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Bosch F, Mulder F, Franken L, Willemsen A, Rentinck M, van den Berg P, Bakker SLD, van der Velden A, van Es N, Mathôt R, Kamphuisen PW. Effect of the P-glycoprotein inhibitor tamoxifen on edoxaban plasma levels in women with breast cancer. Thromb Res 2023; 228:46-53. [PMID: 37269716 DOI: 10.1016/j.thromres.2023.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/08/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Concomitant use of P-glycoprotein inhibitors can reduce clearance of edoxaban and increase its plasma concentration. Caution is advised with simultaneous use of edoxaban and the frequently used P-glycoprotein inhibitor tamoxifen. However, pharmacokinetic data are lacking. OBJECTIVES This study aimed to assess the effect of tamoxifen on edoxaban clearance. METHODS This was a prospective, self-controlled, pharmacokinetic study in breast cancer participants starting tamoxifen. Edoxaban was given at a dose of 60 mg once daily for 4 consecutive days, first without tamoxifen and later with concomitant tamoxifen in steady-state. On day 4 of both edoxaban sequences, serial blood samples were taken. A population pharmacokinetic model was developed using nonlinear mixed effects modelling in which the effect of tamoxifen on edoxaban clearance was assessed. Additionally, mean area under the curves (AUC) were estimated. Geometric least square means (GLM) ratios were calculated and no interaction was concluded if the 90 % CI was within the 80-125 % no-effect boundaries. RESULTS Twenty-four women with breast cancer scheduled for tamoxifen were included. The median age was 56 years (IQR 51-63). The average edoxaban clearance was 32.0 L/h (95 % CI, 11.1-35.0 L/h). There was no effect of tamoxifen on edoxaban clearance, with a fraction of 100 % (95 % CI 92-108) compared to clearance without tamoxifen. The mean AUCs were 1923 ng*h/ml (SD 695) without tamoxifen and 1947 ng*h/ml (SD 595) with tamoxifen (GLM-ratio 100.4; 90 % CI 98.6-102.2). CONCLUSIONS Concomitant use of the P-glycoprotein inhibitor tamoxifen does not lead to reduced clearance of edoxaban in patients with breast cancer.
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Affiliation(s)
- Floris Bosch
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands.
| | - Frits Mulder
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
| | - Linda Franken
- Department of Hospital Pharmacy - Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Annelieke Willemsen
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Marjolein Rentinck
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Pieter van den Berg
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | | | - Ankie van der Velden
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Nick van Es
- Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
| | - Ron Mathôt
- Department of Hospital Pharmacy - Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pieter W Kamphuisen
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
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2
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Lee J, Mulder F, Leeflang M, Wolff R, Whiting P, Bossuyt PM. QUAPAS: An Adaptation of the QUADAS-2 Tool to Assess Prognostic Accuracy Studies. Ann Intern Med 2022; 175:1010-1018. [PMID: 35696685 DOI: 10.7326/m22-0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Whereas diagnostic tests help detect the cause of signs and symptoms, prognostic tests assist in evaluating the probable course of the disease and future outcome. Studies to evaluate prognostic tests are longitudinal, which introduces sources of bias different from those for diagnostic accuracy studies. At present, systematic reviews of prognostic tests often use the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess risk of bias and applicability of included studies because no equivalent instrument exists for prognostic accuracy studies. QUAPAS (Quality Assessment of Prognostic Accuracy Studies) is an adaptation of QUADAS-2 for prognostic accuracy studies. Questions likely to identify bias were evaluated in parallel and collated from QUIPS (Quality in Prognosis Studies) and PROBAST (Prediction Model Risk of Bias Assessment Tool) and paired to the corresponding question (or domain) in QUADAS-2. A steering group conducted and reviewed 3 rounds of modifications before arriving at the final set of domains and signaling questions. QUAPAS follows the same steps as QUADAS-2: Specify the review question, tailor the tool, draw a flow diagram, judge risk of bias, and identify applicability concerns. Risk of bias is judged across the following 5 domains: participants, index test, outcome, flow and timing, and analysis. Signaling questions assist the final judgment for each domain. Applicability concerns are assessed for the first 4 domains. The authors used QUAPAS in parallel with QUADAS-2 and QUIPS in a systematic review of prognostic accuracy studies. QUAPAS improved the assessment of the flow and timing domain and flagged a study at risk of bias in the new analysis domain. Judgment of risk of bias in the analysis domain was challenging because of sparse reporting of statistical methods.
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Affiliation(s)
- Jenny Lee
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
| | - Frits Mulder
- Department of Vascular Medicine, Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (F.M.)
| | - Mariska Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
| | - Robert Wolff
- Kleijnen Systematic Reviews, Escrick, United Kingdom (R.W.)
| | - Penny Whiting
- Bristol Medical School, University of Bristol, Bristol, United Kingdom (P.W.)
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
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3
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Roy PM, Penaloza A, Hugli O, Klok FA, Arnoux A, Elias A, Couturaud F, Joly LM, Lopez R, Faber LM, Daoud-Elias M, Planquette B, Bokobza J, Viglino D, Schmidt J, Juchet H, Mahe I, Mulder F, Bartiaux M, Cren R, Moumneh T, Quere I, Falvo N, Montaclair K, Douillet D, Steinier C, Hendriks SV, Benhamou Y, Szwebel TA, Pernod G, Dublanchet N, Lapebie FX, Javaud N, Ghuysen A, Sebbane M, Chatellier G, Meyer G, Jimenez D, Huisman MV, Sanchez O. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J 2021; 42:3146-3157. [PMID: 34363386 PMCID: PMC8408662 DOI: 10.1093/eurheartj/ehab373] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 12/02/2020] [Revised: 02/02/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
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Affiliation(s)
- Pierre-Marie Roy
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Andrea Penaloza
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,UCLouvain, Brussels, Belgium
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, DTN, Leiden University Medical Center, Leiden, the Netherlands
| | - Armelle Arnoux
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Antoine Elias
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Francis Couturaud
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France.,EA3878-GETBO, CIC-INSERM1412, Univ-Brest, Brest, France
| | - Luc-Marie Joly
- Emergency Department, CHU Rouen, Normandy Univ, UNIROUEN, Rouen, France
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, DTN, the Netherlands
| | - Marie Daoud-Elias
- Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Benjamin Planquette
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes, Grenoble, France.,HP2 INSERM U 1042 Laboratory, University of Grenoble-Alpes, Grenoble, France
| | - Jeannot Schmidt
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Henry Juchet
- Emergency Department, CHU Toulouse, Toulouse, France
| | - Isabelle Mahe
- F-CRIN, INNOVTE, Saint-Etienne, France.,Internal Medicine Department, HU Paris Nord, Louis Mourier Hospital, APHP, Colombes, France.,Inserm UMR_S1140 Hemostasis Therapeutical Innovations, University of Paris, Colombes, France
| | - Frits Mulder
- Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands
| | - Magali Bartiaux
- Emergency Department, Saint-Pierre Hospital, Brussels, Belgium
| | - Rosen Cren
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thomas Moumneh
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Isabelle Quere
- F-CRIN, INNOVTE, Saint-Etienne, France.,Vascular Medicine Department, CHU Montpellier, EA2992, CIC 1001, University of Montpellier, Montpellier, France
| | - Nicolas Falvo
- Vascular Medicine Department, CHU Dijon, Dijon, France
| | - Karine Montaclair
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology, CH Le Mans, Le Mans, France
| | - Delphine Douillet
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Charlotte Steinier
- Emergency Department, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stephan V Hendriks
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Charles Nicolle, Rouen, France.,Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Gilles Pernod
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France.,University Grenoble Alpes, CNRS / TIMC-IMAG UMR 5525 / Themas, Grenoble, France
| | - Nicolas Dublanchet
- Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | | | - Nicolas Javaud
- Emergency Department, CréAk, Louis Mourier Hospital, APHP, University of Paris, Colombes, France
| | - Alexandre Ghuysen
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Mustapha Sebbane
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Gilles Chatellier
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Guy Meyer
- Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - David Jimenez
- Respiratory Department and Medicine Department, Ramon y Cajal Hospital IRYCIS Alcal de Henares University, Madrid, Spain
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Olivier Sanchez
- F-CRIN, INNOVTE, Saint-Etienne, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France.,Pneumology Department and Intensive Care, Hôpital Européen Georges Pompidou, APHP, 20-40 rue Leblanc, Paris, France, F-75908
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4
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Bakker T, Abu-Hanna A, Dongelmans DA, Vermeijden WJ, Bosman RJ, de Lange DW, Klopotowska JE, de Keizer NF, Hendriks S, Ten Cate J, Schutte PF, van Balen D, Duyvendak M, Karakus A, Sigtermans M, Kuck EM, Hunfeld NGM, van der Sijs H, de Feiter PW, Wils EJ, Spronk PE, van Kan HJM, van der Steen MS, Purmer IM, Bosma BE, Kieft H, van Marum RJ, de Jonge E, Beishuizen A, Movig K, Mulder F, Franssen EJF, van den Bergh WM, Bult W, Hoeksema M, Wesselink E. Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study. J Crit Care 2020; 62:124-130. [PMID: 33352505 DOI: 10.1016/j.jcrc.2020.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/12/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. MATERIALS & METHODS In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. RESULTS The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. CONCLUSIONS Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.
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Affiliation(s)
- Tinka Bakker
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Ameen Abu-Hanna
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Dave A Dongelmans
- Amsterdam UMC (location AMC), Department of Intensive Care Medicine, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Wytze J Vermeijden
- Department of Intensive Care, Medisch Spectrum Twente, Koningsplein 1, 7512, KZ, Enschede, the Netherlands.
| | - Rob J Bosman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands.
| | - Dylan W de Lange
- Department of Intensive Care and Dutch Poison Information Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - Joanna E Klopotowska
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Nicolette F de Keizer
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | | | - S Hendriks
- Department of Intensive Care, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - J Ten Cate
- Department of Intensive Care, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P F Schutte
- Department of Intensive Care, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D van Balen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Duyvendak
- Department of Hospital Pharmacy, Antonius Hospital, Sneek, The Netherlands
| | - A Karakus
- Department of Intensive Care Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M Sigtermans
- Department of Intensive Care Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - E M Kuck
- Department of Hospital Pharmacy, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - N G M Hunfeld
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands; Department of Hospital Pharmacy, ErasmusMC, Rotterdam, The Netherlands
| | - H van der Sijs
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - P W de Feiter
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - E-J Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - P E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
| | - H J M van Kan
- Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn, The Netherlands
| | - M S van der Steen
- Department of Intensive Care, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - I M Purmer
- Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - B E Bosma
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - H Kieft
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - R J van Marum
- Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Amsterdam UMC (location VUmc), Department of Elderly Care Medicine, Amsterdam, The Netherlands
| | - E de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - F Mulder
- Department of Pharmacology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - E J F Franssen
- OLVG Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands
| | - W M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Bult
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Hoeksema
- Zaans Medisch Centrum, Department of Anesthesiology, Intensive Care and Painmanagement, Zaandam, The Netherlands
| | - E Wesselink
- Department of Clinical Pharmacy, Zaans Medisch Centrum, Zaandam, The Netherlands
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5
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Kraaijpoel N, Di Nisio M, Mulder F, van Es N, Beyer-Westendorf J, Carrier M, Garcia D, Grosso M, Kakkar A, Mercuri M, Middeldorp S, Hernandez C, Santamaria A, Schwocho L, Segers A, Verhamme P, Wang TF, Weitz J, Zhang G, Zwicker J, Büller H, Raskob G. Clinical Impact of Bleeding in Cancer-Associated Venous Thromboembolism: Results from the Hokusai VTE Cancer Study. Thromb Haemost 2018; 118:1439-1449. [DOI: 10.1055/s-0038-1667001] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In the Hokusai VTE Cancer study, edoxaban was non-inferior to dalteparin for the composite outcome of recurrent venous thromboembolism (VTE) and major bleeding in 1,050 patients with cancer-associated VTE. The absolute rate of recurrent VTE was 3.4% lower with edoxaban, whereas the absolute rate of major bleeding was 2.9% higher. The present analysis focuses on the sites, clinical presentation, course and outcome of bleeding events, and the associated tumour types. Major bleeds and their severity (categories 1–4) were blindly adjudicated by a committee using a priori defined criteria, and data were analysed in the safety population. Major bleeding occurred in 32 of 522 patients given edoxaban (median treatment duration, 211 days) and in 16 of 524 patients treated with dalteparin (median treatment duration, 184 days); no patients had more than one major bleed. There were no fatal bleeds with edoxaban, and two with dalteparin. Severe bleeding at presentation (category 3 or 4) occurred in 10 (1.9%) and 11 (2.1%) patients in the edoxaban and dalteparin groups, respectively. The excess of major bleeding with edoxaban was confined to patients with gastrointestinal cancer. However, severe major bleeding at presentation (category 3 or 4) in this sub-group occurred in 5 of 165 (3.0%) and in 3 of 140 (2.1%) patients given edoxaban or dalteparin, respectively.In conclusion, this analysis suggests that while oral edoxaban is an appropriate alternative to subcutaneous dalteparin for treatment of cancer-associated VTE, the use of edoxaban in patients with gastrointestinal cancer requires careful benefit–risk weighting.
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Affiliation(s)
- Noémie Kraaijpoel
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
| | - Frits Mulder
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington, United States
| | - Michael Grosso
- Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey, United States
| | - Ajay Kakkar
- Thrombosis Research Institute, University College London, London, United Kingdom
| | - Michele Mercuri
- Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey, United States
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristhiam Hernandez
- MD Anderson Cancer Center, University of Texas, Houston, Texas, United States
| | - Amparo Santamaria
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Lee Schwocho
- Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey, United States
| | - Annelise Segers
- ITREAS, Academic Research Organization, Amsterdam, The Netherlands
| | - Peter Verhamme
- University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Tzu-Fei Wang
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Jeffrey Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - George Zhang
- Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey, United States
| | - Jeffrey Zwicker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Harry Büller
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gary Raskob
- University of Oklahoma Health Sciences Center, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, United States
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6
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Vegting IL, Alam N, Ghanes K, Jouini O, Mulder F, Vreeburg M, Biesheuvel T, van Bokhorst J, Go P, Kramer MHH, Koole GM, Nanayakkara PWB. What are we waiting for? Factors influencing completion times in an academic and peripheral emergency department. Neth J Med 2015; 73:331-340. [PMID: 26314716] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND A long completion time in the Emergency Department (ED) is associated with higher morbidity and in-hospital mortality. A completion time of more than four hours is a frequently used cut-off point. Mostly, older and sicker patients exceed a completion time of four hours on the ED. The primary aim was to examine which factors currently contribute to overcrowding and a time to completion of more than four hours on the EDs of two different hospitals, namely: the VU Medical Center (VUmc), an academic level 1 trauma centre and the St. Antonius Hospital, a large community hospital in Nieuwegein. In addition, we compared the differences between these hospitals. METHODS In this observational study, the time steps in the process of diagnosing and treatment of all patients visiting the EDs of the two hospitals were measured for four weeks. Patients triaged as Emergency Severity Index (ESI) category 2/3 or Manchester Triage System (MTS) orange/yellow were followed more closely and prospectively by researchers for detailed information in the same period from 12.00-23.00 hrs. RESULTS In the VUmc, 89% of the patients had a completion time of less than four hours. The average completion time (n = 2262) was 2:10 hours, (median 1:51 hours, range: 0:05-12:08). In the St. Antonius Hospital, 77% of patients had a completion time shorter than four hours (n = 1656). The average completion time in hours was 2:49 (n = 1655, median 2:34, range: 0:08-11:04). In the VUmc, a larger percentage of ESI 1, 2 and 3 patients did not achieve the 4-hour target (14%, 20% and 19%) compared with ESI 4 and 5 patients (2.7% and 0%), p < 0.001. At the St. Antonius Hospital, a greater percentage of orange and yellow categorised patients exceeded four hours on the ED (32% and 28%) compared with red (8%) and green/blue (13%), p < 0.001. For both hospitals there was a significant dependency between exceeding four hours on the ED and the following: whether a consultation was performed (p < 0.001), the number of radiology tests performed (p < 0.001), and an age above 65 years. CONCLUSION Factors leading to ED stagnation were similar in both hospitals, namely old age, treatment by more than one speciality and undergoing radiological tests. Uniform remedial measures should be taken on a nationwide level to deal with these factors to reduce stagnation in the EDs.
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Affiliation(s)
- I L Vegting
- Departments of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, the Netherlands
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Berns RM, Wormer PES, Mulder F, Avoird AVD. Abinitiocalculations of the collision‐induced dipole in He–H2. I. A valence bond approach. J Chem Phys 1978. [DOI: 10.1063/1.436810] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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