to account for death as a competing risk in the derivation of the new model. RESULTS The risk factors significantly associated with VTE at univariate analysis and further confirmed in the multivariate analysis, after bootstrap validation, were the presence of metastatic disease, the compression of vascular/lymphatic structures by tumor, a history of previous VTE, and a Khorana score >2. Time-dependent receiving operating characteristic (ROC) curve analysis showed a significant improvement in the area under the curve of the new score over the Khorana model at 3 months (71.9% vs. 57.9%, p = .001), 6 months (75.4% vs. 58.6%, p < .001), and 12 months (69.8% vs. 58.3%, p = .014). CONCLUSION ONKOTEV score steps into history of cancer-related-VTE as a promising tool to drive the decision about primary prophylaxis in cancer outpatients. The validation represents the goal of the prospective ONKOTEV-2 study, endorsed and approved by the European Organization for Research and Treatment of Cancer Young Investigators Program. The Oncologist 2017;22:601-608 IMPLICATIONS FOR PRACTICE: Preventing venous thromboembolism in cancer outpatients with a risk model score will drive physicians' decision of starting thromboprophylaxis in high-risk patients.
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Affiliation(s)
- Chiara Alessandra Cella
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Michele Arcopinto
- Heart Surgery Department, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Biagio De Simone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Laura Attademo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Arturo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marta Sodano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Moretto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ersilia La Fata
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Tufano A, Di Capua M, Coppola A, Arturo C, Ieranò P, Cerbone AM, Di Minno G. The challenge of diagnosing pulmonary embolism in children, pregnant women, and elderly patients: a descriptive review of the literature. Semin Thromb Hemost 2011; 37:908-17. [PMID: 22198856 DOI: 10.1055/s-0031-1297370] [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: 10/14/2022]
Abstract
The prompt and accurate diagnosis of pulmonary embolism (PE) greatly influences patient outcomes. However, diagnosing PE is one of the most difficult challenges confronting physicians, even more so when the clinical suspicion is addressed in children, during pregnancy, or in elderly patients. In these patient groups, symptoms and signs from concomitant conditions or diseases may mimic PE and make difficult defining clinical probability categories for PE as usually applied to general adult patients. Moreover, the diagnostic techniques show wider, specific limitations in these settings. PE is considered rare in children. The diagnostic management of a child with suspected PE is largely extrapolated from the knowledge achieved in adult patients. An increased risk of venous thromboembolism is reported in all trimesters of pregnancy and in the puerperium. An accurate diagnosis of PE in pregnancy has important implications, including the need for prolonged anticoagulation, delivery planning, and prophylaxis during future pregnancies, as well as concerns about future oral contraceptive use and estrogen therapy. Although incidence, morbidity, and mortality increase steadily with age, PE remains an underdiagnosed disease in elderly patients. About 40% of PE found at necropsy were not suspected antemortem. In the present article, challenges in diagnosing PE in children, during pregnancy, and in the elderly will be discussed, reviewing the available clinical, laboratory, and instrumental diagnostic strategies.
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Affiliation(s)
- Antonella Tufano
- Regional Reference Center for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
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Coppola A, Di Capua M, Di Minno MND, Di Palo M, Marrone E, Ieranò P, Arturo C, Tufano A, Cerbone AM. Treatment of hemophilia: a review of current advances and ongoing issues. J Blood Med 2010; 1:183-95. [PMID: 22282697 PMCID: PMC3262316 DOI: 10.2147/jbm.s6885] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [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: 08/28/2010] [Indexed: 01/27/2023] Open
Abstract
Replacement of the congenitally deficient factor VIII or IX through plasma-derived or recombinant concentrates is the mainstay of treatment for hemophilia. Concentrate infusions when hemorrhages occur typically in joint and muscles (on-demand treatment) is able to resolve bleeding, but does not prevent the progressive joint deterioration leading to crippling hemophilic arthropathy. Therefore, primary prophylaxis, ie, regular infusion of concentrates started after the first joint bleed and/or before the age of two years, is now recognized as first-line treatment in children with severe hemophilia. Secondary prophylaxis, whenever started, aims to avoid (or delay) the progression of arthropathy and improve patient quality of life. Interestingly, recent data suggest a role for early prophylaxis also in preventing development of inhibitors, the most serious complication of treatment in hemophilia, in which multiple genetic and environmental factors may be involved. Treatment of bleeds in patients with inhibitors requires bypassing agents (activated prothrombin complex concentrates, recombinant factor VIIa). However, eradication of inhibitors by induction of immune tolerance should be the first choice for patients with recent onset inhibitors. The wide availability of safe factor concentrates and programs for comprehensive care has now resulted in highly satisfactory treatment of hemophilia patients in developed countries. Unfortunately, this is not true for more than two-thirds of persons with hemophilia, who live in developing countries.
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Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
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D'Ascia SL, Santulli G, Liguori V, Marino V, Arturo C, Chiariello M, D'Ascia C. Advanced algorithms can lead to electrocardiographic misinterpretations. Int J Cardiol 2010; 141:e34-6. [DOI: 10.1016/j.ijcard.2008.11.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 11/26/2008] [Indexed: 11/29/2022]
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