1,721,086 research outputs found
Gender differences of bleeding and stroke risk in very old atrial fibrillation patients on VKA treatment: results of the EPICA study on the behalf of FCSA (Italian Federation of Anticoagulation Clinics).
No full textVenous Thromboembolism Recurrence after a First Episode of Provoked Venous Thrombosis Due to a Transient Risk Factor. A Systematic Review of the Literature
No full textThe role of D-dimer and residual venous obstruction in recurrence of venous thromboembolism after anticoagulation withdrawal in cancer patients
No full textWe assessed the predictive value of D-dimer (D-d) and residual venous obstruction (RVO), alone or in combination, for recurrent venous thromboembolism (VTE) over a 2-year follow-up in a cohort of 88 cancer patients after oral anticoagulant therapy (OAT) withdrawal following a first episode of proximal deep vein thrombosis of the lower limbs. RVO, determined by compression ultrasonography on the day of OAT suspension (T1), and abnormal D-d (cut-off value: 500 ng/mL), measured at T1 and 30+/-10 days afterwards, are independent risk factors for recurrent VTE in cancer patients
sj-docx-1-cath-10.1177_10760296211049402 - Supplemental material for Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study
No full textSupplemental material, sj-docx-1-cath-10.1177_10760296211049402 for Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study by Gualtiero Palareti, Angelo A. Bignamini, Michela Cini, Young-Jun Li, Tomasz Urbanek, Juraj Madaric, Kamel Bouslama, German Y. Sokurenko, Giuseppe M. Andreozzi, Jiří Matuška, Armando Mansilha and Victor Barinov in Clinical and Applied Thrombosis/Hemostasis</p
D-dimer levels in combination with residual venous obstruction and the risk of recurrence after anticoagulation withdrawal for a first idiopathic deep vein thrombosis
No full textWe assessed the predictive value of D-dimer levels in combination with residual venous obstruction (RVO) for recurrent venous thromboembolism (VTE) in a prospective cohort of outpatients after oral anticoagulant therapy (OAT) suspension for a first episode of idiopathic proximal deep vein thrombosis of the lower limbs during a 2-year follow-up. Patients (n=400) were enrolled on the day of OAT suspension when RVO was determined by compression ultrasonography (present in 48.6\% of patients). D-dimer (cut-off value: 500 ng/mL) was measured 30+/-10 days afterwards (abnormal in 56.4\% of patients). The overall recurrence rate was 16.7\% (67/400; 95\% confidence intervals - CI -: 13-21 \%). The multivariate hazard ratio (HR) for recurrence was 3.32 (95\% CI: 1.78-6.75; p0.05) for RVO compared to absent RVO. The recurrence rate was 5.7\% (95\% CI:2-13\%) and 10.4\% (95\% CI:6-18\%), respectively, for normal D-dimer either without or with RVO, 22.9\% (95\% CI: 14-33\%) and 25.9\% (95\% CI: 18-35\%), respectively, for abnormal D-dimer, either without or with RVO. When compared with normal D-dimer without RVO, the multivariate HR for recurrence was similar for abnormal D-dimer either with RVO (4.76 - 95\% CI:1.78-12.8) or without RVO (4.3-95\%:1.56-11.88). Abnormal D-dimer at one month after OAT withdrawal is an independent risk factor for recurrent VTE, while RVO at the time of OAT withdrawal, either with normal or abnormal D-dimer after one month, does not influence the risk of recurrence
Abnormally short activated partial thromboplastin time values are associated with increased risk of recurrence of venous thromboembolism after oral anticoagulation withdrawal
No full textThis study prospectively evaluated the relationship between activated partial thromboplastin time (aPTT) and risk of venous thromboembolism (VTE) recurrence after oral anticoagulant (OA) withdrawal in patients with a previous unprovoked VTE event. Six hundred twenty-eight patients (331 males; median age: 67 years) were followed after OA interruption (mean follow-up = 22 months). Three to four weeks from OA discontinuation patients were given a complete thrombophilic work-out, including aPTT (automated aPTT). Recurrent symptomatic VTE events (objectively documented) occurred in 71/628 (11.3\%, 6.8/100 person-years) patients. The VTE recurrence rate was 17.5\% and 7.5\% in patients with aPTT in the lower (ratio 1.05) quartiles. The recurrence risk was more than twofold higher in patients with ratio < or =0.90 versus those of the reference category [Relative risk (RR): 2.38 (95\% confidence interval (CI): 1.18-4.78)]. As expected, the increase in recurrence risk disappeared after adjustment for factor VIII, IX and XI levels [RR: 1.74 (95\%CI: 0.43-2.76)]. In contrast, the risk was persistently increased in patients with a ratio < or =0.90 [RR: 2.07 (95\%CI: 1.02-4.18)] after adjustment for age, gender and d-dimer level. The aPTT predictive value was independent of the presence of inherited thrombophilic alterations. In conclusion, abnormally short aPTT values are associated with a significantly increased risk of VTE recurrence
Association of the homozygous nonsense mutation R402X in coagulation factor VII with asymptomatic phenotype
No full textFactor VII (FVII) is the serine protease triggering blood coagulation. The deficiency of FVII is associated to variable bleeding tendency and its complete absence is virtually lethal.
The mutational pattern of FVII is heterogeneous and mainly characterized by missense changes. The few nonsense mutations so far described in homozygous state, C72Stop and K316Stop, are associated to moderate or life-threatening symptoms, respectively.
We investigated the R402Stop nonsense mutation, identified in the homozygous condition in two asymptomatic patients. FVII antigen and coagulant levels in patients’ plasma were 0,8% and 5% of normal, respectively, thus suggesting the presence of a truncated molecule (FVII-R402Stop, wild type stop codon at the 407 position), poorly secreted but with improved procoagulant activity. Functional FXa and Thrombin generation assays confirmed these observations in plasma.
The deleted residues are located in the carboxyl-terminal region, which has been shown to be crucial for secretion of the highly homologous coagulation serine proteases PC and FIX. To investigate this issue, we expressed the naturally truncated FVII-402Stop and the FVII variants 403-406Stop. Similarly to the 402Stop, the rFVII-403Stop and rFVII-402Stop variants were poorly secreted (~1%). We found an inverse relationship between secreted protein levels in medium and the extent of the deletion for the rFVII-406Stop (50-60% of WT), rFVII-405Stop (15-20%) and rFVII-404Stop (9-12%). FXa generation as well as PT-based assays revealed a normal specific activity for the rFVII-406Stop, rFVII-405Stop, rFVII-404Stop variants. Intriguingly, upon concentration of conditioned media, the specific activity of the rFVII-402Stop appeared to be 2-3 fold higher than that of rFVII-wt, thus contributing to explain its association to an asymptomatic phenotype.
Altogether these findings demonstrate the importance of the carboxyl-terminal region for FVII biosynthesis/secretion, and also support its participation in FVII function
Recurrent Venous Thromboembolism: What Is the Risk and How to Prevent It
No full textVenous thromboembolism (VTE) that includes deep vein thrombosis and/or pulmonary embolism is a frequent, severe, and potentially lethal disease. After a first episode, VTE has a strong tendency to recur. While VTE is an acute disease, it may have variable outcomes in early and late phases after initial presentation. Furthermore, the incidence of late, clinically important consequences (postthrombotic syndrome and/or chronic thromboembolic pulmonary hypertension) increases in case of recurrent events. The aims of the present review are (i) to analyze the incidence and risk factors for recurrence of VTE (either those related to the type of first thrombotic event or to the patients), the risks associated with occurrence of recurrent events, and the problems linked to the diagnosis, not always easy, of recurrent events; (ii) to discuss whether or not it is possible to predict the individual risk of recurrence after a first event, by stratifying patients at high or low risk of recurrence, and how this can influence their treatment; (iii) to comment what the current guidelines and guidance suggest/recommend about anticoagulant treatment after a first VTE event and, finally, to propose practical indications on how to manage individual patients affected by VTE
Optimal long-term pharmacological treatment of patients with venous thromboembolism that was unprovoked or associated with weak risk factors
No full textThe recent clinical trials on use of the novel direct oral anticoagulants in patients with venous thromboembolism: a review
No full textVenous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, requires an immediate anticoagulation, that has been carried out so far by administering a parenteral anticoagulant drug (heparin or derivatives) overlapped with an oral vitamin K antagonist (VKA), more often warfarin. Several new direct oral anticoagulants (DOACs), with a mechanism of action completely different than VKA, have been developed in recent years. Recent clinical trials have investigated their use in VTE patients showing results at least equal for efficacy and safety, and sometime even better, as the standard anticoagulant treatment. There are differences in the design of the trials. In two cases the involved DOAC was administered immediately after VTE diagnosis as a single drug treatment (rivaroxaban and apixaban), whereas in the other trials (involving dabigatran and edoxaban) the DOAC was administered after an initial course of approximately 7 days with heparin or derivatives. Some clinical trials have also investigated the use of DOACs for extended anticoagulant treatment after the acute phase. Aim of this article is to review the results of the currently available clinical trials that have compared the use of DOACs versus the standard of care in patients with VTE
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