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Birocchi S, Rocchetti M, Minardi A, Podda GM, Squizzato A, Cattaneo M. Guided Anti-P2Y12 Therapy in Patients Undergoing PCI: Three Systematic Reviews with Meta-analyses of Randomized Controlled Trials with Homogeneous Design. Thromb Haemost 2024; 124:482-496. [PMID: 37549688 DOI: 10.1055/a-2149-4344] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/09/2023]
Abstract
BACKGROUND The value of guided therapy (GT) with anti-P2Y12 drugs in percutaneous coronary intervention (PCI) is unclear. Meta-analyses lumped together randomized controlled trials (RCTs) with heterogeneous designs, comparing either genotype-GT or platelet function test (PFT)-GT with unguided therapy. Some meta-analysis also included RCTs that did not explore GT, but included the effects of switching patients with high on-treatment platelet reactivity (HTPR) to alternative therapies (HTPR-Therapy). We performed three distinct systematic reviews/meta-analyses, each exploring only RCTs with homogeneous design. METHODS MEDLINE, Embase, and Central databases were searched for RCTs testing genotype-GT, PFT-GT, or HTPR-Therapy in PCI-treated patients, through October 1, 2022. Two reviewers extracted the data. Risk ratios (RRs) (95% confidence intervals) were calculated. Primary outcomes were major bleedings (MBs) and major adverse cardiovascular events (MACE). RESULTS In seven genotype-GT RCTs, RRs were: MB, 1.06 (0.73-1.54; p = 0.76); MACE, 0.65 (0.47-0.91; p = 0.01), but significant risk reduction was observed in RCTs performed in China (0.30, 0.16-0.54; p < 0.0001) and not elsewhere (0.75, 0.48-1.18; p = 0.21). In six PFT-GT RCTs, RRs were: MB, 0.91 (0.64-1.28, p = 0.58); MACE, 0.82 (0.56-1.19; p = 0.30): 0.62 (0.42-0.93; p = 0.02) in China, 1.08 (0.82-1.41; p = 0.53) elsewhere. In eight HTPR-Therapy RCTs, RRs were: MB, 0.71 (0.41-1.23; p = 0.22); MACE, 0.57 (0.44-0.75; p < 0.0001): 0.56 (0.43-0.74, p < 0.0001) in China, 0.58 (0.27-1.23, p = 0.16) elsewhere. CONCLUSION No GT strategy affected MB. Overall, genotype-GT but not PFT-GT reduced MACE. However, genotype-GT and PFT-GT reduced MACE in China, but not elsewhere. PFT-GT performed poorly compared to HTPR-Therapy, likely due to inaccurate identification of HTPR patients by PFT.
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Affiliation(s)
- Simone Birocchi
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Matteo Rocchetti
- Divisione di Cardiologia, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Minardi
- Divisione di Cardiologia, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Squizzato
- Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
| | - Marco Cattaneo
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
- Fondazione Arianna Anticoagulazione, Bologna, Italy
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Clerici B, Pontisso E, Aloise C, Peroni B, Perricone R, Pisetta C, Scavone M, Birocchi S, Podda GM. Thrombosis and Bleeding in Patients with Vaccine-Induced Immune Thrombotic Thrombocytopenia: A Systematic Review of Published Cases. Thromb Haemost 2024; 124:423-431. [PMID: 38109906 DOI: 10.1055/s-0043-1777134] [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: 12/20/2023]
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a highly prothrombotic reaction to COVID-19 (coronavirus disease 2019) adenoviral vector vaccines. Its distinct bleeding and thrombotic patterns compared with other platelet consumptive disorders remain unclear. METHODS We performed a systematic review of the literature (PubMed and Embase) up to July 31, 2022, including case reports and case series providing nonaggregate data of VITT patients. Accurate VITT diagnosis required fulfillment of the following criteria: (1) endorsement by the authors, (2) consistent vaccine type and timing, (3) presence of thrombocytopenia and thrombosis, (4) detection of anti-platelet factor 4 antibodies. Data are presented as frequencies with 95% confidence intervals (CIs) calculated with the exact binomial method. RESULTS We retrieved 143 eligible studies, describing 366 patients. Of 647 thrombotic events, 53% (95% CI: 49-56) were venous thromboses at unusual sites and 30% (95% CI: 27-34) were cerebral venous sinus thromboses (CVSTs). The ratio of venous-to-arterial events was 4.1. Thromboses in most sites were associated with at least another thrombotic event, with the exception of CVST and CNS arterial thrombosis (isolated in 49 and 39% of cases, respectively). Bleeding occurred in 36% (95% CI: 31-41) of patients; 68% (95% CI: 59-75) of bleeding events were intracranial hemorrhages (ICHs). Overall mortality was 24% (95% CI: 19-29), and 77% (95% CI: 58-90) in patients with isolated CVST complicated by ICH. CONCLUSION VITT displays a venous-to-arterial thrombosis ratio comparable to heparin-induced thrombocytopenia. However, VITT is characterized by a higher prevalence of CVST and ICH, which contribute to the increased bleeding frequency and mortality.
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Affiliation(s)
- Bianca Clerici
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Eleonora Pontisso
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Chiara Aloise
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Benedetta Peroni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Rosaria Perricone
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Chiara Pisetta
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Mariangela Scavone
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Simone Birocchi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
| | - Gian Marco Podda
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Struttura Complessa di Medicina Generale II, Ospedale San Paolo, Milano, Italy
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Morici N, Di Lauro S, Cusmano I, Birocchi S, Torracca L, Rubboli A. Inpatient Cardiac Rehabilitation Following Heart Valve Surgey: A Setting for the Tailored Management of Antithrombotic Therapy. Eur J Prev Cardiol 2024:zwae154. [PMID: 38679602 DOI: 10.1093/eurjpc/zwae154] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Affiliation(s)
| | - Silvia Di Lauro
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Università degli studi di Milano, Milan, Italy
| | | | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Lucia Torracca
- Cardiac Surgery Division, Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy
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Ghali C, Scavone M, Clerici B, Bossi E, Fioretti A, Pisetta C, Birocchi S, Vismara G, Vozzo N, Cattaneo M, Podda GM. Time-dependent in vitro variations of platelet count in samples from subjects with EDTA-induced pseudothrombocytopenia: A comparative analysis across different anticoagulants. Br J Haematol 2024. [PMID: 38471791 DOI: 10.1111/bjh.19406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Claudia Ghali
- Laboratorio di Emostasi e Trombosi - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Mariangela Scavone
- Laboratorio di Emostasi e Trombosi - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Bianca Clerici
- Struttura Complessa di Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Elena Bossi
- Laboratorio di Emostasi e Trombosi - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Antonella Fioretti
- Laboratorio di Emostasi e Trombosi - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Chiara Pisetta
- Struttura Complessa di Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Simone Birocchi
- Struttura Complessa di Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Giuseppina Vismara
- Struttura Complessa Servizio di Immunoematologia e Medicina Trasfusionale, ASST Santi Paolo e Carlo, Milano, Italy
| | - Nadia Vozzo
- Struttura Complessa Servizio di Immunoematologia e Medicina Trasfusionale, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Gian Marco Podda
- Laboratorio di Emostasi e Trombosi - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Struttura Complessa di Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
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Clerici B, Birocchi S, Podda GM. Non-adherence to chronic treatments: A commitment for Internal Medicine specialists. Eur J Intern Med 2024; 119:34-35. [PMID: 38123420 DOI: 10.1016/j.ejim.2023.11.030] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Bianca Clerici
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy
| | - Simone Birocchi
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy
| | - Gian Marco Podda
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy.
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Cattaneo M, Squizzato A, Birocchi S, Podda GM. Guided Anti-P2Y12 Therapy in Patients Undergoing Percutaneous Coronary Intervention. Thromb Haemost 2023. [PMID: 37992750 DOI: 10.1055/a-2216-5263] [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: 11/24/2023]
Affiliation(s)
- Marco Cattaneo
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | - Alessandro Squizzato
- Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
| | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Scavone M, Ghali C, Calogiuri M, Sala M, Bossi E, Mencarini T, Bozzi S, Clerici B, Birocchi S, Fioretti A, Bono V, Maugeri N, Marchetti G, Cattaneo M, Podda GM. Impairment of platelet function in both mild and severe COVID-19 patients. Br J Haematol 2023; 203:656-667. [PMID: 37615207 DOI: 10.1111/bjh.19062] [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: 04/27/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
Abnormalities of platelet function were reported in patients with severe COVID-19 (severe-C), but few data are available in patients with mild COVID-19 (mild-C) and after COVID-19 recovery. The aim of this study was to investigate platelet parameters in mild-C patients (n = 51), with no evidence of pneumonia, and severe-C patients (n = 49), during the acute phase and after recovery, compared to 43 healthy controls. Both mild-C and severe-C patients displayed increased circulating activated platelets, low δ-granule content (ADP, serotonin), impaired platelet activation by collagen (light transmission aggregometry) and impaired platelet thrombus formation on collagen-coated surfaces under controlled flow conditions (300/s shear rate). The observed abnormalities were more marked in severe-C patients than in mild-C patients. Overall, 61% (30/49) of mild-C and 73% (33/45) of severe-C patients displayed at least one abnormal platelet parameter. In a subgroup of just 13 patients who showed no persisting signs/symptoms of COVID-19 and were re-evaluated at least 1 month after recovery, 11 of the 13 subjects exhibited normalization of platelet parameters. In conclusion, mild abnormalities of platelet parameters were present not only in severe-C but also, albeit to a lesser extent, in mild-C patients during the acute phase of COVID-19 and normalized in most tested patients after clinical recovery.
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Affiliation(s)
- Mariangela Scavone
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Claudia Ghali
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Mariagrazia Calogiuri
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Matteo Sala
- ASST Santi Paolo e Carlo, Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Italy
| | - Elena Bossi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Tatiana Mencarini
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Silvia Bozzi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Antonella Fioretti
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Valeria Bono
- ASST Santi Paolo e Carlo, Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Italy
| | - Norma Maugeri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Marchetti
- ASST Santi Paolo e Carlo, Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Italy
| | - Marco Cattaneo
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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8
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Clerici B, Scavone M, Birocchi S, Aloise C, Peroni B, Negrini A, Ghali C, Casazza G, Podda GM. Prevalence of anti-platelet factor 4 antibodies in healthy vaccinees with adenoviral vector vaccines-A systematic review and meta-analysis. Br J Haematol 2023; 200:821-823. [PMID: 36647753 DOI: 10.1111/bjh.18635] [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] [Received: 11/18/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Mariangela Scavone
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Chiara Aloise
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Benedetta Peroni
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Negrini
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Claudia Ghali
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health - Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Bistervels IM, Bavalia R, Beyer‐Westendorf J, ten Cate‐Hoek AJ, Schellong SM, Kovacs MJ, Falvo N, Meijer K, Stephan D, Boersma WG, ten Wolde M, Couturaud F, Verhamme P, Brisot D, Kahn SR, Ghanima W, Montaclair K, Hugman A, Carroll P, Pernod G, Sanchez O, Ferrari E, Roy P, Sevestre‐Pietri M, Birocchi S, Wik HS, Hutten BA, Coppens M, Naue C, Grosso MA, Shi M, Lin Y, Quéré I, Middeldorp S. Postthrombotic syndrome and quality of life after deep vein thrombosis in patients treated with edoxaban versus warfarin. Res Pract Thromb Haemost 2022; 6:e12748. [PMID: 35992565 PMCID: PMC9248314 DOI: 10.1002/rth2.12748] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background Postthrombotic syndrome (PTS) is a long-term complication after deep vein thrombosis (DVT) and can affect quality of life (QoL). Pathogenesis is not fully understood but inadequate anticoagulant therapy with vitamin K antagonists is a known risk factor for the development of PTS. Objectives To compare the prevalence of PTS after acute DVT and the long-term QoL following DVT between patients treated with edoxaban or warfarin. Methods We performed a long-term follow-up study in a subset of patients with DVT who participated in the Hokusai-VTE trial between 2010 and 2012 (NCT00986154). Primary outcome was the prevalence of PTS, defined by the Villalta score. The secondary outcome was QoL, assessed by validated disease-specific (VEINES-QOL) and generic health-related (SF-36) questionnaires. Results Between 2017 and 2020, 316 patients were enrolled in 26 centers in eight countries, of which 168 (53%) patients had been assigned to edoxaban and 148 (47%) to warfarin during the Hokusai-VTE trial. Clinical, demographic, and thrombus-specific characteristics were comparable for both groups. Mean (SD) time since randomization in the Hokusai-VTE trial was 7.0 (1.0) years. PTS was diagnosed in 85 (51%) patients treated with edoxaban and 62 (42%) patients treated with warfarin (adjusted odds ratio 1.6, 95% CI 1.0-2.6). Mean differences in QoL scores between treatment groups were not clinically relevant. Conclusion Contrary to our hypothesis, the prevalence of PTS tended to be higher in patients treated with edoxaban compared with warfarin. No differences in QoL were observed. Further research is warranted to unravel the role of anticoagulant therapy on development of PTS.
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Affiliation(s)
- Ingrid M. Bistervels
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Department of Internal Medicine Flevo Hospital Almere The Netherlands
| | - Roisin Bavalia
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Jan Beyer‐Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, Thrombosis Research University Hospital "Carl Gustav Carus" Dresden Dresden Germany
| | - Arina J. ten Cate‐Hoek
- Thrombosis Expertise Centre, Heart+Vascular Center Maastricht University Medical Centre Maastricht The Netherlands
| | | | - Michael J. Kovacs
- Department of Hematology and Thrombosis London Health Sciences Centre,Victoria Hospital London Ontario Canada
| | - Nicolas Falvo
- Department of Internal Medicine and Immunology Centre Hospitalier Regionale Universitaire Dijon Dijon France
| | - Karina Meijer
- Department of Hematology University Medical Centre Groningen Groningen The Netherlands
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical Pharmacology Regional University Hospital Strasbourg France
| | - Wim G. Boersma
- Department of Pulmonology Noordwest Ziekenhuisgroep Alkmaar The Netherlands
| | - Marije ten Wolde
- Department of Internal Medicine Flevo Hospital Almere The Netherlands
| | - Francis Couturaud
- Department of Pulmonology Centre Hospitalier Regionale Universitaire Brest Brest France
| | - Peter Verhamme
- Department of Vascular Medicine and Hemostasis University Hospital Leuven Leuven Belgium
| | - Dominique Brisot
- Department of Vascular Medicine Clinique du Parc Castelnau le Lez France
| | - Susan R. Kahn
- Department of Medicine McGill University Montreal Canada
| | - Waleed Ghanima
- Department of Research, Østfold Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | - Amanda Hugman
- Department of Haematology St George Hospital Sydney New South Wales Australia
| | - Patrick Carroll
- Department of Vascular Medicine Redcliffe Hospital Queensland Australia
| | - Gilles Pernod
- Department of Medicine Centre Hospitalier Regionale Universitaire de Grenoble‐Alpes Grenoble France
| | - Olivier Sanchez
- Department of Pulmonology Hôpital Européen Georges‐Pompidou Paris France
| | - Emile Ferrari
- Department of Cardiology Centre Hospitalier Universitaire de Nice Nice France
| | - Pierre‐Marie Roy
- Department of Emergency Medicine Centra Hospitalier Universitaire d'Angers Angers France
| | | | - Simone Birocchi
- Department of Hematology and Thrombosis SanPaolo Hospital Milan Italy
| | - Hilde S. Wik
- Department of Haematology Oslo University Hospital Oslo Norway
| | - Barbara A. Hutten
- Department of Epidemiology and Data Science, Amsterdam Cardiovascular Sciences Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Christiane Naue
- Department of Medicine I, Division of Hematology and Hemostasis, Thrombosis Research University Hospital "Carl Gustav Carus" Dresden Dresden Germany
| | | | - Minggao Shi
- Daiichi Sankyo Pharma Development Basking Ridge New Jersey USA
| | - Yong Lin
- Daiichi Sankyo Pharma Development Basking Ridge New Jersey USA
| | - Isabelle Quéré
- Department of Vascular Medicine IDESP Inserm‐Montpellier University, InnoVTE Network, CHU Montpellier Montpellier France
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS)Radboud University Medical Center Nijmegen The Netherlands
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10
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Morici N, Podda G, Birocchi S, Bonacchini L, Merli M, Trezzi M, Massaini G, Agostinis M, Carioti G, Saverio Serino F, Gazzaniga G, Barberis D, Antolini L, Grazia Valsecchi M, Cattaneo M. Enoxaparin for thromboprophylaxis in hospitalized COVID-19 patients: The X-COVID-19 Randomized Trial. Eur J Clin Invest 2022; 52:e13735. [PMID: 34958123 DOI: 10.1111/eci.13735] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is uncertain whether higher doses of anticoagulants than recommended for thromboprophylaxis are necessary in COVID-19 patients hospitalized in general wards METHODS: This is a multicentre, open-label, randomized trial performed in 9 Italian centres, comparing 40 mg b.i.d. versus 40 mg o.d. enoxaparin in COVID-19 patients, between April 30 2020 and April 25 2021. Primary efficacy outcome was in-hospital incidence of venous thromboembolism (VTE): asymptomatic or symptomatic proximal deep vein thrombosis (DVT) diagnosed by serial compression ultrasonography (CUS), and/or symptomatic pulmonary embolism (PE) diagnosed by computed tomography angiography (CTA). Secondary endpoints included each individual component of the primary efficacy outcome and a composite of death, VTE, mechanical ventilation, stroke, myocardial infarction, admission to ICU. Safety outcomes included major bleeding. RESULTS The study was interrupted prematurely due to slow recruitment. We included 183 (96%) of the 189 enrolled patients in the primary analysis (91 in b.i.d., 92 in o.d.). Primary efficacy outcome occurred in 6 patients (6.5%, 0 DVT, 6 PE) in the o.d. group and 0 in the b.id. group (ARR 6.5, 95% CI: 1.5-11.6). The absence of concomitant DVT and imaging characteristics suggests that most pulmonary artery occlusions were actually caused by local thrombi rather than PE. Statistically nonsignificant differences in secondary and safety endpoints were observed, with two major bleeding events in each arm. CONCLUSIONS No DVT developed in COVID-19 patients hospitalized in general wards, independently of enoxaparin dosing used for thromboprophylaxis. Pulmonary artery occlusions developed only in the o.d. group. Our trial is underpowered and with few events.
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Affiliation(s)
- Nuccia Morici
- Intensive Coronary Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - GianMarco Podda
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università Degli Studi di Milano, Milan, Italy
| | | | - Luca Bonacchini
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Trezzi
- Struttura Operativa Complessa (SOC) Malattie Infettive II, AUSL Toscana Centro, Ospedale San Jacopo, Pistoia, Italy
| | - Gianluca Massaini
- Struttura Operativa Semplice (SOS) Chirurgia vascolare, AUSL Toscana Centro, Ospedale San Jacopo, Pistoia, Italy
| | - Marco Agostinis
- Emergency Department, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giulia Carioti
- Emergency Department, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Gianluca Gazzaniga
- Postgraduate School of Clinical Pharmacology and Toxicology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Daniela Barberis
- Intensive Coronary Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Antolini
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Marco Cattaneo
- Unità di Medicina 2, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università Degli Studi di Milano, Milan, Italy
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11
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Scavone M, Clerici B, Birocchi S, Mencarini T, Calogiuri M, Ghali C, Prati D, Bozzi S, Villa P, Cattaneo M, Podda GM. Platelet activation and modulation in thrombosis with thrombocytopenia syndrome associated with ChAdO×1 nCov-19 vaccine. Haematologica 2021; 106:3228-3231. [PMID: 34474550 PMCID: PMC8634168 DOI: 10.3324/haematol.2021.279345] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mariangela Scavone
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Tatiana Mencarini
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano
| | - Mariagrazia Calogiuri
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Claudia Ghali
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Daniele Prati
- Dipartimento di Medicina Trasfusionale e di Ematologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico; Milano
| | - Silvia Bozzi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano
| | - Paolo Villa
- U.O Medicina d'urgenza Sacco - Medico dell'ASST Fatebenefratelli Sacco, Milano
| | - Marco Cattaneo
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan
| | - Gian Marco Podda
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan.
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12
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Clerici B, Birocchi S, Bertinato E, Di Benedetto C, Caberlon S, Cattaneo M, Podda GM. A case of newly diagnosed immune thrombocytopenia in the COVID-19 era. Intern Emerg Med 2021; 16:2221-2225. [PMID: 33180223 PMCID: PMC7658303 DOI: 10.1007/s11739-020-02553-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/24/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Bianca Clerici
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy
| | - Simone Birocchi
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy
| | - Elena Bertinato
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy
| | - Clara Di Benedetto
- Divisione di Gastroenterologia ed Epatologia, ASST Santi Paolo e Carlo, Milan, Italy
| | - Sabrina Caberlon
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy
| | - Marco Cattaneo
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute, ASST Santi Paolo E Carlo, Università degli Studi di Milano, Via di Rudinì, 8, 20142, Milan, Italy.
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13
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Ronca V, Barabino M, Santambrogio R, Opocher E, Hodson J, Bertolini E, Birocchi S, Piccolo G, Battezzati P, Cattaneo M, Podda GM. Impact of Platelet Count on Perioperative Bleeding in Patients With Cirrhosis Undergoing Surgical Treatments of Liver Cancer. Hepatol Commun 2021; 6:423-434. [PMID: 34716696 PMCID: PMC8793986 DOI: 10.1002/hep4.1806] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
In patients with cirrhosis with severe thrombocytopenia (platelet count [PC] <50 × 109/L) and undergoing invasive procedures, it is common clinical practice to increase the PC with platelet transfusions or thrombopoietin receptor agonists to reduce the risk of major periprocedural bleeding. The aim of our study was to investigate the association between native PC and perioperative bleeding in patients with cirrhosis undergoing surgical procedures for the treatment of hepatocellular carcinoma (HCC). We retrospectively evaluated 996 patients with cirrhosis between 1996 and 2018 who underwent surgical treatments of HCC by liver resection (LR) or radiofrequency ablation (RFA) without prophylactic platelet transfusions. Patients were allocated to the following three groups based on PC: high (>100 × 109/L), intermediate (51‐100 × 109/L), and low (≤50 × 109/L). PC was also analyzed as a continuous covariate on multivariable analysis. The primary endpoint was major perioperative bleeding. The overall event rate of major perioperative bleeding was 8.9% and was not found to differ significantly between the high, intermediate, and low platelet groups (8.1% vs. 10.2% vs. 10.8%, P = 0.48). On multivariable analysis, greater age, aspartate aminotransferase, lower hemoglobin, and treatment with LR (vs. RFA) were found to be significant independent predictors of major perioperative bleeding, with associations with disease etiology and year of surgery also observed. After adjusting for these factors, the association between PC and major perioperative bleeding remained nonsignificant. Conclusion: Major perioperative bleeding was not significantly associated with PC in patients with cirrhosis undergoing surgical treatment of HCC, even when their PC was <50 × 109/L. With the limit of a retrospective analysis, our data do not support the recommendation of increasing PC in patients with severe thrombocytopenia in order to decrease their perioperative bleeding risk.
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Affiliation(s)
- Vincenzo Ronca
- Unità di Medicina IIAzienda Socio Sanitaria Territoriale (ASST) Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
- Present address:
Liver Transplant and Hepatobiliary UnitUniversity Hospital of Birmingham National Health Service (NHS) Foundation TrustBirminghamUnited Kingdom
| | - Matteo Barabino
- Unità di Chirurgia EpatobilliareASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - Roberto Santambrogio
- Unità di Chirurgia EpatobilliareASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
- Present address:
Unità di Chirurgia GeneraleASST Fatebenefratelli SaccoMilanoItaly
| | - Enrico Opocher
- Unità di Chirurgia EpatobilliareASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
- Unità di Chirurgia IIASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - James Hodson
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUnited Kingdom
| | - Emanuela Bertolini
- Unità di GastroenterologiaASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - Simone Birocchi
- Unità di Medicina IIAzienda Socio Sanitaria Territoriale (ASST) Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - Gaetano Piccolo
- Unità di Chirurgia EpatobilliareASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - PierMaria Battezzati
- Unità di GastroenterologiaASST Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - Marco Cattaneo
- Unità di Medicina IIAzienda Socio Sanitaria Territoriale (ASST) Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
| | - Gian Marco Podda
- Unità di Medicina IIAzienda Socio Sanitaria Territoriale (ASST) Santi Paolo e CarloDipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly
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14
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Bavalia R, Bistervels IM, Boersma WG, Quere I, Brisot D, Falvo N, Stephan D, Couturaud F, Schellong S, Beyer‐Westendorf J, Montaclair K, Ghanima W, ten Wolde M, Coppens M, Ferrari E, Sanchez O, Carroll P, Roy P, Kahn SR, Meijer K, Birocchi S, Kovacs MJ, Hugman A, ten Cate H, Wik H, Pernod G, Sevestre‐Pietri M, Grosso MA, Shi M, Lin Y, Hutten BA, Verhamme P, Middeldorp S. Quality of life in patients with pulmonary embolism treated with edoxaban versus warfarin. Res Pract Thromb Haemost 2021; 5:e12566. [PMID: 34278193 PMCID: PMC8279124 DOI: 10.1002/rth2.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Long-term sequelae of acute pulmonary embolism (PE) include decreased quality of life (QoL). Evidence suggests that adequacy of initial anticoagulant treatment in the acute phase of venous thrombosis has a key impact on late postthrombotic complications. We hypothesize that patients with acute PE treated with edoxaban for acute PE experience have improved QoL compared to those treated with warfarin. METHODS Patients with PE who participated in the Hokusai-VTE trial were contacted between June 2017 and September 2020 for a single long-term follow-up visit. Main outcomes were the generic and disease-specific QoL measured by the 36-Item Short Form Health Survey (SF-36) and Pulmonary Embolism Quality of Life questionnaire. RESULTS We included 251 patients from 26 centers in eight countries, of which 129 (51%) had been assigned to edoxaban and 122 (49%) to warfarin. Patient- and thrombus-specific characteristics were similar in both groups. Mean time since randomization in the Hokusai-VTE trial was 7.0 years (standard deviation, 1.0). No relevant or statistical differences were observed in the QoL for patients treated with edoxaban compared to patients treated with warfarin. The mean difference between patients treated with edoxaban and patients with PE treated with warfarin was 0.8 (95% confidence interval [CI]. -1.6 to 3.2) for the SF-36 summary mental score and 1.6 (95% CI, -0.9 to 4.1) for summary physical score. CONCLUSION Our findings indicate that patients with an index PE treated with edoxaban or warfarin have a similar long-term QoL. Since our study was a follow-up study from a well-controlled clinical trial setting, future studies should be designed in a daily clinical practice setting. We suggest a longitudinal design for investigation of changes in QoL over time.
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Affiliation(s)
- Roisin Bavalia
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Ingrid M. Bistervels
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Wim G. Boersma
- Department of PulmonologyNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | - Isabelle Quere
- Department of Vascular MedicineMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Dominique Brisot
- Department of Vascular MedicineClinique du ParcCastelnau Le LezFrance
| | - Nicolas Falvo
- Department of Internal Medicine and ImmunologyCentre Hospitalier Regionale Universitaire DijonDijonFrance
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical PharmacologyRegional University HospitalStrasbourgFrance
| | - Francis Couturaud
- Department of PulmonologyCentre Hospitalier Regionale Universitaire BrestBrestFrance
| | | | - Jan Beyer‐Westendorf
- Division of Hematology and HemostasisDeptartment of Medicine IThrombosis ResearchUniversity Hospital “Carl Gustav Carus” DresdenDresdenGermany
| | | | - Waleed Ghanima
- Department of ResearchØstfold Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Marije ten Wolde
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Emile Ferrari
- Department of CardiologyCentre Hospitalier Universitaire de NiceNiceFrance
| | - Olivier Sanchez
- Department of PulmonologyHôpital Européen Georges‐PompidouParisFrance
| | - Patrick Carroll
- Department of Vascular MedicineRedcliffe HospitalRedcliffeQldAustralia
| | - Pierre‐Marie Roy
- Department of Emergency MedicineCentra Hospitalier Universitaire d'AngersAngersFrance
| | - Susan R. Kahn
- Department of MedicineMcGill UniversityMontrealQCCanada
| | - Karina Meijer
- Department of HematologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | | | - Michael J. Kovacs
- Department of Hematology and ThrombosisLondon Health Sciences CentreVictoria HospitalLondonONCanada
| | - Amanda Hugman
- Department of HaematologySt George HospitalSydneyNSWAustralia
| | - Hugo ten Cate
- Thrombosis Expertise CentreHeart+Vascular CenterMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Hilde Wik
- Department of HaemotologyOslo University HospitalOsloNorway
| | - Gilles Pernod
- Department of MedicineCentre Hospitalier Regionale Universitaire de Grenoble‐AlpesGrenobleFrance
| | | | | | - Minggao Shi
- Daiichi Sankyo Pharma DevelopmentBasking RidgeNJUSA
| | - Yong Lin
- Daiichi Sankyo Pharma DevelopmentBasking RidgeNJUSA
| | - Barbara A. Hutten
- Department of Epidemiology and Data SciencesAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Peter Verhamme
- Department of Vascular Medicine and HemostasisUniversity Hospital LeuvenLeuvenBelgium
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHSRadboud University Medical CenterNijmegenThe Netherlands
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15
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Galassi A, Casanova F, Gazzola L, Rinaldo R, Ceresa M, Restelli E, Giorgini A, Birocchi S, Giovenzana M, Zoni U, Valli F, Massironi L, Belletti S, Magagnoli L, Stucchi A, Ippolito M, Carugo S, Parazzini E, Cozzolino M. SARS-CoV-2-related ARDS in a maintenance hemodialysis patient: case report on tailored approach by daily hemodialysis, noninvasive ventilation, tocilizumab, anxiolytics, and point-of-care ultrasound. Clin Case Rep 2021; 9:694-703. [PMID: 33362933 PMCID: PMC7753751 DOI: 10.1002/ccr3.3623] [Citation(s) in RCA: 3] [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: 10/18/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Without rescue drugs approved, holistic approach by daily hemodialysis, noninvasive ventilation, anti-inflammatory medications, fluid assessment by bedside ultrasound, and anxiolytics improved outcomes of a maintenance hemodialysis patient affected by severe COVID-19.
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Affiliation(s)
- Andrea Galassi
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Francesca Casanova
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Lidia Gazzola
- Department of Health SciencesClinic of Infectious Disease“San Paolo” Hospital‐University of MilanMilanItaly
| | - Rocco Rinaldo
- Respiratory UnitDepartment of Health SciencesUniversity of MilanASST Santi Paolo e CarloMilanItaly
| | - Marco Ceresa
- Palliative Care UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Elena Restelli
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Alessia Giorgini
- Gastroenterology and Hepatology UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Simone Birocchi
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Marco Giovenzana
- Unit of Hepatobiliary, Pancreatic, and Digestive SurgeryDepartment of SurgeryS. Paolo HospitalUniversity of MilanMilanItaly
| | - Ulisse Zoni
- Internal Medicine UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Federica Valli
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | - Laura Massironi
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | | | - Lorenza Magagnoli
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Andrea Stucchi
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Michela Ippolito
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
| | - Stefano Carugo
- Division of CardiologyS. Paolo HospitalUniversity of MilanMilanItaly
| | - Elena Parazzini
- Respiratory UnitDepartment of Health SciencesUniversity of MilanASST Santi Paolo e CarloMilanItaly
| | - Mario Cozzolino
- Renal & Dialysis UnitS. Paolo HospitalASST Santi Paolo e CarloMilanItaly
- Department of Health SciencesUniversity of MilanMilanItaly
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16
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Birocchi S, Manzoni M, Podda GM, Casazza G, Cattaneo M. High rates of pulmonary artery occlusions in COVID-19. A meta-analysis. Eur J Clin Invest 2021; 51:e13433. [PMID: 33053206 PMCID: PMC7646003 DOI: 10.1111/eci.13433] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND COVID-19 patients are considered at high risk of venous thromboembolism (VTE). The real nature of pulmonary artery occlusions (PAO) in COVID-19 has been questioned, suggesting that it is caused also by in situ thrombi, rather than only by emboli (PE) from peripheral thrombi. METHODS We searched MEDLINE for studies published until 6 June 2020 that included COVID-19 patients or non-COVID-19 medical patients at VTE risk, treated with heparins, in whom VTE (PE and deep vein thrombosis, DVT) had been reported. Systematic review and results reporting were conducted in accordance with PRISMA guidelines. Data were independently extracted by two observers, and estimates were pooled using random-effects meta-analysis. RESULTS We identified 17 studies including 3224 COVID-19 patients and 7 including 11 985 non-COVID-19 patients. Two analyses were performed: in all COVID-19 patients and only in those (n = 515) who, like non-COVID-19 patients, were screened systematically for DVT. The latter analysis revealed that the prevalence of DVT was 15.43% (95%CI, 4.08-31.77) in COVID-19 and 4.21% (2.27-6.68) in non-COVID-19 patients (P = .0482). The prevalence of PE was 4.85% (40.33-13.01) in COVID-19 patients and 0.22% (0.03-0.55) in non-COVID-19 patients (P = .0128). The percentage of PE among VTE events was 22.15% (5.31-44.60) in COVID-19 and 6.39% (3.17-10.41) in non-COVID-19 patients (P = .0482). Differences were even more marked when all COVID-19 patients were analysed. CONCLUSIONS The results of our meta-analysis highlight a disproportion in the prevalence of PE among all VTE events in COVID 19 patients, likely reflecting PAO by pulmonary thrombi, rather than emboli from peripheral vein thrombi.
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Affiliation(s)
- Simone Birocchi
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Marco Manzoni
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Gian Marco Podda
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università degli Studi di Milano, Milano, Italy
| | - Marco Cattaneo
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
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17
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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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18
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Podda GM, Fiorelli EM, Birocchi S, Rambaldi B, Di Chio MC, Casazza G, Cattaneo M. Treatment of immune thrombocytopenia (ITP) secondary to malignancy: a systematic review. Platelets 2020; 33:59-65. [PMID: 32967527 DOI: 10.1080/09537104.2020.1822521] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Immune thrombocytopenia (ITP) can be associated with lymphoproliferative diseases (LPD) or solid tumors. A systematic review of published literature was conducted to evaluate response to treatment of ITP secondary to malignancy. Primary outcome was overall response (complete response+response) to first-line treatments [steroids alone or in combination with intravenous immunoglobulins (IVIg)]. Among secondary outcomes, overall response to second-line treatments [splenectomy, rituximab or thrombopoietin receptor agonists (TPO-RA)] and death were evaluated. Of the retrieved 238 text articles, 108 were analyzable, for a total of 154 patients: 142 in 105 case reports and 12 in 3 observational studies. Thirty-nine patients had solid tumors, 114 LPD, and 1 both. The median follow up was 19 months (IQR, 9-40). The overall response was 50% (62% in solid tumors, 46% in LPD) after steroids and 47% (67% in solid tumors, 36% in LPD) after steroids+IVIg, which are lower than historical responses observed in primary ITP (≈80%). The overall responses to rituximab (used in LPD only), splenectomy and TPO-RA (70%, 73% and 92%, respectively) were similar to those observed in primary ITP. Seven patients (6%) died due to bleeding events. ITP secondary to malignancy appears to be associated with unsatisfactory response to first-line treatments.
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Affiliation(s)
- Gian Marco Podda
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Elisa M Fiorelli
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Simone Birocchi
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Benedetta Rambaldi
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Maria Chiara Di Chio
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Giovanni Casazza
- Dipartimento Di Scienze Biomediche E Cliniche "L. Sacco", Università Degli Studi Di Milano, Milano, Italy
| | - Marco Cattaneo
- Unità Di Medicina III, ASST Santi Paolo E Carlo - Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
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Cattaneo M, Bertinato EM, Birocchi S, Brizio C, Malavolta D, Manzoni M, Muscarella G, Orlandi M. Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified? Thromb Haemost 2020; 120:1230-1232. [PMID: 32349132 PMCID: PMC7516356 DOI: 10.1055/s-0040-1712097] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Cattaneo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Elena M Bertinato
- Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Simone Birocchi
- Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Carolina Brizio
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Daniele Malavolta
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Marco Manzoni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Gesualdo Muscarella
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
| | - Michela Orlandi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Medicina II, ASST Santi Paolo e Carlo-Ospedale San Paolo, Milan, Italy
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Birocchi S, Podda GM, Manzoni M, Casazza G, Cattaneo M. Thrombopoietin receptor agonists for the treatment of primary immune thrombocytopenia: a meta-analysis and systematic review. Platelets 2020; 32:216-226. [PMID: 32281449 DOI: 10.1080/09537104.2020.1745168] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previous meta-analyses reported discordant results on the efficacy and safety of thrombopoietin receptor agonists (TPO-RA) as second-line treatment in patients with immune thrombocytopenia (ITP). We conducted a meta-analysis of primary ITP treatment with the TPO-RA Romiplostim, Eltrombopag and Avatrombopag, including additional studies and relevant endpoints. We searched MEDLINE, EMBASE and CENTRAL for randomized clinical trials (RCTs) and cohort studies on TPO-RA in ITP published until December 31, 2018. The primary endpoints were: risk ratio (RR) of treatment failure and bleeding of WHO grade ≥2; rate of remission after discontinuation of treatment. The principal safety outcome was RR and incidence of thrombotic events and liver damage. From 1044 identified records we selected 16 RCTs and 19 cohort studies. RCTs included 909 patients assigned to TPO-RA and 427 to the control arm. Treatment failure was observed in 21% TPO-RA-treated patients and 47% control arm patients (RR = 0.42, 95% CI 0.33-0.53) in RCTs during a median follow-up of 13 weeks, and in 29% TPO-RA-treated patients in cohort studies, during a median follow-up of 69 weeks. The incidence of remission after TPO discontinuation was 18% (5-36%). RR of WHO grade ≥2 bleeding was 0.58 (0.38-0.86) in TPO-RA-treated patients, compared to control arm patients. Adverse events were rare and not significantly different in the two groups of patients. All-cause mortality was significantly lower with TPO-RA (RR 0.21, 95% CI, 0.06-0.68). In conclusion, TPO-RA are effective and safe in patients with ITP, even in the long term.
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Affiliation(s)
- Simone Birocchi
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Gian Marco Podda
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Marco Manzoni
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Marco Cattaneo
- Unità di Medicina II, ASST Santi Paolo e Carlo - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
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21
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Sondey J, Taurel N, Khem C, Negre L, Birocchi S, Reynaud-Maurupt C. The Good Behavior Game: when the classroom becomes the playground for life skills (Toulon area). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.564] [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: 11/13/2022] Open
Abstract
Abstract
Children presenting disruptive and antisocial behavior are more at risk of developping health and life complications. The “Good Behavior Game” (GBG) is an American classroom behaviour management program implemented by trained teachers. Its effectiveness in public health has been shown by several scientific studies. The program was recently adapted for France by the GRVS, Nice. During 2017-2018, four schools - 1,400 children- benefitted from the GBG program, conducted in the Toulon area by the CODES 83 under the supervision of the GRVS. During their bi-monthly visits to the 29 teachers in training, coaches collected data reports on the past games, and observed a live GBG session. They discussed then with the teacher to build the best classroom management strategy.
Does the GBG help pupils improve their peer relationships? What can the program realistically bring in terms of classroom wellbeing? Those questions are crucial to assess, children’s quick benefits, as well as the development of life skills as protective factors for healthy living.
Based on the coaches’ observations and feedbacks with the teachers, preliminary results tend to demonstrate that the GBG help pupils improve their peer relationships, notably by evoking cooperation and inclusive behaviors. Pupils present a more positive state-of-mind whether to give a personal opinion, to share speaking time, learn patience, to make collective decisions, to be aware of one’s need, to peacefully deal with disagreement, to explain instructions to one another, to ask for another point of view. More active and peaceful approaches to conflict resolution have been noticed. The program seems to enhance wellbeing at class including positive peer interactions and self-appreciation.
Regarding the experiment in the Toulon area, GBG has a strong potential to develop social and life skills of children. GBG seems to work towards better self-esteem, a key lever for peer-pressure resistance and for making healthy choices.
Key messages
The “Good Behavior Game” (GBG) creates a positive environment in the classroom, leading children towards positive peer interactions. GBG enhances protective factors against peer-pressure an important determinant of risky behavior.
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Affiliation(s)
- J Sondey
- Comité Départemental d’Education pour la Santé du Var (CODES 83), La Garde, France
| | - N Taurel
- Comité Départemental d’Education pour la Santé du Var (CODES 83), La Garde, France
| | - C Khem
- Comité Départemental d’Education pour la Santé du Var (CODES 83), La Garde, France
| | - L Negre
- Comité Départemental d’Education pour la Santé du Var (CODES 83), La Garde, France
| | - S Birocchi
- Comité Départemental d’Education pour la Santé du Var (CODES 83), La Garde, France
| | - C Reynaud-Maurupt
- Groupe de Recherche sur la Vulnérabilité Sociale (GRVS), Nice, France
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Kremers BMM, Birocchi S, van Oerle R, Zeerleder S, Spronk HMH, Mees BME, Luken BM, Ten Cate H, Ten Cate-Hoek AJ. Searching for a Common Thrombo-Inflammatory Basis in Patients With Deep Vein Thrombosis or Peripheral Artery Disease. Front Cardiovasc Med 2019; 6:33. [PMID: 31001542 PMCID: PMC6454153 DOI: 10.3389/fcvm.2019.00033] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/12/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Inflammation and hypercoagulability play a pivotal role in venous thromboembolism and atherothrombosis. Since venous thrombosis increases the risk of atherothrombotic events and vice versa, common mechanisms may be involved. Objectives: To elucidate the role of neutrophils and coagulation in the occurrence of atherothrombotic events in patients with a history of deep vein thrombosis (DVT or peripheral artery disease (PAD). Materials and Methods: We studied 115 patients from two cohorts (75 DVT, 40 PAD). From those with PAD, 20 patients had progressive disease; from those with DVT, 25 patients had a recurrent DVT and 25 suffered from post thrombotic syndrome (PTS); patients were age and sex matched to DVT and PAD patients without events. Markers of neutrophil recruitment (p-selectin) and activation [nucleosomes, human neutrophil elastase- α1anti-trypsin (HNE-AT)], an anti-inflammatory marker (Lipoxin A4) and a clotting activity marker (d-dimer), were measured with ELISA. Coagulation potential was analyzed by thrombin generation (CAT method). Results: Higher nucleosome levels were found in DVT patients [11.3 U/mL (7.4–17.7)] compared to PAD patients [7.1 U/mL (5.1–13.8)], lower HNE-AT levels were found in DVT patients [33.4 ng/mL (23.5–40.5)] in comparison to PAD patients [158 ng/mL (88.1–283)]. No difference in nucleosome levels was found between DVT patients with cardiovascular (CV) events [12.6 U/mL (8.2–16.1)], and PAD patients with CV events [6.9 U/mL (4.9–11.2)]. Lipoxin A4 levels appeared to be significantly lower in DVT [2.4 ng/mL (1.7–4.8)] vs. PAD [35.6 ng/mL (16.6–80.1)], with similar results in DVT patients with CV events vs. PAD patients with CV events. Thrombin generation showed higher ETP [160.4% (141.1–215.4)], and peak height [292.1% (177.9–330)] values in DVT patients. D-dimer levels were significantly lower in the DVT cohort [330 ng/mL (220–550)] compared to the PAD cohort [550 ng/mL (369–959)]. Conclusion: In DVT patients, neutrophil activity does not appear to be an important driver of CV events. Although neutrophil activity is more pronounced in PAD, its effect is partly dampened by Lipoxin A4. Moreover, no associations were found between NET products and coagulation activity, suggesting that neutrophil activation does not play a pivotal role in the risk of thrombosis in either DVT or PAD.
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Affiliation(s)
- Bram M M Kremers
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, Netherlands
| | | | - Rene van Oerle
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, Netherlands
| | - Sacha Zeerleder
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland.,Immunopathology, Sanquin Research, Amsterdam, Netherlands.,Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Henri M H Spronk
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, Netherlands
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Brenda M Luken
- Immunopathology, Sanquin Research, Amsterdam, Netherlands
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, Netherlands.,Thrombosis Expertise Center, Maastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arina J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, Netherlands.,Thrombosis Expertise Center, Maastricht, Netherlands
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23
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Birocchi S, Podda GM. Oral anticoagulants for stroke prevention in patients with atrial fibrillation and previous intracranial hemorrhage. Intern Emerg Med 2017; 12:527-529. [PMID: 27815808 DOI: 10.1007/s11739-016-1568-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Simone Birocchi
- ASST Santi Paolo e Carlo, A.O. San Paolo, U.O. Medicina 3, via antonio di Rudini, 6, Milan, Italy.
| | - Gian Marco Podda
- ASST Santi Paolo e Carlo, A.O. San Paolo, U.O. Medicina 3, via antonio di Rudini, 6, Milan, Italy
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Fiorelli EM, Ricci S, Birocchi S, Carpani G, Cattaneo M. Retrospective study of patients' persistence on treatment with vitamin K antagonists in the setting of an anticoagulation clinic in Italy. Thromb Res 2015; 136:484-5. [DOI: 10.1016/j.thromres.2015.06.004] [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: 02/22/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 11/28/2022]
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Birocchi S, Cernuschi G. Adjunct prednisone therapy for patients with community-acquired pneumonia. Intern Emerg Med 2015; 10:629-30. [PMID: 25998223 DOI: 10.1007/s11739-015-1247-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Simone Birocchi
- Medicina a indirizzo fisiopatologico, Dipartimento di Medicina Interna, Ospedale "L. Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20157, Milan, Italy,
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Cogliati C, Antivalle M, Torzillo D, Birocchi S, Norsa A, Bianco R, Costantino G, Ditto MC, Battellino M, Sarzi Puttini PC, Montano N. Standard and pocket-size lung ultrasound devices can detect interstitial lung disease in rheumatoid arthritis patients. Rheumatology (Oxford) 2014; 53:1497-503. [DOI: 10.1093/rheumatology/keu033] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Birocchi S, Scannella E, Ferrari L, Podda GM. Aspirin in the secondary prevention of unprovoked thromboembolism: the WARFASA and ASPIRE studies. Intern Emerg Med 2013; 8:757-60. [PMID: 23744554 DOI: 10.1007/s11739-013-0961-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Simone Birocchi
- U. O. Medicina III, Ospedale San Paolo, Università degli Studi di Milano, Milan, Italy
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Torzillo D, Antivalle M, Birocchi S, Columpsi D, Ditto M, Battellino M, Sarzi-Puttini P, Norsa A, Montano N, Cogliati C. FRI0107 Lung ultrasound for the diagnosis of interstitial disease in rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2564] [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: 11/04/2022]
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Birocchi S, Cernuschi G, Podda GM, Costantino G. To anticoagulate or not to anticoagulate? That is the question : A Medline-based quantitative approach to share evidence on common clinical problems. Intern Emerg Med 2013; 8:245-8. [PMID: 22847728 DOI: 10.1007/s11739-012-0816-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Simone Birocchi
- Medicina Interna 2, Az. Ospedaliera Ospedale L. Sacco, Università degli Studi di Milano, Via G.B. Grassi, 74, 20157, Milan MI, Italy.
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Abstract
The editorial and peer-review processes should guarantee readers as to the reliability of published data. The first step of these processes is to check for errors. The aim of our study was to look for the presence of objective errors in consecutive articles published on three of the most authoritative clinical journals. Two reviewers evaluated the presence of any error in 200 consecutive original articles containing at least two tables, allowing a reanalysis of the data, published between October 2010 and April 2011. Error was considered any action different from what was planned. Errors were listed as: methodological, numerical and slips. They were considered as severe if numbers in the abstract were completely different from numbers reported in the full text. Among the 125 articles included in the study, 102 (82 %, 95 % CI 74-88 %) contained some kind of error, even multiple. Nine articles (7 %, 95 % CI 3-13 %) contained one slip, 92 articles (74 %, 95 % CI 65-81 %) contained at least one numerical error, and 22 articles (18 %, 95 % CI 11-25 %) contained one methodological error. Five articles (4 %, 95 % CI 1-9 %) contained one serious error. None of the errors retrieved (0 %, 95 % CI 0-2 %) would have changed the results of the studies. Most of the articles published in the most important medical journals present mistakes. Our results could be a clue to editorial and peer review systems system weaknesses. A debate within the scientific medical community about these systems, and possible alternative adjustments are needed.
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Affiliation(s)
- Giorgio Costantino
- Medicina Interna II, Dipartimento di Medicina Interna, Ospedale "L. Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20157, Milan, Italy.
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Casella F, Birocchi S. Is a liberal transfusion strategy better than a symptomatic strategy in patients with cardiovascular disease undergoing surgical hip fracture repair? Intern Emerg Med 2012; 7:475-6. [PMID: 22872569 DOI: 10.1007/s11739-012-0836-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/14/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Francesco Casella
- U.O. Medicina 3, Dipartimento di Medicina, Ospedale L. Sacco, Università degli Studi di Milano, Milan, Italy
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Cernuschi G, Bonzi M, Fiorelli E, Birocchi S. Do outcomes of near syncope parallel syncope? Am J Emerg Med 2012; 30:2064-5; author reply 2064. [PMID: 22867828 DOI: 10.1016/j.ajem.2012.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022] Open
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Birocchi S, Cernuschi GCL. Eplerenone, an aldosterone antagonist, reduces hospitalization and death in heart failure patients with NYHA class II and an ejection fraction of less than 30%. Intern Emerg Med 2011; 6:453-4. [PMID: 21769601 DOI: 10.1007/s11739-011-0661-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Simone Birocchi
- Medicina Interna 2, Ospedale L. Sacco, Università degli Studi di Milano, Via G.B. Grassi, 74, 20157 Milan, MI, Italy.
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