1
|
Wysokinski WE, Houghton DE, Vlazny DT, Ashrani AA, Froehling DA, Kamath PS, Meverden RA, Hodge DO, Peterson LG, Lang TR, McBane RD, Casanegra AI. Influence of primary cancer site on clinical outcomes of anticoagulation for associated venous thromboembolism. Thromb Res 2023; 221:37-44. [PMID: 36463701 DOI: 10.1016/j.thromres.2022.11.005] [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] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/29/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The outcome of anticoagulation for cancer-associated venous thromboembolism (Ca-VTE) differs according to cancer location, but data are limited and inconsistent. MATERIALS AND METHODS Patients with acute venous thromboembolism (VTE) enrolled between 03/01/2013 and 04/30/2021 were followed prospectively to assess VTE recurrence, major bleeding (MB), clinically relevant non-major bleeding (CRNMB), and death. RESULTS There were 1702 (45.3 %) patients with Ca-VTE including: gastrointestinal (n = 340), pancreatic (n = 223), hematologic (n = 188), genitourinary (n = 163), lung (n = 139), ovarian (n = 109), breast (n = 97), renal (n = 75), prostate (n = 73), hepatobiliary (n = 70), brain (n = 57), and other cancers (n = 168); 2057 VTE patients had no cancer (NoCa-VTE). Hepatobiliary cancer had the highest VTE recurrence (all rates 100 person-years) of all cancers and higher compared to NoCa-VTE (13.69, p = 0.01), while the MB rate, although numerically higher (15.91), was not different (p = 0.09). Another 3 cancers had higher VTE recurrence but similar MB rates compared to NoCa-VTE: genitourinary [(9.59, p = 0.01) and (7.03, p = 1.0)], pancreatic [(9.74, p < 0.001) and (5.47, p = 1.00)], and hematologic [(5.29, p = 0.05) and (3.59, p = 1.0)]. Renal cancer had the highest rate of MB among all cancers and was higher than that of NoCa-VTE (16.49; p < 0.001), with no difference in VTE recurrence (1.62; p = 1.0). VTE recurrence and MB rates were not significantly different between NoCa-VTE and gastrointestinal, lung, breast, prostate, and brain cancers. CRNMB rates were similar and mortality higher in Ca-VTE patients, except for prostate and breast cancer, compared to NoCa-VTE. CONCLUSIONS Significant differences in clinical outcomes indicate that anticoagulation strategies may need to be tailored to the primary cancer location.
Collapse
Affiliation(s)
- Waldemar E Wysokinski
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America.
| | - Damon E Houghton
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Danielle T Vlazny
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Aneel A Ashrani
- Hematology/Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - David A Froehling
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Patrick S Kamath
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
| | - Ryan A Meverden
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America
| | - Lisa G Peterson
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Teresa R Lang
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Robert D McBane
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| | - Ana I Casanegra
- Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
2
|
Wysokinska EM, Houghton DE, Vlazny DT, Ashrani AA, Froehling DA, Meverden R, Hodge DO, Peterson LG, McBane RD, Wysokinski WE, Casanegra AI. Incidental pulmonary embolism in cancer and noncancer patients: Prospective cohort study. Eur J Haematol Suppl 2022; 110:88-98. [PMID: 36210612 DOI: 10.1111/ejh.13877] [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] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical picture and outcome of incidental pulmonary embolism (iPE) compared to symptomatic pulmonary embolism (sPE) remain unclear. METHODS Demographics, recurrent venous thromboembolism (VTE), mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) were compared between iPE and sPE patients who were followed prospectively at Mayo Thrombophilia Clinic (March 1, 2013 to August 1, 2020). RESULTS Out of 3576 VTE patients, 1417 (39.6%) had PE: 562 (39.7%) iPE and 855 sPE. Patients with cancer were more likely to have iPE (400 iPE vs. 314 sPE) compared to those without cancer (162 iPE vs. 541 sPE). VTE recurrence rate (all per 100 person-years) was similar in all iPE and sPE patients (3.34 vs. 3.68, p = .50), with cancer (4.16 vs. 4.89, p = .370), and without cancer patients (0.89 vs. 2.80, p = .25). Higher mortality observed in all patients with iPE compared to sPE (46.45 vs. 23.47, p < .001) and with cancer (56.41 vs. 45.77, p = .03) became not significant after adjustment for age, antiplatelet therapy, metastases, and cancer location. Noncancer iPE patients had higher mortality (15.95 vs. 7.18, p = .006) even after adjustment (p = .05). The major bleeding rate was also higher in all patients iPE compared to sPE (7.10 vs. 3.68, p = .03), but not after adjustment (p = .974); higher major bleeding rate in noncancer patients (6.49 vs. 1.25, p = .007) remained significant after adjustment (.02). CRNMB rate was similar to iPE and sPE patients. CONCLUSION iPE represents a more serious clinical condition compared to sPE as indicated by the higher mortality and major bleeding but these differences reflect underlying comorbidities rather than the seriousness of the embolic event.
Collapse
Affiliation(s)
| | - Damon E Houghton
- Hematology Division, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Danielle T Vlazny
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aneel A Ashrani
- Hematology Division, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Froehling
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Meverden
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Lisa G Peterson
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert D McBane
- Hematology Division, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Waldemar E Wysokinski
- Hematology Division, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I Casanegra
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Hirao-Try Y, Vlazny DT, Meverden R, Houghton DE, Casanegra AI, Froehling DA, Hodge DO, Peterson LG, McBane RD, Wysokinski WE. Single versus multiple and incidental versus symptomatic subsegmental pulmonary embolism: clinical characteristics and outcome. J Thromb Thrombolysis 2022; 54:82-90. [PMID: 34993715 DOI: 10.1007/s11239-021-02623-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
It remains unexplored if the clinical picture and outcome of subsegmental pulmonary embolism (SSPE) differ between single versus multiple, and incidental versus symptomatic embolism. Consecutive patients anticoagulated for SSPE at the Mayo Thrombophilia Clinic (03/01/2013-12/31/2020) were followed forward to assess venous thromboembolism (VTE) recurrence, mortality, major bleeding, and clinically relevant non-major bleeding (CRNMB); expressed as a rate per 100 person-years. Among 3878 VTE patients, 1541 had pulmonary embolism including 224 (14.6%) with SSPE either single (n = 139) or multiple (n = 85; 46 bilateral and 39 unilateral emboli); 134 had incidental and 90 symptomatic SSPE. Patients with single were less often symptomatic and less often had coexisting DVT than multiple SSPE. Patients with incidental had a two-fold higher frequency of cancer compared to symptomatic SSPE. During the study period, 1 patient with single and 2 with multiple SSPE had VTE recurrence (rate of 1.14 vs 3.63, p = 0.280). Single SSPE patients experienced 2 episodes of major bleeding (rate of 2.36) while the multiple SSPE group had no major bleeding. Seven patients in each group had CRNMB events (rate of 8.20 vs 13.58 for single and multiple SSPE, respectively, p = 0.282). Patients with single SSPE had a higher death rate compared to multiple SSPE (43.07 vs 22.22, p = 0.031) but no difference was noted after adjusting for cancer (p = 0.388). Also, incidental had similar clinical outcomes to symptomatic SSPE.Interpretation Anticoagulated SSPE patients with single and multiple as well as incidental and symptomatic have a different clinical profile but similar clinical outcomes.
Collapse
Affiliation(s)
- Yumiko Hirao-Try
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Danielle T Vlazny
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Ryan Meverden
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Damon E Houghton
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Ana I Casanegra
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - David A Froehling
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, FL, USA
| | - Lisa G Peterson
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Robert D McBane
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA
| | - Waldemar E Wysokinski
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA. .,Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| |
Collapse
|
4
|
Houghton DE, Vlazny DT, Casanegra AI, Brunton N, Froehling DA, Meverden RA, Hodge DO, Peterson LG, McBane RD, Wysokinski WE. Bleeding in Patients With Gastrointestinal Cancer Compared With Nongastrointestinal Cancer Treated With Apixaban, Rivaroxaban, or Enoxaparin for Acute Venous Thromboembolism. Mayo Clin Proc 2021; 96:2793-2805. [PMID: 34425962 DOI: 10.1016/j.mayocp.2021.04.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/13/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the bleeding risk in patients with gastrointestinal (GI) cancer with that in patients with non-GI cancer treated with anticoagulation for acute cancer-associated venous thromboembolism (Ca-VTE). PATIENTS AND METHODS Consecutive patients with Ca-VTE seen at the Mayo Thrombophilia Clinic between March 1, 2013, and April 20, 2020, were observed prospectively to assess major bleeding and clinically relevant nonmajor bleeding (CRNMB). RESULTS In the group of 1392 patients with Ca-VTE, 499 (35.8%) had GI cancer including 272 with luminal GI cancer (lower GI, 208; upper GI, 64), 176 with pancreatic cancer, and 51 with hepatobiliary cancer. The rate of major bleeding and CRNMB in patients with GI cancer was similar to that in 893 (64.2%) patients with non-GI cancer treated with apixaban, rivaroxaban, or enoxaparin. Apixaban had a higher rate of major bleeding in luminal GI cancer compared with the non-GI cancer group (15.59 vs 3.26 per 100 person-years; P=.004) and compared with enoxaparin in patients with luminal GI cancer (15.59 vs 3.17; P=.04). Apixaban had a lower rate of CRNMB compared with rivaroxaban in patients with GI cancer (3.83 vs 9.40 per 100 person-years; P=.03). Patients treated with rivaroxaban in the luminal GI cancer group had a major bleeding rate similar to that of patients with non-GI cancer (2.04 vs 4.91 per 100 person-years; P=.37). CONCLUSION Apixaban has a higher rate of major bleeding in patients with luminal GI cancer compared with patients with non-GI cancer and compared with enoxaparin in patients with luminal GI cancer. Rivaroxaban shows no increased risk of major bleeding in patients with GI cancer or luminal GI cancer compared with patients with non-GI cancer. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03504007.
Collapse
Affiliation(s)
- Damon E Houghton
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Danielle T Vlazny
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ana I Casanegra
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - David A Froehling
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan A Meverden
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Lisa G Peterson
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Robert D McBane
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
5
|
Augustine MR, Knavel Koepsel EM, Peterson LG, Rupkalvis L, Comstock A, McPhail I, McBane RD, Bjarnason H, Houghton DE. Evaluation of Changing Vena Cava Filter Use and Inpatient Hospital Mortality from 2016-2019: A Single-Institution Quality Improvement Project. Mayo Clin Proc Innov Qual Outcomes 2021; 5:851-858. [PMID: 34514336 PMCID: PMC8424125 DOI: 10.1016/j.mayocpiqo.2021.08.006] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the changing trends of vena cava filter (VCF) insertion and determine whether changes in VCF use affected inpatient mortality. Patients and Methods A quality improvement project at Mayo Clinic, Rochester, Minnesota, tracks the type and reason for VCF insertions from January 1, 2016, through December 31, 2019, to facilitate appropriate retrieval. The rate of VCF insertions was compared with inpatient mortality rates, normalized for patient volumes using the number of hospital inpatient discharges. Results A total of 698 VCFs were placed in 695 patients: 2016 (n=243), 2017 (n=156), 2018 (n=156), and 2019 (n=120). The rate of VCF insertions (per 1000 inpatient discharges) was 4.02 in 2016, 2.91 in 2017, 2.54 in 2018, and 1.93 in 2019. Mean ± SD age at placement was 62±16.4 years and 59.2% (413/698) were men. Most VCFs were retrievable (85.1%; 594/698) and were placed for treatment (78.4%; 547/698) indications (acute venous thromboembolism within 3 months). The rate of VCF insertions was compared with the inpatient mortality rate (per 100 inpatient discharges) and remained stable (1.83 in 2016, 1.79 in 2017, 1.83 in 2018, and 1.76 in 2019) despite the significant decline in VCF use. Conclusion Data from this quality improvement study demonstrate a reduction of more than 50% in the use of VCFs from 2016 through 2019 at a large academic hospital. These changes are difficult to attribute to any single change in clinical use and there was no appreciable increase in the inpatient hospital mortality rate associated with this decrease in VCF filter use.
Collapse
Affiliation(s)
| | | | | | - Laurie Rupkalvis
- Gonda Vascular Center, Departments of Radiology, Mayo Clinic, Rochester, MN
| | - Ann Comstock
- Gonda Vascular Center, Departments of Radiology, Mayo Clinic, Rochester, MN
| | - Ian McPhail
- Gonda Vascular Center, Departments of Radiology, Mayo Clinic, Rochester, MN
| | | | - Haraldur Bjarnason
- Gonda Vascular Center, Departments of Radiology, Mayo Clinic, Rochester, MN
| | - Damon E. Houghton
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Correspondence: Address to Damon E. Houghton, MD, MSc, 200 1st St NW, Rochester, MN 55901.
| |
Collapse
|
6
|
Wysokinski WE, Froehling DA, Houghton DE, McBane RD, Vlazny DT, Bott‐Kitslaar DM, Kuczmik W, Sutkowska K, Bator K, Hodge DO, Peterson LG, Casanegra AI. Effectiveness and safety of apixaban and rivaroxaban for acute venous thromboembolism therapy in patients with extremes in bodyweight. Eur J Haematol 2020; 105:484-494. [DOI: 10.1111/ejh.13471] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Waldemar E. Wysokinski
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - David A. Froehling
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Damon E. Houghton
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Robert D. McBane
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Danielle T. Vlazny
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Dalene M. Bott‐Kitslaar
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | | | | | - Kaja Bator
- Wroclaw Medical University Wroclaw Poland
| | - David O. Hodge
- Department of Health Sciences Research Mayo Clinic Jacksonville FL USA
| | - Lisa G. Peterson
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Ana I. Casanegra
- Gonda Vascular Center Thrombophilia Clinic Division of Vascular Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| |
Collapse
|
7
|
Houghton DE, Casanegra AI, Peterson LG, Cochuyt J, Hodge DO, Vlazny D, McBane RD, Froehling D, Wysokinski WE. Treatment of upper extremity deep vein thrombosis with apixaban and rivaroxaban. Am J Hematol 2020; 95:817-823. [PMID: 32267011 DOI: 10.1002/ajh.25820] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022]
Abstract
Randomized controlled trials leading to the approval of apixaban and rivaroxaban for venous thromboembolism (VTE) did not include patients with upper extremity deep vein thrombosis (UE-DVT). We sought to evaluate the safety and effectiveness of rivaroxaban and apixaban for the treatment of acute UE-DVT. Consecutive patients with VTE enrolled into the Mayo Clinic VTE Registry, between March 1, 2013 and December 31, 2019, were followed prospectively. Clinical, demographic and imaging data were collected at the time of study recruitment. Patients with a diagnosis of acute UE-DVT who received rivaroxaban, apixaban, LMWH or warfarin were included. Recurrent VTE, major bleeding, clinical-relevant non-major bleeding (CRNMB), and death were assessed at 3-month intervals. During the study period, 210 patients with acute UE-DVT were included; 63 were treated with apixaban, 39 with rivaroxaban, and 108 with LWMH and/or warfarin. Overall 51% had catheter-associated UE-DVT, 60% had a diagnosis of malignancy, and 14% had concurrent pulmonary embolism. Malignancy was more common in patients treated with LMWH/warfarin (67% vs 52%, P = .03). At 3 months of follow up, one (0.9%) recurrent VTE occurred in a patient treated with LMWH/warfarin and one (1.0%) patient treated with apixaban or rivaroxaban (P = .97). Major bleeding occurred in three patients treated with LMWH/warfarin, and in none of those treated with apixaban or rivaroxaban (P = .09). Clinical-relevant non-major bleeding occurred in one patient (0.9%) treated with LWMH/warfarin and two patients (2.0%) treated with apixaban or rivaroxaban (P = .53). Treatment of UE-DVT with apixaban or rivaroxaban appears to be as safe and effective as LMWH/warfarin.
Collapse
Affiliation(s)
- Damon E. Houghton
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Ana I. Casanegra
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Lisa G. Peterson
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Jordan Cochuyt
- Department of Health Sciences ResearchMayo Clinic Jacksonville Florida USA
| | - David O. Hodge
- Department of Health Sciences ResearchMayo Clinic Jacksonville Florida USA
| | - Danielle Vlazny
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Robert D. McBane
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - David Froehling
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Waldemar E. Wysokinski
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| |
Collapse
|
8
|
Wysokinski WE, Houghton DE, Casanegra AI, Vlazny DT, Bott‐Kitslaar DM, Froehling DA, Hodge DO, Peterson LG, Mcbane RD. Comparison of apixaban to rivaroxaban and enoxaparin in acute cancer-associated venous thromboembolism. Am J Hematol 2019; 94:1185-1192. [PMID: 31378995 DOI: 10.1002/ajh.25604] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/15/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
To provide direct comparison between apixaban and rivaroxaban in patients with acute cancer-associated venous thromboembolism (Ca-VTE), consecutive patients treated with apixaban, rivaroxaban, or enoxaparin at Mayo Thrombophilia Clinic (March 1, 2013 to January 31, 2018)) were followed prospectively. The primary effectiveness outcome was venous thromboembolism (VTE) recurrence, and the secondary was mortality. The primary safety outcome was major bleeding, the secondary clinically relevant safety outcome was non-major bleeding (CRNMB), and the third a composite of major and CRNMB. There were 750 patients treated for acute Ca-VTE with apixaban (n = 224), rivaroxaban (n = 163), and enoxaparin (n = 363) within 14 days of diagnosis and for at least 3 months, or until study event. Recurrent VTE was diagnosed in 11 receiving apixaban, 7 receiving rivaroxaban (apixaban vs rivaroxaban hazard ratio (HR) 1.31, 95% confidence interval (95% CI) 0.51-3.36) and 17 in the enoxaparin receiving group (apixaban vs enoxaparin HR 1.14, 95% CI: 0.54, 2.42 and rivaroxaban vs enoxaparin HR 0.85, 95% Cl: 0.36, 2.06). There were 82 deaths in apixaban, 74 rivaroxaban (apixaban vs rivaroxaban HR 1.67, 95% Cl: 1.20, 2.33) and 171 in enoxaparin group (rivaroxaban vs enoxaparin HR 0.73, 95% Cl: 0.56, 0.96). Major bleeding occurred in 11 apixaban, 12 rivaroxaban (apixaban vs rivaroxaban HR 0.73, 95% Cl: 0.32, 1.66) and 21 enoxaparin group (apixaban vs enoxaparin HR 0.89, 95% Cl: 0.43, 1.84 and rivaroxaban vs enoxaparin HR 1.23, 95% Cl: 0.61, 2.50). The CRNMB rate was higher in rivaroxaban compared to apixaban (P = .03) and LMWH (P = .01) groups. Recurrence of VTE and major bleeding were similar in apixaban, rivaroxaban, and enoxaparin groups. Rivaroxaban was associated with higher CRNMB but lower mortality compared to apixaban and enoxaparin.
Collapse
Affiliation(s)
| | - Damon E. Houghton
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| | - Ana I. Casanegra
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| | - Danielle T. Vlazny
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| | | | - David A. Froehling
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| | - David O. Hodge
- Department of Health Sciences ResearchMayo Clinic Jacksonville Florida
| | - Lisa G. Peterson
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| | - Robert D. Mcbane
- Vascular Medicine DivisionGonda Vascular Center, Mayo Clinic Rochester Minnesota
| |
Collapse
|
9
|
Barnard EP, AbdElmagied AM, Vaughan LE, Weaver AL, Laughlin-Tommaso SK, Hesley GK, Woodrum DA, Jacoby VL, Kohi MP, Price TM, Nieves A, Miller MJ, Borah BJ, Gorny KR, Leppert PC, Peterson LG, Stewart EA. Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis. Am J Obstet Gynecol 2017; 216:500.e1-500.e11. [PMID: 28063909 DOI: 10.1016/j.ajog.2016.12.177] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/21/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Uterine fibroids are a common problem for reproductive-aged women, yet little comparative effectiveness research is available to guide treatment choice. Uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery are minimally invasive therapies approved by the US Food and Drug Administration for treating symptomatic uterine fibroids. The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study is the first randomized controlled trial to compare these 2 fibroid treatments. OBJECTIVE The objective of the study was to summarize treatment parameters and compare recovery trajectory and adverse events in the first 6 weeks after treatment. STUDY DESIGN Premenopausal women with symptomatic uterine fibroids seen at 3 US academic medical centers were enrolled in the randomized controlled trial (n = 57). Women meeting identical criteria who declined randomization but agreed to study participation were enrolled in a nonrandomized parallel cohort (n = 34). The 2 treatment groups were analyzed by using a comprehensive cohort design. All women undergoing focused ultrasound and uterine artery embolization received the same postprocedure prescriptions, instructions, and symptom diaries for comparison of recovery in the first 6 weeks. Return to work and normal activities, medication use, symptoms, and adverse events were captured with postprocedure diaries. Data were analyzed using the Wilcoxon rank sum test or χ2 test. Multivariable regression was used to adjust for baseline pain levels and fibroid load when comparing opioid medication, adverse events, and recovery time between treatment groups because these factors varied at baseline between groups and could affect outcomes. Adverse events were also collected. RESULTS Of 83 women in the comprehensive cohort design who underwent treatment, 75 completed postprocedure diaries. Focused ultrasound surgery was a longer procedure than embolization (mean [SD], 405 [146] vs 139 [44] min; P <.001). Of women undergoing focused ultrasound (n = 43), 23 (53%) underwent 2 treatment days. Immediate self-rated postprocedure pain was higher after uterine artery embolization than focused ultrasound (median [interquartile range], 5 [1-7] vs 1 [1-4]; P = .002). Compared with those having focused ultrasound (n = 39), women undergoing embolization (n = 36) were more likely to use outpatient opioid (75% vs 21%; P < .001) and nonsteroidal antiinflammatory medications (97% vs 67%; P < .001) and to have a longer median (interquartile range) recovery time (days off work, 8 [6-14] vs 4 [2-7]; P < .001; days until return to normal, 15 [10-29] vs 10 [10-15]; P = .02). There were no significant differences in the incidence or severity of adverse events between treatment arms; 86% of adverse events (42 of 49) required only observation or nominal treatment, and no events caused permanent sequelae or death. After adjustment for baseline pain and uterine fibroid load, uterine artery embolization was still significantly associated with higher opioid use and longer time to return to work and normal activities (P < .001 for each). Results were similar when restricted to the randomized controlled trial. CONCLUSION Women undergoing uterine artery embolization have longer recovery times and use more prescription medications, but women undergoing focused ultrasound have longer treatment times. These findings were independent of baseline pain levels and fibroid load.
Collapse
|
10
|
Peterson LG, Bongar B. Training physicians in the clinical evaluation of the suicidal patient. Adv Psychosom Med 2015; 20:89-108. [PMID: 2239507 DOI: 10.1159/000418261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L G Peterson
- Department of Family and Community Medicine, University of Massachusetts Medical School, Worcester
| | | |
Collapse
|
11
|
|
12
|
Bouwsma EVA, Hesley GK, Woodrum DA, Weaver AL, Leppert PC, Peterson LG, Stewart EA. Comparing focused ultrasound and uterine artery embolization for uterine fibroids-rationale and design of the Fibroid Interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertil Steril 2011; 96:704-10. [PMID: 21794858 DOI: 10.1016/j.fertnstert.2011.06.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To present the rationale, design, and methodology of the Fibroid Interventions: Reducing Symptoms Today and Tomorrow (FIRSTT) study. DESIGN Randomized clinical trial. SETTING Two academic medical centers. PATIENT(S) Premenopausal women with symptomatic uterine fibroids. INTERVENTION(S) Participants are randomized to two U.S. Food and Drug Administration-approved minimally invasive treatments for uterine leiomyomas: uterine artery embolization and magnetic resonance-guided focused ultrasound. MAIN OUTCOME MEASURE(S) The primary endpoint is defined as the need for an additional intervention for fibroid symptoms following treatment. Secondary outcomes consist of group differences in symptom alleviation, recovery trajectory, health-related quality of life, impairment of ovarian reserve, treatment complications, and the economic impact of these issues. RESULT(S) The trial is currently in the phase of active recruitment. CONCLUSION(S) This randomized clinical trial will provide important evidence-based information for patients and health care providers regarding optimal minimally invasive treatment approach for women with symptomatic uterine leiomyomas. CLINICAL TRIAL REGISTRATION NCT00995878.
Collapse
Affiliation(s)
- Esther V A Bouwsma
- Center for Uterine Fibroids, Mayo Clinic, Rochester, Minnesota; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55901, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Bouwsma EVA, Gorny KR, Hesley GK, Jensen JR, Peterson LG, Stewart EA. Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility. Fertil Steril 2011; 96:e9-e12. [PMID: 21570071 PMCID: PMC5333557 DOI: 10.1016/j.fertnstert.2011.04.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To describe magnetic resonance-guided focused ultrasound surgery (FUS) as a treatment for a case of leiomyoma-associated infertility. DESIGN Case report from a randomized clinical trial. SETTING Academic medical center. PATIENT(S) A 37-year-old woman with known leiomyomas and a history of 18 months of home-inseminations from a known donor. INTERVENTION(S) Magnetic resonance-guided FUS treatment of uterine fibroids, where the dominant fibroid distorted the uterine cavity. MAIN OUTCOME MEASURE(S) Pregnancy. RESULT(S) A viable intrauterine pregnancy, with a full-term vaginal delivery, was conceived after a single clomiphene citrate and intrauterine insemination cycle. CONCLUSION(S) The role of FUS for enhancement of fertility in women with nonhysteroscopically resectable uterine fibroids distorting the uterine cavity should be investigated further.
Collapse
Affiliation(s)
- Esther V A Bouwsma
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | |
Collapse
|
14
|
Riegel C, Nelson SD, Dickson DW, Allen LH, Peterson LG. Efficacy of 1,3-dichloropropene in soil amended with compost and unamended soil. J Nematol 2001; 33:289-293. [PMID: 19265889 PMCID: PMC2620517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
1,3-Dichloropropene (1,3-D) is a likely alternative soil fumigant for methyl bromide. The objective was to determine root-knot nematode, Meloidogyne incognita, survival in microplots after exposure to 1,3-D for various periods of time in soil that have previously been amended with compost. The treatments were 1,3-D applied broadcast at 112 liters/ha and untreated controls in both compost-amended and unamended soil. Soil samples were collected from each microplot at 6, 24, 48, 72, and 96 hours after fumigation at three depths (0-15, 15-30, and 30-45 cm). One week after fumigation, six tomato seedlings were transplanted into each microplot and root galling was recorded 6 weeks later. Plants grown in fumigated compost-amended soil had more galls than plants from fumigated unamended soil at P </= 0.1. Gall indices from roots in fumigated soil amended with compost were not different from nonfumigated controls. Based on soil bioassays, the number of galls decreased with increasing time after fumigation in both compost-amended and unamended soil at 0-to-15 and 15-to-30 cm depths, but not at 30 to 45 cm deep. Higher soil water content due to the elevated levels of organic matter in the soil at these depths may have interfered with 1,3-D movement, thus reducing its efficacy.
Collapse
|
15
|
Riegel C, Dickson DW, Peterson LG, Nance JL. Rate response of 1,3-dichloropropene for nematode control in spring squash in deep sand soils. J Nematol 2000; 32:524-530. [PMID: 19271005 PMCID: PMC2620479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The soil fumigant 1,3-dichloropropene (1,3-D) formulated with chloropicrin is viewed as a likely alternative for replacing methyl bromide in Florida when the latter is phased out in 2005. Therefore, it behooves us to learn more about using 1,3-D in deep, sand soils. Two trials were conducted on spring squash to determine the most effective rate of 1,3-D for the control of Meloidogyne spp. Rates tested included 0, 56, 84, 112, and 168 liters/ha of 1,3-D applied broadcast with conventional chisels 30 cm deep. The chisel traces were sealed by disking immediately after fumigant application. Cucurbita pepo cv. Sunex 9602 was sown 7 days after fumigation. The population density of plant-parasitic nematodes in soil and root-knot nematode galling severity was determined at 34 and 65 days after planting (DAP), and the number of marketable fruit and yield were determined. The number of fruit and yield were higher in all plots that received 1,3-D than in untreated controls. The number of Meloidogyne spp. second-stage juveniles was lower in all fumigated plots in trial 1 at both 34 and 65 DAP, and in trial 2 at 65 DAP, than in the untreated control. The severity of root galling was decreased with all treatments in both trials, with broadcast rates of 84, 112, and 168 liters/ha providing the best control of root-knot nematodes in spring squash grown in sandy soil. Satisfactory management of root knot on squash grown in early spring months in north Florida can be achieved with low rates of 1,3-D.
Collapse
|
16
|
Klaiber EL, Broverman DM, Vogel W, Peterson LG, Snyder MB. Relationships of serum estradiol levels, menopausal duration, and mood during hormonal replacement therapy. Psychoneuroendocrinology 1997; 22:549-58. [PMID: 9373888 DOI: 10.1016/s0306-4530(97)00043-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A study was undertaken in 38 menopausal women on-cyclic HRT (estropipate) and estropipate + nor-ethindrone). Serum estradiol levels during treatment were related to mood changes and platelet MAO activity. The relationship between serum estradiol levels and mood changes was found to be a function of the duration of menopause. Women with a short duration of menopause (12.9 months +/- 6.1) were compared to women with a long duration of menopause (76.6 months +/- 52.3). Women with a short duration of menopause had significantly lower mean serum estradiol levels during HRT compared to women with a long duration of menopause (216.9 +/- 62.3 vs. 291.13 +/- 118.12, respectively, p < .02). It had previously been reported that estrogen treatment in menopausal women had a positive effect on mood, whereas the combination of estrogen plus a progestin had a negative effect on mood. We found that the women with a long duration of menopause and higher treatment serum estradiol levels had significantly more dysphoria when receiving a combination of estrogen plus progestin than did the women with a short duration of menopause and lower serum estradiol levels. However, both short and long duration menopausal groups showed improvement in mood when estrogen was administered alone. Platelet MAO levels, a marker of adrenergic and serotonergic function thought to relate to mood, were negatively correlated with serum estradiol levels during HRT. We suggest that these paradoxical findings may be secondary to a prolonged estrogen deficiency state in women with a long duration of menopause.
Collapse
Affiliation(s)
- E L Klaiber
- Worcester Foundation for Biomedical Research, Shrewsbury, MA, USA
| | | | | | | | | |
Collapse
|
17
|
Steketee G, Perry JC, Goisman RM, Warshaw MG, Massion AO, Peterson LG, Langford L, Weinshenker N, Farreras IG, Keller MB. The psychosocial treatments interview for anxiety disorders. A method for assessing psychotherapeutic procedures in anxiety disorders. J Psychother Pract Res 1997; 6:194-210. [PMID: 9185065 PMCID: PMC3330464] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors report on development, reliability, and findings of the Psychosocial Treatments Interview (PTI) to assess treatments reported by patients in a naturalistic study of the longitudinal course of anxiety disorders. The PTI ascertains frequency of different types of psychosocial treatments, based on patients' reports. The PTI showed good internal consistency and very good interrater reliability. At first 6-month follow-up, the most common modalities were supportive, medication discussion, and dynamic intervention. Combinations were common. Delivery of treatments differed by site. Overall, the PTI fills a methodological need for the assessment of the treatments reported by patients in naturalistic follow-up studies.
Collapse
Affiliation(s)
- G Steketee
- Boston University School of Social Work, Massachusetts 02215, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Klaiber EL, Broverman DM, Vogel W, Peterson LG, Snyder MB. Individual differences in changes in mood and platelet monoamine oxidase (MAO) activity during hormonal replacement therapy in menopausal women. Psychoneuroendocrinology 1996; 21:575-92. [PMID: 9044441 DOI: 10.1016/s0306-4530(96)00023-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Estrogen replacement treatment in menopausal women has been reported to have a positive effect on mood states. However, the addition of a progestin partially negates this positive effect in some women. The opposite effects of estrogen and progestin on mood may relate to their opposite effects on adrenergic and serotonergic neural function. In a double-blind, placebo-controlled, crossover study, 38 nondepressed menopausal women were cyclically treated with estrogen and estrogen plus progestin, or with placebo, for five 28-day cycles. This paper identifies the pretreatment attributes of women who do and do not have negative mood responses to progestin, and examines the relationship of these adverse side-effects to platelet monoamine oxidase (MAO), a marker of adrenergic and serotonergic functioning. Adverse mood responses to progestin occur in women with a long duration of menopause, low pretreatment serum estradiol and testosterone levels, high pretreatment serum FSH levels, low pretreatment platelet MAO activity, and pretreatment mood abnormalities. We conclude that adverse mood response to the addition of a progestin occurs in menopausal women who have low pretreatment gonadal hormone levels secondary to a long duration of menopause. Impaired central nervous system adrenergic and serotonergic functioning also may be a factor predisposing to a negative mood response to progestin.
Collapse
Affiliation(s)
- E L Klaiber
- Worcester Foundation for Biomedical Research, Shrewsbury, MA 01545, USA
| | | | | | | | | |
Collapse
|
19
|
Abstract
This paper examines factors associated with suicidal behavior in patients with anxiety disorders. HARP is a naturalistic, prospective, longitudinal follow-up study. This paper examines 527 subjects with panic disorder (with or without agoraphobia). 9% of the subjects reported past suicidal behavior. Factors associated with suicidal behavior were depressive disorders, substance abuse, eating disorders, PTSD and personality disorders as well as having early onset of the first anxiety or depressive disorder. Subjects had a 4.5% P of suicidal behavior during the first 30 months of follow-up. All prospectively recorded suicidal behavior occurred in subjects with depressive disorders. In these panic disorder patients, suicidal behavior rarely occurred in the absence of affective disorders. Certain nondepressive disorders also substantially increased the risks of suicide attempts/gestures.
Collapse
Affiliation(s)
- M G Warshaw
- Department of Psychiatry Research, Brown University, Providence, RI 02912, USA
| | | | | | | | | |
Collapse
|
20
|
Goisman RM, Warshaw MG, Peterson LG, Rogers MP, Cuneo P, Hunt MF, Tomlin-Albanese JM, Kazim A, Gollan JK, Epstein-Kaye T. Panic, agoraphobia, and panic disorder with agoraphobia. Data from a multicenter anxiety disorders study. J Nerv Ment Dis 1994; 182:72-9. [PMID: 8308535 DOI: 10.1097/00005053-199402000-00002] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In a cross-sectional investigation of the properties of DSM-III-R panic disorder (PD), panic disorder with agoraphobia (PDA), and agoraphobia without history of panic disorder (AWOPD), we analyzed demographic, descriptive, comorbidity, treatment, and course data for 562 subjects with PD, PDA, or AWOPD in a multicenter anxiety-disorders study. In general, AWOPD subjects had the worst functioning and PD subjects the best, as measured by length of intake episodes, education attained, likelihood of receiving financial assistance, depressive comorbidity, and likelihood of having experienced 8 weeks symptom-free. Panic disorder with agoraphobia was the most common disorder and emerged as a condition intermediate in severity between the other two. Treatments received varied little by diagnosis. Most subjects received medication, usually benzodiazepines. Psychodynamic psychotherapy was the most frequently received psychosocial treatment; cognitive and behavioral approaches were less common. Subjects classified with AWOPD were the most likely to have received exposure therapies.
Collapse
Affiliation(s)
- R M Goisman
- Massachusetts Mental Health Center, Boston 02115
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Fierman EJ, Hunt MF, Pratt LA, Warshaw MG, Yonkers KA, Peterson LG, Epstein-Kaye TM, Norton HS. Trauma and posttraumatic stress disorder in subjects with anxiety disorders. Am J Psychiatry 1993; 150:1872-4. [PMID: 8238645 DOI: 10.1176/ajp.150.12.1872] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Trauma histories were obtained from 711 subjects in a large study of anxiety disorders, with the intent of determining the prevalence and nature of psychological trauma in this group. Twenty-seven percent of subjects reported significant trauma; 35% of these (10% of all subjects) met DSM-II-R criteria for posttraumatic stress disorder (PTSD). Subjects reporting sexual trauma were significantly more likely to have PTSD. The rate of PTSD was not higher in subjects with panic disorder than in those with other anxiety disorders.
Collapse
Affiliation(s)
- E J Fierman
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
The objective of this report is to determine whether those patients with panic disorder who have current major depression disorder (MDD) differ from those who do not in terms of demographics, comorbid disorders, severity of illness, nature of symptoms of panic attacks and psychosocial functioning. The sample consisted of 182 patients with current or history of panic disorder measured by standardized interview techniques. For analysis these patients were then divided by presence or absence of current MDD. The two groups were not different in age, sex, or marital status, age of onset, or symptom characteristics of panic attacks. However, patients with MDD were more likely to have Social Phobia and Generalized Anxiety Disorder, been hospitalized, made suicide attempts or gestures, have poorer psychosocial functioning, and currently be experiencing panic with more severe symptoms. These findings are discussed in terms of previous literature in the area.
Collapse
Affiliation(s)
- J Reich
- Department of Psychiatry, Brown University, Providence, RI 02912
| | | | | | | | | | | | | |
Collapse
|
23
|
Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, Lenderking WR, Santorelli SF. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992; 149:936-43. [PMID: 1609875 DOI: 10.1176/ajp.149.7.936] [Citation(s) in RCA: 793] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders. METHOD The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period. RESULTS Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings. CONCLUSIONS A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
Collapse
Affiliation(s)
- J Kabat-Zinn
- Department of Medicine, University of Massachusetts Medical School, Worcester 01605
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Affiliation(s)
- R F Bessette
- Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01605
| | | |
Collapse
|
25
|
Peterson LG, Bongar B. Repetitive suicidal crises: characteristics of repeating versus nonrepeating suicidal visitors to a psychiatric emergency service. Psychopathology 1990; 23:136-45. [PMID: 2277820 DOI: 10.1159/000284650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The present study involves a retrospective chart review of all patients who visited the Emergency Mental Health Service during the period of July 1, 1985 to June, 30, 1986 (total visits = 2,772). It compares those 'suicidal' patients seen only once during the index year with those seen multiple times (comparison of first visit only for both 'one-timers' and 'repeaters'). The 'repeaters' were generally found to be older and were more likely to have a diagnosis of schizophrenia and personality disorder. Unlike previous studies, substance abuse and affective disorder did not significantly differentiate the two groups. The 'repeaters' were also more likely to be taking antipsychotic and antiparkinson medications, have histories of past psychiatric hospitalizations in the public sector, be living alone, and most importantly, to have made a previous suicide attempt.
Collapse
Affiliation(s)
- L G Peterson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester
| | | |
Collapse
|
26
|
Abstract
A single blind study design was used to evaluate the efficacy and safety of Navane versus Haldol in acute organic mental syndromes in a general hospital setting. Seventeen patients were entered into the study; only 14 remained in the study long enough to complete the protocol. Most patients treated with either neuroleptic agent improved. Only one patient was worse. Improvement occurred rapidly (2-3 days), and few significant side effects were observed. There was a trend toward lower BPRS scores in patients treated with Navane (thiothixene).
Collapse
Affiliation(s)
- L G Peterson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655
| | | |
Collapse
|
27
|
Abstract
A number of changes in the demographics of suicide and suicide attempters have occurred in the last 10 to 15 years. To assess some of the factors that may be involved in these changes, this study examines a group of suicide attempters in Houston, Texas, where a large percentage of the attempts were violent. These violent attempters are compared with nonviolent attempters, and the entire population of attempters is compared with suicide attempters in New Haven, Connecticut. Finally, the two attempter populations are compared with the underlying general population demographics of two regions (Houston and New Haven). Several differences emerged between attempters in Houston and in New Haven, including larger proportions of violent attempters, male attempters, and married attempters in Houston. Demographic factors in the general populations for the two regions are different, but these differences are not directly reflected in the nature of the attempter populations. Reasons for observed differences are discussed.
Collapse
Affiliation(s)
- L G Peterson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester 01605-2397
| | | | | | | |
Collapse
|
28
|
Abstract
Udder preparations of wet towel plus drying and .1% iodophor premilking teat dipping plus drying were compared with no preparation to determine effects on number of new intramammary infections. Teats of 84 cows were challenged (5 d/wk) for 18 wk with a culture broth of Streptococcus uberis 3 h prior to each p.m. milking to stimulate environmental contamination. Wet towel plus drying and premilking teat dipping plus drying significantly reduced number of new intramammary infections compared to no preparation. Cleaning with water or dipping with a premilking teat dip and manual drying of teats may have contributed to the reduction in number of new infections. Premilking teat dipping plus drying further reduced number of new infections compared to use of wet towel plus drying. Apparently, teat dipping was more effective in reducing the number of new infections than water used with the wet towel. This study showed that udder preparations can affect udder health when an experimental bacterial challenge is applied.
Collapse
Affiliation(s)
- D M Galton
- Department of Animal Science, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY 14853
| | | | | |
Collapse
|
29
|
Peterson LG, Bongar B. Adolescent suicide: sensationalism and sensitivity. Am J Emerg Med 1987; 5:546-8. [PMID: 3663299 DOI: 10.1016/0735-6757(87)90196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
30
|
Abstract
Psychotropic drug use in the patient with cancer is reviewed from the perspective of the practicing oncologist and the consulting psychiatrist. Guidelines are offered for use of psychotropic agents for specific symptoms, such as nausea and vomiting, pain control, treatment of depression, delirium, anxiety, and psychosis. The importance of careful assessment and treatment of the causes of psychiatric symptoms is stressed. Recommendations for use of specific psychotropic agents are reviewed, including dosage range and route of administration as well as possible drug interactions and other factors affecting the use of these agents in patients. Anecdotal uses of these agents are also considered.
Collapse
|
31
|
Gamble DE, Peterson LG. Trazodone overdose: four years of experience from voluntary reports. J Clin Psychiatry 1986; 47:544-6. [PMID: 3771499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The details of 88 cases involving trazodone overdose, either alone or in combination with other drugs, have been forwarded to the manufacturer by reporting physicians since trazodone was made available in March 1982. In 73 of these cases, recovery was uneventful; in 6 cases unexpected complications developed. Nine deaths occurred in patients who had taken trazodone in combination with other drugs and/or alcohol. These case reports are supplemented by data from the American Association of Poison Control Centers and the National Institute on Drug Abuse. Of 206 reported overdose exposures to trazodone, no deaths were recorded. For comparison, 2263 reported tricyclic and tetracyclic overdoses resulted in 16 deaths, and 125 reported monoamine oxidase inhibitor overdoses produced 3 fatalities. When taken alone in overdose, trazodone appears to have limited toxicity. Nevertheless, treatment should be monitored closely in patients who present with a history of seizures or who suffer from cardiovascular or respiratory disease.
Collapse
|
32
|
|
33
|
Abstract
Several important points should be considered regarding psychiatric symptoms in endocrine disorders. The presence of cognitive deficits in a patient presenting with anxiety, depression, or another apparently "functional" psychiatric complaint should raise the index of suspicion of organic etiology, with endocrine disorders high on the list. Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. When significant disruption of cognitive functioning is evident, residual deficits may develop. Treatment with psychotropic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders.
Collapse
|
34
|
Abstract
The authors studied 30 patients treated at an urban trauma center for self-inflicted gunshot wounds, most or all of which would have been fatal without emergency treatment. About half the patients had used alcohol or drugs immediately before wounding themselves, and slightly more than half had experienced interpersonal conflict just before the incident. Thirteen of the 30 were women. Only nine were given diagnoses of major depressive episode or dysthymia; none of the patients had written suicide notes. These data indicate that the reported demographic and clinical characteristics of impulsive, violent self-injury must be reexamined.
Collapse
|
35
|
Peterson LG, O'Shanick GJ. Psychiatric patients in the emergency center. Am J Emerg Med 1984; 2:370. [PMID: 6518041 DOI: 10.1016/0735-6757(84)90175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
36
|
O'Shanick GJ, Scott R, Peterson LG. Psychiatric referral after head trauma. Psychiatr Med 1984; 2:131-7. [PMID: 6571618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This preliminary study of 22 patients referred for psychiatric consultation after HT requires further investigation to better define the trends observed regarding diagnosis, injury site, and medication choice. The absence of a control population of HT patients not referred for psychiatric evaluation limits our ability to make definitive conclusions. Further work is also planned to systematically explore the injury site-medication relationship.
Collapse
|
37
|
Benson D, Peterson LG, Bartay J. Neuropsychiatric manifestations of antihypertensive medications. Psychiatr Med 1983; 1:205-214. [PMID: 6152847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- D Benson
- Department of Internal Medicine, Milwaukee County General Hospital, Wisconsin 53226
| | | | | |
Collapse
|
38
|
Peterson LG, Popkin MK, Hall RC. Psychiatric presentations of cancer and sequelae of treatment. Psychiatr Med 1983; 1:79-92. [PMID: 6599845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- L G Peterson
- Department of Psychiatry, University of Texas Health Sciences Center, Houston 77025
| | | | | |
Collapse
|
39
|
|
40
|
|
41
|
Maronpot RR, Peterson LG. Spontaneous proteus nephritis among male C3H/HeJ mice. Lab Anim Sci 1981; 31:697-700. [PMID: 7045517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The spontaneous occurrence of nephritis and resultant mortality was investigated among 2,836 control or treated (dermal carcinogenesis bioassays) C3H/HeJ male mice. Overall incidence of nephritis putatively caused by Proteus mirabilis was 1.2%. Incidences were similar in control and treated mice and ranged from 2.5--32.5% among 73 unrelated treatment or control groups. Diagnosis was based upon characteristic gross or histologic renal lesions. Grossly affected kidneys contained either multiple, discrete tan foci or elevated pale tan patches. Histologic renal lesions consisted of a multifocal necropurulent nephritis with numerous gram negative bacteria present in affected tubules. Necrotizing pyelitis and papillitis usually was present, an necropurulent cystitis was present in half of the cases examined histologically. Proteus mirabilis, isolated in pure culture from an affected kidney, produced similar renal lesions after intraperitoneal or intravenous inoculation of clinically normal C3H/HeJ males. The organism was reisolated from the kidneys of the experimentally produced cases. It was concluded that nephritis putatively caused by Proteus mirabilis was an important cause of mortality in male C3H/HeJ mice.
Collapse
|
42
|
|
43
|
Peterson LG. On being a necessary evil at a mental health center. Hosp Community Psychiatry 1981; 32:644. [PMID: 7275044 DOI: 10.1176/ps.32.9.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
44
|
|
45
|
Santrach PJ, Peterson LG, Yunginger JW. Comparison of diagnostic tests for hymenoptera sting allergy. Ann Allergy 1980; 45:130-36. [PMID: 6158280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The authors examined correlations among individual Hymenoptera venom skin tests, venom radioallergosorbent tests (RAST), venom-induced leukocyte histamine release (LHR) assays and individual Hymenoptera whole body extract (WBE) skin tests in 37 patients with histories of systemic reactions to Hymenoptera stings. Significant positive correlations were seen between the venom skin test results and results from either the venom RAST or the LHR assay for most venoms. There was a relatively high frequency of positive WBE skin tests in association with other negative tests. The ultimate diagnostic test for stinging insect sensitivity is a deliberate sting challenge; in lieu of such a sting the clinical history and the venom skin test appear to provide the best estimate of clinical Hymenoptera sting sensitivity.
Collapse
|
46
|
|