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Giorgi-Pierfranceschi M, Monreal M, Di Micco P, Francisco I, Hernández-Blasco L, Madridano O, López-Sáez JB, Hernando E, Meireles J, Dentali F. Prognostic Impact of Active Cigarette Smoking on Mortality in Patients with Acute Venous Thromboembolic Events, Findings from Real World Data. Medicina (B Aires) 2022; 58:medicina58020295. [PMID: 35208618 PMCID: PMC8880138 DOI: 10.3390/medicina58020295] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. Results: 50,881 patients (43,426 non-smoking and 7455 smoking patients) were included. After a median follow-up of 8.8 months, 7110 patients died (fatal PE 292 and fatal bleeding 281), 3243 presented VTE recurrence, and 1579 had major bleeding. At multivariate analysis, smoking behavior was associated with a higher hazard of death, (HR: 1.28; 95% CI: 1.19–1.40). The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI: 1.02–1.27). Major bleeding did not differ in smoking and non-smoking patients (1.15; 95% CI: 0.96–1.38). The presence of cancer did not appear to influence the association between smoking habits and death (HR: 1.34; 95% CI: 1.22–1.47 in cancer patients and HR: 1.23; 95% CI: 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms.
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Affiliation(s)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, 08016 Barcelona, Spain;
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, 17007 Gerona, Spain;
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, 03014 Alicante, Spain;
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, 28042 Madrid, Spain;
| | - Juan Bosco López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, 11006 Cádiz, Spain;
| | - Elena Hernando
- Department of Pneumonology, Hospital San Pedro, 26001 Logroño, Spain;
| | - Jose Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, 4520-195 Santa María da Feira, Portugal;
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy;
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Giorgi-Pierfranceschi M. Is Aspirin Effective in Preventing Intensive Care Unit Admission in Patients With Coronavirus Disease 2019 Pneumonia? Anesth Analg 2021; 132:e89-e90. [PMID: 33369927 DOI: 10.1213/ane.0000000000005401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Matteo Giorgi-Pierfranceschi
- Department of Internal Medicine, Hospital of Cremona, Azienda Socio-Sanitaria Territoriale-Cremona, Cremona, Italy,
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3
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Generali D, Bosio G, Malberti F, Cuzzoli A, Testa S, Romanini L, Fioravanti A, Morandini A, Pianta L, Giannotti G, Viola EM, Giorgi-Pierfranceschi M, Foramitti M, Tira RA, Zangrandi I, Chiodelli G, Machiavelli A, Cappelletti MR, Giossi A, De Giuli V, Costanzi C, Campana C, Bernocchi O, Sirico M, Zoncada A, Molteni A, Venturini S, Giudici F, Scaltriti M, Pan A. Canakinumab as treatment for COVID-19-related pneumonia: A prospective case-control study. Int J Infect Dis 2021; 104:433-440. [PMID: 33385581 PMCID: PMC7771302 DOI: 10.1016/j.ijid.2020.12.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Canakinumab is an IL-1β antibody that neutralises the activity of IL-1β. This study examined the efficacy and safety of canakinumab in patients with moderate COVID-19-related pneumonia. DESIGN This study aimed to evaluate the reduction in duration of hospitalisation with adequate oxygen status. Forty-eight patients with moderate COVID-19-related pneumonia were asked to participate in the prospective case-control study: 33 patients (cases) signed informed consent and received canakinumab (Cohort 1) and 15 patients (Controls) refused to receive the experimental drug and received institutional standard of care (Cohort 2). RESULTS Hospital discharge within 21 days was seen in 63% of patients in Cohort 1 vs. 0% in Cohort 2 (median 14 vs. 26 days, respectively; p < 0.001). There was significant clinical improvement in ventilation regimes following administration of canakinumab compared with Cohort 2 (Stuart-Maxwell test for paired data, p < 0.001). Patients treated with canakinumab experienced a significant increase in PaO2:FiO2 (p < 0.001) and reduction in lung damage by CT (p = 0.01), along with significant decreases in immune/inflammation markers that were not observed in Cohort 2. Only mild side-effects were seen in patients treated with canakinumab; survival at 60 days was 90.0% (95% CI 71.9-96.7) in patients treated with canakinumab and 73.3% (95% CI 43.6-89.1) for Cohort 2. CONCLUSIONS Treatment with canakinumab in patients with COVID-19-related pneumonia rapidly restored normal oxygen status, decreased the need for invasive mechanical ventilation, and was associated with earlier hospital discharge and favourable prognosis versus standard of care.
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Affiliation(s)
- Daniele Generali
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - Giancarlo Bosio
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Fabio Malberti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Antonio Cuzzoli
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Center, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Laura Romanini
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Antonio Fioravanti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Luca Pianta
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Erika Maria Viola
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Marina Foramitti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Rosa Angela Tira
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Ilaria Zangrandi
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Giulia Chiodelli
- Pharmacy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Andrea Machiavelli
- Pharmacy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Maria Rosa Cappelletti
- Haemostasis and Thrombosis Center, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alessia Giossi
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Valeria De Giuli
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Chiara Costanzi
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Chiara Campana
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianna Sirico
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alessia Zoncada
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alfredo Molteni
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Sergio Venturini
- Department of Management, University of Turin, Turin, Italy; Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Fabiola Giudici
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Maurizio Scaltriti
- Department of Pathology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angelo Pan
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
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Mumoli N, Vitale J, Pagnamenta A, Mastroiacovo D, Cei M, Pomero F, Giorgi-Pierfranceschi M, Giuntini L, Porta C, Capra R, Mazzone A, Dentali F. Bedside Abdominal Ultrasound in Evaluating Nasogastric Tube Placement: A Multicenter, Prospective, Cohort Study. Chest 2021; 159:2366-2372. [PMID: 33545162 DOI: 10.1016/j.chest.2021.01.058] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chest radiography is universally accepted as the method of choice to confirm correct positioning of a nasogastric tube (NGT). Considering also that radiation exposure could increase with multiple insertions in a single patient, bedside abdominal ultrasound (BAU) may be a potentially useful alternative to chest radiography in the management of NGTs. RESEARCH QUESTION What is the accuracy of BAU in confirming the correct positioning of an NGT? STUDY DESIGN AND METHODS After a specific course consisting of 10 h of training, the authors studied, in a prospective multicenter cohort, the validity of BAU to confirm correct NGT placement. All patients were also evaluated by auscultation (whoosh test) and by chest radiography. Every involved operator was blind to each other. Interobserver agreement and accuracy analyses were calculated. RESULTS This study evaluated 606 consecutive inpatients with an indication for NGT insertion. Eighty patients were excluded for protocol violation or incomplete examinations and 526 were analyzed. BAU was positive, negative, and inconclusive in 415 (78.9%), 71 (13.5%), and 40 (7.6%), respectively. The agreement between BAU and chest radiography was excellent. Excluding inconclusive results, BAU had a sensitivity of 99.8% (99.3%-100%), a specificity of 91.0% (88.5%-93.6%), a positive predictive value of 98.3% (97.2%-99.5%), and a negative predictive value of 98.6% (97.6%-99.7%). The accuracy of BAU slightly changed according to the different assignments of the uncertain cases and was improved by the exclusion of patients with an altered level of consciousness. INTERPRETATION These results suggest that BAU has a good positive predictive value and may confirm the correct placement of NGTs when compared with chest radiography. However, considering its suboptimal specificity, caution is necessary before implementing this technique in clinical practice.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy; Department of Internal Medicine, ASST Ovest Milanese, Magenta, Italy.
| | - Josè Vitale
- Department of Intensive Medicine, Intensive Care Unit and Biostatistics Unit, Regional Hospital Mendrisio, Ente Ospedaliero Cantonale, Switzerland
| | - Alberto Pagnamenta
- Department of Intensive Medicine, Intensive Care Unit and Biostatistics Unit, Regional Hospital Mendrisio, Ente Ospedaliero Cantonale, Switzerland
| | | | - Marco Cei
- Department of Internal Medicine, Cecina Hospital, Cecina, Italy
| | - Fulvio Pomero
- Department of Internal Medicine, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | - Lucia Giuntini
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - Cesare Porta
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, Italy
| | - Riccardo Capra
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, Italy
| | - Antonino Mazzone
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, Italy
| | - Francesco Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
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5
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Saifi ES, Giorgi-Pierfranceschi M, Salvetti M, Maninetti L, Cavalli I, Muiesan ML. Factors associated with survival in older patients affected by COVID-19: A retrospective cohort study. Arch Gerontol Geriatr 2021; 94:104349. [PMID: 33508512 PMCID: PMC7825838 DOI: 10.1016/j.archger.2021.104349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
Aim Mortality is high in Coronavirus disease 2019 patients with pre-existing comorbidities and advanced age. Associated complications have added to the negative prognosis. Nevertheless, many have fully recovered, even among the most fragile. Factors associated with their survival was investigated. Methods Retrospective study of patients aged ≥90 years admitted for COVID-19 to the Internal Medicine wards of two hospitals in Lombardy, Italy. Results Among 34 patients with SARS-CoV-2 pneumonia, 33 (97.1%) had respiratory failure. Eighteen patients (52.9%) survived and 16 (47.1%) died during hospital stay. Survivors compared to deceased had a significantly longer hospitalization (19 vs. 10 days respectively; p = 0.02), a better PaO2:FiO2 ratio (241 vs. 171 respectively; p = 0.003), higher lymphocyte counts (p = 0.01) and lower serum LDH levels (p < 0.001) at admission. At multivariate analysis only higher PaO2:FiO2 was associated with survival (OR 1.06 [95%CI 1.0–1.03]; p = 0.02). Kaplan-Meier analysis showed a significant difference in event-free survival between patients treated or not with LMWH (p < 0.0001) and between those treated or not with beta-blockers (p = 0.008). Cox regression, performed in the subgroup of patients who received LMWH, did not show significant difference for sex (HR 2.7 [95% CI 0.53–14.3], p = 0.23), CCI (HR 0.7 [95% CI 0.37–1.45], p = 0.38), PaO2:FiO2 ratio (HR 0.98 [95% CI 0.97–1.0], p = 0.07), corticosteroid therapy (HR 0.99 [95% CI 0.22–4.5], p = 0.99) and beta-blocker therapy (HR 2.8 [95% CI 0.56–14,7], p = 0.21). Conclusions Despite higher mortality in elderly, treatment with LMWH and betablockers might be associated with better survival. Dedicated studies are required to confirm our result.
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Affiliation(s)
- Erkin Saeed Saifi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; II Medicina Generale, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25125, Brescia, Italy; Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy.
| | | | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; II Medicina Generale, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25125, Brescia, Italy
| | - Letizia Maninetti
- Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy
| | - Ilaria Cavalli
- Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy
| | - Maria L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; II Medicina Generale, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25125, Brescia, Italy
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6
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Giorgi-Pierfranceschi M, Paoletti O, Pan A, De Gennaro F, Nardecchia AL, Morandini R, Dellanoce C, Lombi S, Tala M, Cancelli V, Zambelli S, Bosio G, Romanini L, Testa S. Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study. Intern Emerg Med 2020; 15:1425-1433. [PMID: 32840805 PMCID: PMC7445816 DOI: 10.1007/s11739-020-02472-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.
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Affiliation(s)
| | - Oriana Paoletti
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Angelo Pan
- Department of Infectious Disease, Hospital of Cremona, Cremona, Italy
| | - Fabio De Gennaro
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Anna Laura Nardecchia
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | | | - Claudia Dellanoce
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Samuele Lombi
- Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Maurizio Tala
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Vanessa Cancelli
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Silvia Zambelli
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
| | - Giancarlo Bosio
- Department of Pneumology, Hospital of Cremona, Cremona, Italy
| | - Laura Romanini
- Department of Radiology, Hospital of Cremona, Cremona, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
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7
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Dentali F, Pomero F, Micco PD, La Regina M, Landini F, Mumoli N, Pieralli F, Giorgi-Pierfranceschi M, Re R, Vitale J, Fabbri LM, Fontanella A, Arioli D. Prevalence and risk factors for pulmonary embolism in patients with suspected acute exacerbation of COPD: a multi-center study. Eur J Intern Med 2020; 80:54-59. [PMID: 32474052 DOI: 10.1016/j.ejim.2020.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) prevalence in acute exacerbations of COPD is highly variable. METHODS To investigate the prevalence and risk factors of PE in patients hospitalized in Departments of Internal Medicine because of AECOPD and suspected PE we conducted a retrospective multicenter study in patients with an AECOPD undergoing chest angio-computed tomography (angio-CT) because of clinical suspect of PE. RESULTS 1043 patients (mean age 75.8 years ± 9.7 years, 34.5 % women) were included; 132 patients had PE (mean prevalence 12.66%, 95% confidence interval 10.73, 14.77%).) confirmed by angio-CT and 54 patients died during hospitalization (5.18 %). At multivariate analysis, age, female gender, clinical signs and symptoms suggestive of deep vein thrombosis, hypertension, PaCO2 ≤ 40 mmHg, and normal chest-x-ray were significantly associated with a higher PE prevalence. Prevalence of PE in patients with 0, 1, 2, 3 or ≥4 risk factors progressively increase from 1.76 to 30.43%. Mean length of hospitalization (LOH) (15.7 vs 14.2 days, p 0.07) and in-hospital mortality (6.1% vs 5.1%, P=0.62) were slightly but not significantly higher in in patients with PE (6.1% vs 5.1%, P=0.62). CONCLUSIONS PE prevalence is not negligible in this setting. A number of risk factors may help clinicians in identification of patients at increased risk of PE.
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Affiliation(s)
- Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy.
| | - Fulvio Pomero
- Department of Internal Medicine, S. Lazzaro Hospital, Alba, Cuneo Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Micaela La Regina
- Risk Management Unit, East Ligurian Hospital, La Spezia, ASL5 Liguria, La Spezia, Italy
| | - Federica Landini
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale Fornaroli, Magenta, Milan, Italy
| | - Filippo Pieralli
- Medicina Interna e di Urgenza, Azienda Ospedaliera Universitaria 'Careggi', Firenze, Italy
| | | | - Roberta Re
- Department of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy
| | - Josè Vitale
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Leonardo M Fabbri
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy
| | - Dimitriy Arioli
- Internal Medicine, Centro Emostasi e Trombosi, Stroke Unit, Azienda Ospedaliera ASMN, Reggio Emilia, Italy
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Testa S, Paoletti O, Giorgi-Pierfranceschi M, Pan A. Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients. Intern Emerg Med 2020; 15:751-753. [PMID: 32297089 PMCID: PMC7157827 DOI: 10.1007/s11739-020-02331-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 10/26/2022]
Abstract
The development of COVID-19 syndrome in anticoagulated patients, and especially their admission to intensive-care units with acute severe respiratory syndrome (SARS-CoV-2), expose them to specific problems related to their therapy, in addition to those associated with the acute viral infection. Patients on VKA hospitalized with SARS-CoV-2 show high instability of PT INR due to the variability of vitamin K metabolism, diet, fasting, co-medications, liver impairment, and heart failure. Patients on DOAC are exposed to under/over treatment caused by significant pharmacological interferences. In consideration of the pharmacological characteristics of oral anticoagulant drugs, the multiple pharmacological interactions due to the treatment of acute disease and the possible necessity of mechanical ventilation with hospitalization in intensive-care units, we suggest replacing oral anticoagulant therapies (VKA and DOAC) with parenteral heparin to avoid the risk of over/under treatment.
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Affiliation(s)
- Sophie Testa
- Haemostasis and Thrombosis Center, Cremona Hospital, Viale Concordia 1, 26100, Cremona, Italy.
| | - Oriana Paoletti
- Haemostasis and Thrombosis Center, Cremona Hospital, Viale Concordia 1, 26100, Cremona, Italy
| | | | - Angelo Pan
- Division of Infectious Disease, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy
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9
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Pan A, Giorgi-Pierfranceschi M, Bosio G, Cammelli L, Canino R, Coluccello A, Cuzzoli A, Machiavelli A, Romanini L, Zoncada A, Testa S. Suggestions from Cremona, Italy: 2 months into the pandemic at the frontline of COVID-19 in Europe. Clin Microbiol Infect 2020; 26:1127-1129. [PMID: 32531476 PMCID: PMC7282733 DOI: 10.1016/j.cmi.2020.05.038] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- A Pan
- Azienda Socio Sanitaria Territoriale di Cremona, Viale Concordia 1, 26100 Cremona, Italy.
| | | | - G Bosio
- Azienda Socio Sanitaria Territoriale di Cremona, Pneumology, Cremona, Italy
| | - L Cammelli
- Azienda Socio Sanitaria Territoriale di Cremona, Medical Direction, Cremona, Italy
| | - R Canino
- Azienda Socio Sanitaria Territoriale di Cremona, Sanitary Direction, Cremona, Italy
| | - A Coluccello
- Azienda Socio Sanitaria Territoriale di Cremona, Intensive Care Unit, Cremona, Italy
| | - A Cuzzoli
- Azienda Socio Sanitaria Territoriale di Cremona, Emergency Department, Cremona, Italy
| | - A Machiavelli
- Azienda Socio Sanitaria Territoriale di Cremona, Pharmacy, Cremona, Italy
| | - L Romanini
- Azienda Socio Sanitaria Territoriale di Cremona, Radiology, Cremona, Italy
| | - A Zoncada
- Azienda Socio Sanitaria Territoriale di Cremona, Infectious Diseases, Cremona, Italy
| | - S Testa
- Azienda Socio Sanitaria Territoriale di Cremona, Laboratory Medicine, Cremona, Italy
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Testa S, Prandoni P, Paoletti O, Morandini R, Tala M, Dellanoce C, Giorgi-Pierfranceschi M, Betti M, Danzi GB, Pan A, Palareti G. Direct oral anticoagulant plasma levels' striking increase in severe COVID-19 respiratory syndrome patients treated with antiviral agents: The Cremona experience. J Thromb Haemost 2020; 18:1320-1323. [PMID: 32329231 PMCID: PMC7264501 DOI: 10.1111/jth.14871] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Antiviral drugs are administered in patients with severe COVID-19 respiratory syndrome, including those treated with direct oral anticoagulants (DOACs). Concomitant administration of antiviral agents has the potential to increase their plasma concentration. A series of patients managed in the Cremona Thrombosis Center were admitted at Cremona Hospital for SARS-CoV-2 and started antiviral drugs without stopping DOAC therapy. DOAC plasma levels were measured in hospital and results compared with those recorded before hospitalization. METHODS All consecutive patients on DOACs were candidates for administration of antiviral agents (lopinavir, ritonavir, or darunavir). Plasma samples for DOAC measurement were collected 2to 4 days after starting antiviral treatment, at 12 hours from the last dose intake in patients on dabigatran and apixaban, and at 24 hours in those on rivaroxaban and edoxaban. For each patient, C-trough DOAC level, expressed as ng/mL, was compared with the one measured before hospitalization. RESULTS Of the 1039 patients hospitalized between February 22 and March 15, 2020 with COVID-19 pneumonia and candidates for antiviral therapy, 32 were on treatment with a DOAC. DOAC was stopped in 20 and continued in the remaining 12. On average, C-trough levels were 6.14 times higher during hospitalization than in the pre-hospitalization period. CONCLUSION DOAC patients treated with antiviral drugs show an alarming increase in DOAC plasma levels. In order to prevent bleeding complications, we believe that physicians should consider withholding DOACs from patients with SARS-CoV-2 and replacing them with alternative parenteral antithrombotic strategies for as long as antiviral agents are deemed necessary and until discharge.
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Affiliation(s)
- Sophie Testa
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | | | - Oriana Paoletti
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | | | - Maurizio Tala
- Haemostasis and Thrombosis Center, Cremona Hospital, Cremona, Italy
| | | | | | - Monia Betti
- Division of Pneumology, Cremona Hospital, Cremona, Italy
| | | | - Angelo Pan
- Division of Infectious Disease, Cremona Hospital, Cremona, Italy
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Giorgi-Pierfranceschi M, López-Núñez JJ, Monreal M, Cattabiani C, Lodigiani C, Di Micco P, Bikdeli B, Braester A, Soler S, Dentali F. Morbid Obesity and Mortality in Patients With VTE: Findings From Real-Life Clinical Practice. Chest 2020; 157:1617-1625. [PMID: 32004553 DOI: 10.1016/j.chest.2019.12.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for VTE has not been consistently evaluated. METHODS Data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry were used to compare the mortality risk during anticoagulation in patients with VTE and morbid obesity (BMI ≥ 40 kg/m2) vs those with normal weight (BMI, 18.5-24.9 kg/m2). Patients with or without active cancer were analyzed separately. RESULTS By September 2018, there were 1,642 patients with VTE and morbid obesity and 14,848 with normal weight in RIETE. Of these, 245 (5.5%) and 1,397 (11.6%), respectively, had cancer. Median duration of anticoagulant therapy was longer in the morbidly obese patients, with cancer (185 vs 114 days) or without cancer (203 vs 177 days). Among cancer patients, 44 (18.0%) morbidly obese and 1,377 (32.8%) patients with normal weight died during anticoagulation. Among those without cancer, 44 (3.1%) morbidly obese died and 601 (5.6%) with normal weight died. On bivariate analysis, morbid obesity was associated with a lower mortality rate, both in patients with cancer (hazard ratio, 0.34; 95% CI, 0.25-0.45) and in those without cancer (hazard ratio, 0.43; 95% CI, 0.32-0.58). Multivariable analysis confirmed a lower hazard of death in morbidly obese patients with cancer (hazard ratio, 0.68; 95% CI, 0.50-0.94) and without cancer (hazard ratio, 0.67; 95% CI, 0.49-0.96). The risk for VTE recurrences or major bleeding did not differ in patients with or without morbid obesity. CONCLUSIONS In patients with VTE, the risk for death during anticoagulation was about one-third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer.
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Affiliation(s)
| | - Juan J López-Núñez
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
| | - Chiara Cattabiani
- Department of Internal Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Corrado Lodigiani
- Thrombosis and Hemorrhagic Diseases Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY; Yale New Haven Health, Center for Outcomes Research & Evaluation, New Haven, CT; Cardiovascular Research Foundation, New York, NY
| | - Andrei Braester
- Department of Haematology, Azrieli School of Medicine in Galilee, Bar-ilan University, Safed, Israel
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
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12
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Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M, Pesavento R, Mochi M, Cei M, Pomero F, Mazzone A, Vitale J, Ageno W, Dentali F. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost 2018; 16:2482-2491. [PMID: 30225971 DOI: 10.1111/jth.14297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications. BACKGROUND: Background Ultrasound elastography (UE) imaging is a novel sonographic technique that is commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear whether this technique may be useful in determining the age of deep vein thrombosis (DVT). Thus, the aim of this study was to assess the role of UE in distinguishing acute from chronic DVT. Methods Consecutive patients with a first unprovoked acute and chronic (3 months old) DVT of the lower limbs were analyzed. Patients with recurrent DVT or with a suspected recurrence were excluded. The mean elasticity index (EI) values of acute and chronic popliteal and femoral vein thrombosis were compared. The accuracy of the EI in distinguishing acute from chronic DVT was also assessed by measuring the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results One-hundred and forty-nine patients (mean age 63.9 years, standard deviation 13.6; 73 males) with acute and chronic DVT were included. The mean EI of acute femoral DVT was higher than that of chronic femoral DVT (5.09 versus 2.46), and the mean EI of acute popliteal DVT was higher than that of chronic popliteal DVT (4.96 versus 2.48). An EI value of > 4 resulted in a sensitivity of 98.9% (95% confidence interval [CI] 93.3-99.9), a specificity of 99.1% (95% CI 94.8-99.9), a positive predictive value of 91.1% (95% CI 77.9-97.1), a negative predictive value of 98.6% (95% CI 91.3-99.9), a positive likelihood ratio of 13.23 (95% CI 93-653) and a negative likelihood ratio of 0.001 (95% CI 0.008-0.05) for acute DVT. Conclusions UE appears to be a promising technique for distinguishing between acute and chronic DVT. Larger prospective studies are warranted to confirm our preliminary findings.
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Affiliation(s)
- N Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - D Mastroiacovo
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | | | - R Pesavento
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - M Mochi
- General Electric Healthcare, Milano, Italy
| | - M Cei
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - F Pomero
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - A Mazzone
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - J Vitale
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - W Ageno
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - F Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Fornaroli, Via Donatori Sangue, 50, 20013, Magenta, Italy.
| | | | - Cesare Porta
- Department of Internal Medicine, Ospedale Fornaroli, Via Donatori Sangue, 50, 20013, Magenta, Italy
| | - Guendalina Manzionna
- Department of Internal Medicine, Ospedale Fornaroli, Via Donatori Sangue, 50, 20013, Magenta, Italy
| | - Marianna Barberio
- Department of Internal Medicine, Ospedale Fornaroli, Via Donatori Sangue, 50, 20013, Magenta, Italy
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Giorgi-Pierfranceschi M, Artom N, Di Pasquale G, Squizzato A, Pellegrinet M, Romano G, Tana M, Mathieu G, Maggioni AP, Fontanella A, Campanini M, Mazzone A, Gussoni G, Dentali F. Factors associated with anticoagulation prescription in elderly patients with atrial fibrillation. Eur J Prev Cardiol 2018; 26:660-663. [DOI: 10.1177/2047487318795237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nathan Artom
- Department of Internal Medicine, Ospedale S. Paolo di Savona, Italy
| | | | - Alessandro Squizzato
- Department of Clinical and Experimental Medicine, Insubria University Varese, Italy
| | | | - Giulia Romano
- Department of Internal Medicine, Ospedale di Vittoria, Italy
| | - Marco Tana
- Department of Internal Medicine, University of Chieti, Italy
| | | | | | - Andrea Fontanella
- Department of Internal Medicine, Ospedale Madonna del Buonconsiglio Fatebenefratelli di Napoli, Italy
| | - Mauro Campanini
- Department of Internal Medicine, Ospedale Maggiore di Novara, Italy
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Mumoli N, Mastroiacovo D, Tamborini-Permunian E, Vitale J, Giorgi-Pierfranceschi M, Cei M, Dentali F. Dabigatran in nonvalvular atrial fibrillation: from clinical trials to real-life experience. J Cardiovasc Med (Hagerstown) 2018; 18:467-477. [PMID: 28509761 DOI: 10.2459/jcm.0000000000000524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
: Atrial fibrillation is the most common arrhythmia in over-midlife patients. In addition to systolic heart failure, cerebral thromboembolism represents the most dramatic complication of this rhythm disorder, contributing to morbidity and mortality. Traditionally, anticoagulation has been considered the main strategy in preventing stroke and systemic embolism in atrial fibrillation patients and vitamin K-dependent antagonists have been widely used in clinical practice. Recently, the development of direct oral anticoagulants has certainly improved the management of this disease, providing, for the first time, the opportunity to go beyond vitamin K-dependent antagonists limits. In the RE-LY trial, dabigatran 150 mg twice daily was superior to warfarin in the prevention of stroke or systemic embolism and dabigatran 110 mg twice daily was noninferior. Both doses greatly reduced hemorrhagic stroke, and dabigatran 110 mg twice daily significantly reduced major bleeding compared with warfarin. Based on these results, dabigatran, a direct thrombin inhibitor, was the first direct oral anticoagulant to receive the regulatory approval for nonvalvular atrial fibrillation patients. To date, a specific reversal agent has just been approved as an antidote for this molecule. This review provides a summary of randomized trials, postmarket registries and specific clinical-settings summary on dabigatran in nonvalvular atrial fibrillation.
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Affiliation(s)
- Nicola Mumoli
- aDepartment of Internal Medicine, Ospedale Civile di Livorno, Livorno bAngiology Unit, Ospedale SS, Filippo e Nicola, Avezzano cDepartment of Internal Medicine, Ospedale di Circolo, Varese dEmergency Department, Ospedale della Val d'Arda, Piacenza, Italy
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16
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Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Sabatini S, Tulino R, Cei M, Bucherini E, Bova C, Mastroiacovo D, Camaiti A, Palmiero G, Puccetti L, Dentali F. General Practitioner-Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study. Ann Fam Med 2017; 15:535-539. [PMID: 29133492 PMCID: PMC5683865 DOI: 10.1370/afm.2109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/09/2016] [Revised: 03/30/2017] [Accepted: 04/24/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT. METHODS From May 2014 to May 2016, we evaluated in a multicenter, prospective cohort study all consecutive outpatients with suspected DVT; bilateral proximal lower limb compression US was performed by general practitioners and by physicians expert in vascular US, each group blinded to the other's findings. In all examinations with a negative or nondiagnostic result, compression US was repeated by the same operator after 5 to 7 days. Inter-observer agreement and accuracy were calculated. RESULTS We enrolled a total of 1,107 patients. The expert physicians diagnosed DVT in 200 patients, corresponding to an overall prevalence of 18.1% (95% CI, 15.8%-20.3%). The agreement between the trained general practitioners and the experts was excellent (Cohen κ = 0.86; 95% CI, 0.84-0.88). Compression US performed by general practitioners had a sensitivity of 90.0% (95% CI, 88.2%-91.8%) and a specificity of 97.1% (95% CI, 96.2%-98.1%) with a diagnostic accuracy for DVT of 95.8% (95% CI, 94.7%-97.0%). CONCLUSIONS Our results suggest that, even in hands of physicians not expert in vascular US, compression US can be a reliable tool in the diagnosis of DVT. We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali).
| | - Josè Vitale
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Matteo Giorgi-Pierfranceschi
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Silvia Sabatini
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Renato Tulino
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Marco Cei
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Eugenio Bucherini
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Carlo Bova
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Daniela Mastroiacovo
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Alberto Camaiti
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Gerardo Palmiero
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Luca Puccetti
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Francesco Dentali
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
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Mumoli N, Barco S, Cei M, Giorgi-Pierfranceschi M, Campanini M, Fontanella A, Ageno W, Dentali F. Prevention and treatment of venous thromboembolism in patients with solid brain neoplasms: results of a survey among Italian physicians. Intern Emerg Med 2017; 12:437-443. [PMID: 27878663 DOI: 10.1007/s11739-016-1578-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022]
Abstract
The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives' Associations (FADOI) in June 2015. Three hundred and fifty two physicians (14.5%) returned it (participants' median age 51 years; females 46.9%). The majority of respondents prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases in concomitance with high-risk conditions. Full-dose anticoagulation with either low-molecular-weight heparin or fondaparinux is the preferred option for acute VTE (69.6%), while a reduced dose is chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype mandates the prescription of a reduced-dose antithrombotic regimen in a minority of respondents. Vena cava filter placement is an option for the treatment of acute VTE in more than 6% of respondents. Anticoagulants are often prescribed for both VTE primary prevention and treatment. In conclusion, physicians' managements are partially in contrast to recent guidelines, reinforcing the need for educational programs and other studies in this setting.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Viale Alfieri, 36, 57124, Livorno, Italy.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - Marco Cei
- Department of Internal Medicine, Ospedale Civile di Livorno, Viale Alfieri, 36, 57124, Livorno, Italy
| | | | - Mauro Campanini
- Department of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - Francesco Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
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Tzoran I, Papadakis M, Brenner B, Fidalgo Á, Rivas A, Wells PS, Gavín O, Adarraga MD, Moustafa F, Monreal M, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Adarraga M, Aibar M, Alfonso M, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Cañada G, Cañas I, Chic N, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García A, García M, García-Bragado F, García-Brotons P, Gavín O, Gómez C, Gómez V, González J, González-Marcano D, Grau E, Grimón A, Guijarro R, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Hermosa-Los Arcos M, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Llamas P, Lecumberri R, Lobo J, López P, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Maestre A, Marchena P, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Odriozola M, Otero R, Pedrajas J, Pérez G, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez C, Rodríguez-Dávila M, Rosa V, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez-Martínez R, Sánchez Simón-Talero R, Sanz O, Soler S, Suriñach J, Torres M, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vicente M, Villalobos A, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, del Pozo G, Salgado E, Sánchez G, Bertoletti L, Bura-Riviere A, Mahé I, Merah A, Moustafa F, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Bortoluzzi C, Cattabiani C, Ciammaichella M, Di Biase J, Di Micco P, Duce R, Ferrazzi P, Giorgi-Pierfranceschi M, Grandone E, Imbalzano E, Lodigiani C, Maida R, Mastroiacovo D, Pace F, Pesavento R, Pinelli M, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Gibietis V, Skride A, Vitola B, Monteiro P, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Calanca L, Erdmann A, Mazzolai L. Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation. Am J Med 2017; 130:482.e1-482.e9. [PMID: 27986523 DOI: 10.1016/j.amjmed.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/22/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored. METHODS We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers. RESULTS Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57). CONCLUSIONS During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.
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Affiliation(s)
- Inna Tzoran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | - Manolis Papadakis
- Haematology and Hemostasis Unit, Hospital Papageorgiou, Saloniki, Greece
| | - Benjamin Brenner
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain
| | - Agustina Rivas
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
| | - Olga Gavín
- Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Farès Moustafa
- Department of Emergency, Clermont-Ferrand University Hospital, France
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
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Trujillo-Santos J, Bergmann JF, Bortoluzzi C, López-Reyes R, Giorgi-Pierfranceschi M, López-Sáez JB, Ferrazzi P, Bascuñana J, Suriñach JM, Monreal M. Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism. J Thromb Haemost 2017; 15:429-438. [PMID: 28120516 DOI: 10.1111/jth.13616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/23/2016] [Indexed: 11/30/2022]
Abstract
Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. SUMMARY Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.
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Affiliation(s)
- J Trujillo-Santos
- Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain
| | - J F Bergmann
- Department of Internal Medicine, Hôpital Lariboisiere, Paris, France
| | - C Bortoluzzi
- Department of Internal Medicine, Ospedale SS. Giovanni e Paolo di Venezia, Venice, Italy
| | - R López-Reyes
- Department of Pneumonology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - J B López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - P Ferrazzi
- Centro Trombosi, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - J Bascuñana
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - J M Suriñach
- Department of Internal Medicine, Hospital Vall d'Hebrón, Barcelona, Spain
| | - M Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Murcia, Spain
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Giorgi-Pierfranceschi M, Cravo J, Dentali F, Esquinas AM. Is Procalcitonin Really Useful for Diagnosis and Prognosis of COPD Exacerbations Requiring Mechanical Ventilation? Respiration 2017; 93:151-152. [DOI: 10.1159/000454839] [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: 11/19/2022] Open
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Giorgi-Pierfranceschi M, Dentali F. Sepsis in internal wards: results of an Italian multicenter prospective study. Ital J Med 2016. [DOI: 10.4081/itjm.2016.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sepsis is a frequent inflammatory disease with a high mortality and morbidity rate. Most of the data about epidemiology, management and prognosis of patients with sepsis came mainly from studies conducted within Intensive Care Units (ICUs). A consistent number of studies suggest that a proportion of patients with sepsis and severe sepsis are admitted to internal medicine units, and not transferred to an ICU. In this article, we presented the data of an Italian study, a multicenter study, evaluating consecutive patients, with an objective diagnosis of sepsis treated in internal medicine units.
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Abstract
Not available
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Vitale J, Mumoli N, Giorgi-Pierfranceschi M, Cresci A, Cei M, Basile V, Cocciolo M, Dentali F. Comparison of the Accuracy of Nurse-Performed and Physician-Performed Lung Ultrasound in the Diagnosis of Cardiogenic Dyspnea. Chest 2016; 150:470-1. [DOI: 10.1016/j.chest.2016.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/30/2016] [Indexed: 12/13/2022] Open
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Giorgi-Pierfranceschi M, Mumoli N, Scarpioni R, Croci E, Dentali F. Argatroban for Treatment of Heparin-Induced Thrombocytopenia and Thrombosis in a Patient with Multiple Myeloma Undergoing Hemodialysis. J Am Geriatr Soc 2016; 64:1748-50. [PMID: 27448437 DOI: 10.1111/jgs.14186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Nicola Mumoli
- Department of Internal Medicine, Civil Hospital, Livorno, Italy
| | - Roberto Scarpioni
- Department of Nephrology, Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - Ezio Croci
- Department of Clinical Pathology, Hospital "Guglielmo da Saliceto", Piacenza, Italy
| | - Francesco Dentali
- Department of Internal Medicine, University of Insubria, Varese, Italy
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy
| | | | | | - Josè Vitale
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy
| | - Marco Cei
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy
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Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Cresci A, Cei M, Basile V, Brondi B, Russo E, Giuntini L, Masi L, Cocciolo M, Dentali F. Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study. Medicine (Baltimore) 2016; 95:e2925. [PMID: 26945396 PMCID: PMC4782880 DOI: 10.1097/md.0000000000002925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Indexed: 11/26/2022] Open
Abstract
In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.
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Affiliation(s)
- Nicola Mumoli
- From the Department of Internal Medicine, Ospedale Civile di Livorno, Livorno (NM, AC, MC, VB, BB, ER, LG, LM, MC), Department of Internal Medicine, Ospedale di Circolo, Varese (JV, FD), and Emergency Department, Ospedale della Val d'Arda, Piacenza (MGP), Italy
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Mumoli N, Permunian ET, Vitale J, Cei M, Giorgi-Pierfranceschi M, Brondi B, Sabatini S, Dentali F. Progesterone Levels in Men with Unprovoked Deep Vein Thrombosis. J Am Geriatr Soc 2016; 64:213-5. [DOI: 10.1111/jgs.13917] [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: 11/26/2022]
Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine; Ospedale Civile Livorno; Livorno Italy
| | | | - Josè Vitale
- Department of Clinical and Experimental Medicine; University of Insubria; Varese Italy
| | - Marco Cei
- Department of Internal Medicine; Ospedale Civile Livorno; Livorno Italy
| | | | - Barbara Brondi
- Department of Internal Medicine; Ospedale Civile Livorno; Livorno Italy
| | - Silvia Sabatini
- Department of Internal Medicine; Ospedale Civile Livorno; Livorno Italy
| | - Francesco Dentali
- Department of Clinical and Experimental Medicine; University of Insubria; Varese Italy
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Morelli N, Rota E, Immovilli P, Cosottini M, Giorgi-Pierfranceschi M, Magnacavallo A, Michieletti E, Morelli J, Guidetti D. Computed tomography perfusion-based thrombolysis in wake-up stroke. Intern Emerg Med 2015; 10:977-84. [PMID: 26370239 DOI: 10.1007/s11739-015-1299-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Abstract
Wake-up stroke (WUS) patients are typically excluded from reperfusion treatment, as the time of symptoms onset is unknown. The purpose of this study is to evaluate the clinical outcome and safety of intravenous thrombolysis with rt-PA in patients with WUS eligible for therapy using computed tomography perfusion criteria (CTP), compared to patients treated with rt-PA within 4.5 h of symptoms onset (non-WUS). This is an experimental, open-label trial, controlled against the best therapy currently in use. Primary endpoints were functional independence after 3 months [modified Rankin scale (mRS) ≤ 1] for clinical outcome and symptomatic intracerebral hemorrhage (SICH) for safety. Secondary endpoints were no or only mild disability after 3 months (mRS ≤ 2) for clinical outcome, total intracerebral hemorrhage (TICH) and contrast-induced nephropathy (CIN) for safety. 170 patients were treated, 143 non-WUS patients and 27 patients with WUS. Strokes of cardioembolic origin were most common in WUS patients (p < 0.001). Primary endpoints: mRS ≤ 1 was found in 35.8 % (non-WUS: 36.4% vs. WUS 33.3%; p = 0.62) and SICH was observed in 3.4 % of non-WUS patients and in WUS patients (p = 0.32). Secondary endpoints: mRS ≤ 2 was observed in 66.4 % of patients (non-WUS: 67.1% vs. WUS 62.9%; p = 0.67), TICH in 13.5 % of patients (13.9 % non-WUS vs. 11.1 % WUS; p = 0.69). CIN was documented in 3.7 % of WUS patients. rt-PA treatment carried out in WUS patients selected on the basis of CTP data demonstrate comparable clinical outcome and safety with respect to non-WUS patients. The study supports the hypothesis that a selected group of WUS patients may be suitable for thrombolysis.
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Affiliation(s)
- Nicola Morelli
- Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy.
- Radiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Eugenia Rota
- Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy
| | - Paolo Immovilli
- Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | | | - John Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy
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Giorgi-Pierfranceschi M, Di Micco P, Cattabiani C, Guida A, Pagán B, Morales MDV, Salgado E, Suriñach JM, Tolosa C, Monreal M. Platelet Count and Major Bleeding in Patients Receiving Vitamin K Antagonists for Acute Venous Thromboembolism, Findings From Real World Clinical Practice. Medicine (Baltimore) 2015; 94:e1915. [PMID: 26632687 PMCID: PMC5058956 DOI: 10.1097/md.0000000000001915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Indexed: 01/03/2023] Open
Abstract
The outcome of patients with acute venous thromboembolism (VTE) and abnormal platelet count (PlC) at baseline has not been consistently studied. In real-world clinical practice, a number of patients with abnormal PlC receive vitamin K antagonists (VKAs) to treat acute VTE despite their higher risk of bleeding.We used the Registro Informatizado de Enfermedad TromboEmbólica registry database to compare the rate of major bleeding in patients receiving VKA for long-term therapy of acute VTE according to PlC levels at baseline. Patients were categorized as having very low (<100,000/μL), low (100,000-150,000/μL), normal (150,000-300,000/μL), high (300,000-450,000/μL), or very high (>450,000/μL) PlC at baseline.Of 55,369 patients recruited as of January 2015, 37,000 (67%) received long-term therapy with VKA. Of these, 611 patients (1.6%) had very low PlC, 4006 (10.8%) had low PlC, 25,598 (69%) had normal PlC, 5801 (15.6%) had high PlC, and 984 (2.6%) had very high PlC at baseline. During the course of VKA therapy (mean, 192 days), there were no differences in the duration or intensity (as measured by international normalized ratio levels) of treatment between subgroups. The rate of major bleeding was 3.6%, 2.1%, 1.9%, 2.1%, and 3.7%, respectively, and the rate of fatal bleeding was 0.98%, 0.17%, 0.29%, 0.34%, and 0.50%, respectively. Patients with very low or very high PlC levels were more likely to have severe comorbidities.We found a nonlinear "U-shaped" relationship between PlC at baseline and major bleeding during therapy with VKA for VTE. Consistent alteration of PlC values at baseline suggested a greater frailty.
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Affiliation(s)
- Matteo Giorgi-Pierfranceschi
- From the Emergency Department, Val d'Arda Hospital, Piacenza, (MGP, CC); Department of Internal Medicine, Ospedale Buonconsiglio Fatebenefratelli, Naples, (PDM); University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno (AG); Department of Internal Medicine, Hospital de Madrid Norte Sanchinarro (BP); Department of Internal Medicine, Hospital del Tajo, Madrid, Spain (MDVM); Intensive Care Unit, Hospital Clinica La Merced, Quito, Ecuador (ES); Department of Internal Medicine, Hospital Vall d[Combining Acute Accent]Hebrón (JMS); Department of Internal Medicine, Corporación Sanitaria Parc Tauli, (CT); and Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain (MM)
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Giorgi-Pierfranceschi M, Cattabiani C, Dentali F. New oral anticoagulants: key messages for clinicians. Ital J Med 2013. [DOI: 10.4081/itjm.2013.s8.74] [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: 11/22/2022] Open
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Crippa G, Sverzellati E, Giorgi-Pierfranceschi M, Carrara GC. Magnesium and cardiovascular drugs: interactions and therapeutic role. Ann Ital Med Int 1999; 14:40-5. [PMID: 10528423] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Numerous experimental, epidemiological and clinical studies have pointed out a relevant role for magnesium deficiency in the development of many cardiovascular diseases. Some pharmacological treatments may interfere with magnesium turnover, and magnesium deficiency may alter the pharmacokinetics and pharmacodynamics of some cardiovascular drugs. Loop and thiazide-like diuretics increase magnesiuresis, and total bodily magnesium deficiency may appear during prolonged treatment with diuretically active doses of these drugs. The potassium retaining agents, such as amiloride, triamterene and spironolactone, tend to retain magnesium but they are not magnesium-retaining substances to the extent to which they are potassium-retaining diuretics. The interaction between magnesium and digitalis is complex. Magnesium, acting as an indirect antagonist of digoxin at the sarcolemma Na(+)-K(+)-ATPase pump, reduces cardiac arrhythmias due to digoxin poisoning. Recent controlled studies have shown that treatment with magnesium significantly reduces the frequency and complexity of ventricular arrhythmias in digoxin-treated patients with congestive heart failure without digoxin toxicity. Magnesium improves the efficacy of digoxin in slowing the ventricular response in atrial fibrillation. Digoxin reduces tubular magnesium reabsorption, and in patients with congestive heart failure this interaction may be cumulative with other causes of magnesium deficiency (diuretics, diet, poor intestinal absorption). The complex and potentially life-threatening interactions between magnesium and some cardiovascular drugs suggest that magnesium status should be carefully monitored in patients receiving such drugs. Therapy with magnesium is rapidly acting, has a safe toxic-therapeutic ratio, is easy to administer and titrate. The correction of magnesium deficit should therefore always be considered for patients with cardiopathy.
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Affiliation(s)
- G Crippa
- Dipartimento di Medicina Interna, Ospedale Civile di Piacenza
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Sverzellati E, Espinas RD, Giorgi-Pierfranceschi M, Meny MG, Crippa G, Reyes AJ. Lung water is a critical determinant of functional capacity in congestive heart failure. J Card Fail 1998. [DOI: 10.1016/s1071-9164(98)90054-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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