Journal of Thrombosis and Thrombolysis Impact Factor & Information

Publisher: Springer Verlag

Journal description

The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists hematologists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. Its principal focus centers on the pathobiology of thrombosis and the use of anticoagulants platelet antagonists and thrombolytic agents in scientific investigation and patient care. The journal publishes original work that interlinks basic scienctific principles with clinical investigation thus creating a unique forum for interdisciplinary dialogue. Published works will advocate the development of solid platforms for planned clinical research and precise clinically-applicable benchwork. The Journal of Thrombosis and Thrombolysis 's comprehensive and interdisciplinary design will expand the reader's knowledge base and provide important insights for the most rapidly growing field in medicine. The journal seeks original manuscripts devoted to laboratory investigation and clinical studies. State-of-the-art reviews and editorials will be summoned by invitation. The journal will closely follow new trends on the cutting edge of the field and highlight drugs in the early stages of development which may warrant testing in the clinical arena. Updates of major national and international clinical trials will also be provided as will a forum of guidelines for interpreting the results of these trials from a patient care perspective. The Journal will publish an ongoing educational series of topics applicable to clinician scientists that will include such topics as: 'Seminars in Thrombosis Thromboysis and Vascular Biology' and a 6-part series on 'Hematology for the Cardiologist'. Manuscripts submitted must not be under consideration by an other journal and should not have been published elsewhere in similar form. All articles will be refereed by two qualified referees. All clinical trials being considered for publication will also be reviewed by a statistician. A response will be provided within four weeks of receipt.

Current impact factor: 2.04

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.039
2012 Impact Factor 1.985
2011 Impact Factor 1.476
2010 Impact Factor 1.539
2009 Impact Factor 1.846
2008 Impact Factor 2.266
2007 Impact Factor 1.432
2006 Impact Factor 1.155
2005 Impact Factor 1.093
2004 Impact Factor 0.909
2003 Impact Factor 1.066
2002 Impact Factor 1.067
2001 Impact Factor 1.055
2000 Impact Factor 0.785

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.70
Cited half-life 4.00
Immediacy index 0.30
Eigenfactor 0.01
Article influence 0.49
Website Journal of Thrombosis and Thrombolysis website
Other titles Journal of thrombosis and thrombolysis (Online)
ISSN 0929-5305
OCLC 41973481
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process.
    Journal of Thrombosis and Thrombolysis 04/2015; 39(3). DOI:10.1007/s11239-015-1184-8
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    ABSTRACT: Computed tomographic pulmonary angiography (CTPA) has a high sensitivity for diagnosing filling defects in subsegmental pulmonary arteries. The adoption of CTPA as the prefered diagnostic modality for the diagnosis of pulmonary embolism (PE) has led to an increased rate of PE diagnosis. However, the case fatality rate is lower and the mortality rate of PE has remained unchanged despite this rise in PE diagnosis suggesting that the disease is of lesser severity. There continues to be clinical equipoise on whether patients diagnosed with isolated subsegmental PE (SSPE) require anticoagulation or can be managed conservatively if the presence of deep vein thrombosis (DVT) has been excluded. Recent recommendations from the European Society of Cardiology suggest an individualized approach for the management of patients with newly diagnosed SSPE based on the risk/benefit ratio of anticoagulation and the presence of lower limb DVT. Prospective data evaluating the safety and efficacy of management strategies for SSPE is needed in order to determine the optimal management of these patients.
    Journal of Thrombosis and Thrombolysis 04/2015; 39(3). DOI:10.1007/s11239-015-1169-7
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    ABSTRACT: Strokes can have a catastrophic impact on patients' health-related quality of life (HRQoL). In addition to warfarin, two novel oral anticoagulants, i.e., dabigatran and rivaroxaban, have been approved to prevent strokes. This study aimed to use direct measures to elicit patient-reported utilities (i.e., preferences) for anticoagulant-related outcomes. A cross-sectional survey was administered to 100 patients taking warfarin in an anticoagulation clinic. Utilities for six long-term and four short-term anticoagulant-related health states were elicited by the visual analogue scale (VAS) and standard gamble (SG) methods. Health states with the highest SG-derived mean utility values were "well on rivaroxaban" (mean ± SD = 0.90 ± 0.15), "well on warfarin" (0.86 ± 0.17), and "well on dabigatran" (0.83 ± 0.18). Approximately half of the patients considered major ischemic stroke (-1.57 ± 6.77) and intracranial hemorrhage (-1.99 ± 6.98) to be worse than death. The percentages of patients who considered a particular health state worse than death ranged from 0 to 55 % among various health states assessed. The VAS had similar findings. Good logical consistency was observed in both VAS- and SG-derived utility values. Ischemic stroke and intracranial hemorrhage had a significant impact on patients' HRQoL. Greater variation in patients' preferences was observed for more severely impaired health states, indicating the need for individualized medical decision-making. In this study, both long-term and short-term health states were included in the utility assessment. The findings of this study can be used in cost-utility analysis of future anticoagulation therapies.
    Journal of Thrombosis and Thrombolysis 02/2015; DOI:10.1007/s11239-015-1191-9
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    ABSTRACT: This review addresses current treatment strategies for nonvalvular atrial fibrillation (AF) and their potential impact on thromboembolic risk and complications. It updates current classification schemes for the arrhythmia and discusses specific treatment alternatives including rate control, pharmacologic rhythm suppression, catheter ablation, and left atrial appendage obliteration, each in context of thromboembolic risks and stroke prevention.
    Journal of Thrombosis and Thrombolysis 02/2015; 39(3). DOI:10.1007/s11239-015-1181-y
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    ABSTRACT: This study evaluated avoidances in medical costs associated with clinical endpoints from randomized clinical trials that evaluated the efficacy and safety of the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban for extended treatment of patients with venous thromboembolism (VTE). Event rates of efficacy and safety endpoints from the clinical trials (RE-SONATE, EINSTEIN-EXT, and AMPLIFY-EXT) were obtained from published literature. Incremental annual medical costs among patients with clinical events from a US payer perspective were obtained from the literature or healthcare claims databases and inflation adjusted to 2013 costs. Differences in total medical costs associated with clinical endpoints for patients treated with NOACs versus placebo were then estimated. One-way univariate and Monte Carlo sensitivity analyses were additionally carried out. In all three NOAC trials lower rates of recurrent VTE occurred with NOAC use versus placebo. As a result of the reduction in VTE recurrence the overall medical costs avoided were −$2,794, −$2,948, −$4,249, and −$4,244 for VTE patients treated with dabigatran, rivaroxaban, apixaban 2.5 mg, and apixaban 5 mg respectively versus patients treated with placebo. Apixaban was associated with the greatest avoidance in medical costs, which was driven mainly by a greater reduced rate in recurrent VTE than other NOACs versus placebo and also a reduction in major bleeding rate. Further evaluation is needed to validate these results in the real-world setting.
    Journal of Thrombosis and Thrombolysis 12/2014; DOI:10.1007/s11239-014-1158-2
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    ABSTRACT: The objective of this study was to review all cases in literature in which the clinical manifestations of ischemic stroke and immune thrombocytopenia (ITP) were presented in the same patient including a new case of our own and discuss the possible mechanism and management of this syndrome. We reviewed 12 reports in which 18 cases were diagnosed as ischemic stroke and ITP. The clinical manifestations and ischemic lesion patterns of the 18 cases and our new case were analyzed in detail to elucidate the characteristics and management of this kind of syndrome. Of all the cases, 8 females and 10 males, 10 of them were Koreans; 3 were Americans; 3 were Japanese; 1 was British and 1 was Australian. The age of eight patients was no more than 50 years old. Most of them had a low platelet count. CT and/or MRI of brain were seen in all tested cases. Prognosis of ischemic stroke was good in 18 of the 19 patients. Although extremely rare, ischemic stroke and ITP may present in the same patient with variant characteristics. This paradoxical mechanism and management of ischemic stroke associated with ITP requires further investigation.
    Journal of Thrombosis and Thrombolysis 11/2014; DOI:10.1007/s11239-014-1146-6
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    ABSTRACT: This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.
    Journal of Thrombosis and Thrombolysis 11/2014; 39(4). DOI:10.1007/s11239-014-1144-8
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    ABSTRACT: Non vitamin K antagonist oral anticoagulants (NOACs) have advantages relative to traditional vitamin K antagonist oral anticoagulants and represents an important advance in the management of patients with atrial fibrillation and venous thromboembolism. Yet it is unclear whether the clinical trials evaluating these agents were inclusive of diverse populations. To assess the inclusion and reporting of race and ethnicity in clinical trials of NOACs across disease states including, atrial fibrillation, venous thromboembolism, and acute coronary syndromes, we queried PubMed and ClinicalTrials.gov for trials of NOACs between 2007 and 2013. We determined the reporting rate and inclusion of the following ethnic groups: whites, blacks, Asians, and Hispanics. We reviewed data from 30 randomized clinical trials of NOACs that enrolled 184,414 patients. Among these trials, 21 (70 %) reported race/ethnicity data in the primary manuscript or on ClinicalTrials.gov. Principal investigators provided race/ethnicity data for two additional trials. Enrollment by race included: 109,729 (75.2 %) white, 20,901 (14.3 %) Asian, 5,718 (3.9 %) Hispanic, and 2,941 (2.0 %) black. Hispanic ethnicity was only reported in 10 trials. The major clinical trials of NOACs inconsistently reported race/ethnicity and overall black and Hispanic patient enrollment was poor. As such, the relative safety and efficacy of NOACs in minority populations remains uncertain.
    Journal of Thrombosis and Thrombolysis 11/2014; 39(2). DOI:10.1007/s11239-014-1145-7
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    ABSTRACT: Pulmonary embolism due to hydatid disease has been rare clinically. Here we present a patient case who suffered from multiple cystic hydatidosis within bilateral lung parenchyma and complicated bilateral pulmonary embolisms. The case was a 70-year-old man who complained of an increasingly severe cough and hemoptysis post-operation of hepatic hydatid cyst. Chest radiographs showed that the patient had multiple nodules in the bilateral chest. Computed tomography (CT) depicted that some lesions were multivesicular cysts and some consisting of sophisticated complications. CT pulmonary angiography revealed bilateral pulmonary arterial embolisms. T2-weighted magnetic resonance images (MRI) clearly demonstrated the daughter cysts inside the lesions with high intensive signal. Echinococcosis serologic testing was positive. Thus, the pulmonary embolism was caused by hydatid cyst based on the imaging findings and serologic test.
    Journal of Thrombosis and Thrombolysis 10/2014; 40(1). DOI:10.1007/s11239-014-1147-5
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    ABSTRACT: The clinical significance of isolated subsegmental pulmonary embolism (SSPE) remains an area of controversy. In cancer patients, venous thromboembolism (VTE) is common and is a major cause of morbidity and mortality. The management of overt VTE in cancer patients is well established, nevertheless the management of incidentally diagnosed PE and especially SSPE, an increasingly frequent finding with the ubiquity of thin-slice computed tomography is less well defined. We have surveyed current attitudes towards treating SSPE in cancer patients among oncologists, respiratory and palliative care physicians. The survey was conducted between September 2012 and May 2013. Physicians surveyed were asked to select their management plan from options available depending on the site, number, symptoms, and in the presence of previous VTE. 154 physicians responded. We observed differences in the attitudes towards treatment between different specialties. In the adjuvant setting, oncologists were more likely to immediately anticoagulate for a single SSPE than palliative care physicians or chest physicians (84 vs 46 vs 56 %, respectively, p = 0.001). In the metastatic setting the differences were smaller (89 vs 69 vs 76 %, respectively, p = 0.057) but palliative care physicians remained less likely to immediately anticoagulate even in the case of multiple-site SSPE (85 vs 96 %, p = 0.014). Despite the unknown clinical significance of SSPE, and the likelihood that even in cancer patients some of these SSPEs may have trivial effects on prognosis if left untreated, the majority of the physicians surveyed would opt for anticoagulation in patients with unsuspected SSPE regardless of its extent.
    Journal of Thrombosis and Thrombolysis 10/2014; 40(1). DOI:10.1007/s11239-014-1143-9
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    ABSTRACT: The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic subjects with stable coronary artery disease (CAD). Subjects were allocated to either ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) followed by clopidogrel 600 mg LD/75 mg once-daily MD with an intervening washout period, or vice versa. The primary endpoint was on-treatment reactivity (OTR) at 2 h post-LD according to the VerifyNow P2Y12 test. OTR was significantly lower at 2 h post-LD with ticagrelor compared with clopidogrel (34 PRU vs. 201 PRU, least square means difference = −167 PRU [95 % CI, −197, −137], P < 0.001). OTR was also lower with ticagrelor at 30 min and 8 h post-LD (P < 0.001). The greater magnitude of antiplatelet effect with ticagrelor persisted after 7 days of MD (52 PRU [95 % CI, 30, 73] vs. 182 PRU [95 % CI, 160, 205], P < 0.001). Mean plasma concentration of ticagrelor and its active metabolite were greatest at 2 h post-LD, with similar levels at 2 h post-MD after 7 days of MD. Among Hispanic subjects with stable CAD, ticagrelor provides a more rapid onset of platelet inhibition and a significantly greater antiplatelet effect compared with clopidogrel during both the loading and maintenance phases of treatment. Electronic supplementary material The online version of this article (doi:10.1007/s11239-014-1135-9) contains supplementary material, which is available to authorized users.
    Journal of Thrombosis and Thrombolysis 10/2014; 39(1). DOI:10.1007/s11239-014-1135-9
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    ABSTRACT: Current guidelines consider outpatient treatment as an option for low-risk pulmonary embolism (PE), and risk assessment tools such as the HESTIA criteria can be used to identify PE patients who could feasibly be treated in an outpatient setting. Little is known about what proportion of patients in daily care this would comprise, and, in these patients, outcome data outside of clinical trials are scarce. To assess the proportion of PE patients receiving outpatient early discharge or in-hospital therapy, evaluate differences in patient characteristics between these subgroups and to assess clinical outcomes at 6 months. Monocentric, retrospective cohort study in 439 consecutive patients undergoing outpatient, early-discharge or in-hospital treatment for PE. Outcome data on recurrent VTE, pulmonary hypertension or death were collected from routine follow-up visits 6 months after VTE diagnosis. PE patients were treated as outpatient (OP; n = 49; 11.2 %); early-discharge (ED; n = 62; 14.1 %) or in-hospital (IH; n = 328; 74.7 %). Median duration of hospital stay in the ED and IH groups were 1 (IQR: 1) day and 9 (IQR: 7) days, respectively. Outcome event rates at 6 months were 3.9 % for recurrent VTE (95 % CI 2.3-6.1, similar between groups), 5.2 % for pulmonary hypertension (95 % CI 3.3-7.8, similar between groups) and 10.7 % for mortality (95 % CI 8.0-14.0). Mortality was significantly higher in IH patients (14.0 %; 95 % CI 10.5-18.3) compared to OP (0 %; 95 % CI 0.0-7.3) or ED (1.6 %; 95 % CI 0.0-8.7) patients. Mortality risk factors were high-risk ESC category (OR: 5.7), paraneoplastic VTE (OR: 3.0), need for oxygen supplementation (OR: 5.2), diabetes (OR: 2.5), age (OR per additional year: 1.1) and elevated INR (OR per 0.1 point increase: 1.5). No difference in the treatment groups for pulmonary hypertension during follow-up was found. Independent risk factors were thrombophilia (OR: 8.43), signs of right ventricular strain in baseline ECG (OR: 6.64) or echocardiography (RVESP > 40 mmHg OR: 2.99). 32 % of the OP or ED patients had at least one criterion of the HESTIA score that would have excluded them from outpatient treatment. In daily care, treating PE in an almost exclusively outpatient setting seems feasible and safe for up to 25 % of all PE patients. The HESTIA criteria seem to exclude up to 30 % of patients for whom outpatient or early-discharge treatment seems feasible and safe.
    Journal of Thrombosis and Thrombolysis 10/2014; 40(1). DOI:10.1007/s11239-014-1141-y
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    ABSTRACT: Antiplatelet switching in the management of acute coronary syndrome (ACS) seems to be safe, but prospective data are limited. This retrospective study assessed the safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with ACS. We analysed 525 consecutive patients with ACS admitted to our coronary care unit. We assessed the prevalence and the short-term outcomes of in-hospital clopidogrel-to-prasugrel switching. Bleeding and thrombotic events were assessed using propensity score matching analysis. A total of 468 patients received acetylsalicylic acid and a P2Y12 ADP receptor inhibitor. Medication switching occurred in 117 patients (25 %). Compared with the clopidogrel group, the switching group consisted preferentially of younger males with STEMI, exhibited fewer comorbidities, and had lower ischaemic risk. We found no differences between the switching group and the clopidogrel group in the bleeding rate [3.6 vs. 2.3 %, odds ratio (OR):1.59 95 % confidence interval (CI): 0.26-9.7, p NS], and in adverse cardiac or cerebrovascular events (MACCE) (5 vs. 8.4 %, OR: 0.57 95 % CI 0.16-2, p NS). In-hospital switching from clopidogrel to prasugrel in a selected high-risk ACS population resulted in a similar incidence of in-hospital haemorrhagic and thrombotic events. This strategy should be clarified in further randomised studies.
    Journal of Thrombosis and Thrombolysis 10/2014; 39(4). DOI:10.1007/s11239-014-1139-5
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    ABSTRACT: The link between myeloma and thrombosis is well established. Monoclonal gammopathy of undetermined significance (MGUS) has also been associated with an increased risk of thrombosis. It was recently demonstrated that patients with myeloma display changes in thromboelastometry that may indicate a prothrombotic state. There is little data with regard to changes in thromboelastography in patients with myeloma or MGUS. The aim of this study was to investigate the differing coagulation profiles of patients of patients with myeloma and MGUS by means of conventional coagulation tests and thromboelastography. Blood was taken by direct venepuncture from patients with myeloma, MGUS and normal controls. Routine coagulation tests were performed in an accredited hospital laboratory. Thromboelastography (TEG(®)) was performed as per the manufacturer's protocol. Eight patients were recruited in each group. Patients with myeloma had a significantly lower mean haemoglobin level than patients with MGUS or normal controls (p < 0.001). Pateints with myeloma had a significantly more prolonged mean prothrombin time than normal controls (p = 0.018) but not patients with MGUS. Patients with myeloma had significantly higher median D-dimer levels than normal controls (p = 0.025), as did patients with MGUS (p = 0.017). Patients with myeloma had a significantly higher mean factor VIII level than normal controls (p = 0.009) and there was a non-significant trend towards patients with MGUS having higher factor VIII levels than normal controls (p = 0.059). There was no significant difference in thromboelastographic parameters between the three groups. Patients with MGUS appear to have a distinct coagulation profile which is intermediate between patients with myeloma and normal controls.
    Journal of Thrombosis and Thrombolysis 10/2014; 39(2). DOI:10.1007/s11239-014-1140-z
  • Journal of Thrombosis and Thrombolysis 09/2014; 39(1). DOI:10.1007/s11239-014-1126-x
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    ABSTRACT: Deep vein thrombosis is one of the common complications of orthopedic surgery, and pulmonary embolism which is one of its lethal complications can lead to mortality. Numerous efforts have been made to identify reliable and predictive biomarkers to detect the early signs of deep vein thrombosis. These studies have, however, not delivered any more informative candidates than the D-dimer that have been available. Cell-free microRNAs are present in a range of body fluids and have recently been shown to be useful biomarkers in many diseases. Therefore, the purpose of present study was to identify potential microRNA biomarkers of deep vein thrombosis that are present in serum. Serum samples were taken from 18 deep vein thrombosis patients and 20 age- and sex-matched controls. TaqMan microRNA array was used for an initial screening. Real-time PCR assay was implemented to confirm the concentrations of candidate microRNAs. We found that the serum levels of miR-582, miR-195 and miR-532 of deep vein thrombosis patients were higher than those of controls. miR-582 yielded an AUC (the areas under the ROC curve) of 0.959, and the other two microRNAs yielded an AUC of 1.000 in discriminating deep vein thrombosis from controls. These data hint that serum miR-582, miR-195 and miR-532 might have potential to be a novel noninvasive biomarkers for detection of DVT. And this is the first study suggesting that serum microNRAs might be used as biomarkers for deep vein thrombosis.
    Journal of Thrombosis and Thrombolysis 09/2014; 39(2). DOI:10.1007/s11239-014-1131-0
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    ABSTRACT: I read with interest the recent meta-analysis by Phan et al. [1] on primary prophylaxis against venous thromboembolism (VTE) in patients with solid cancers. It is a welcome addition to the literature. However, I have several concerns about the accuracy of the data and the interpretation of the results.First, there was inaccuracy of the data analyzed that could potentially render the results of the study invalid.Although the focus of the meta-analysis was on “venous” thromboembolic events, the authors included studies with reduction in all types of “vascular” thromboembolic events (including stroke and myocardial infarction) as a primary endpoint, e.g., FRAGEM study by Maraveyas et al. [2] and PROTECHT study by Agnelli et al. [3] I found that the number of all “vascular” thromboembolic events in these studies were erroneously counted as “venous” thromboembolic events in the meta-analysis [1]. In order to obtain a valid pooled result of the primary efficacy outcome of the meta-analysi ...
    Journal of Thrombosis and Thrombolysis 09/2014; 39(2). DOI:10.1007/s11239-014-1138-6
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    ABSTRACT: Oral anticoagulation (OAC) with either new oral anticoagulants (NOACs) or Vitamin-K antagonists (VKAs) is recommended by guidelines for patients with atrial fibrillation (AF) and a moderate to high risk of stroke. Based on a claims-based data set the aim of this study was to quantify the stroke-risk dependent OAC utilization profile of German AF patients and possible causes of OAC under-use. Our claims-based data set was derived from two German statutory health insurance funds for the years 2007-2010. All prevalent AF-patients in the period 2007-2009 were included. The OAC-need in 2010 was assumed whenever a CHADS2- or CHA2DS2-VASC-score was >1 and no factor that disfavored OAC use existed. Causes of OAC under-use were analyzed using multivariate logistic regression. 108,632 AF-prevalent patients met the inclusion criteria. Average age was 75.43 years, average CHA2DS2-VASc-score was 4.38. OAC should have been recommended for 56.1/62.9 % of the patients (regarding factors disfavouring VKA/NOAC use). For 38.88/39.20 % of the patient-days in 2010 we could not observe any coverage by anticoagulants. Dementia of patients (OR 2.656) and general prescription patterns of the treating physician (OR 1.633) were the most important factors increasing the risk of OAC under-use. Patients who had consulted a cardiologist had a lower risk of being under-treated with OAC (OR 0.459). OAC under-use still seems to be one of the major challenges in the real-life treatment of AF patients. Our study confirms that both patient/disease characteristics and treatment environment/general prescribing behaviour of physicians may explain the OAC under-use in AF patients.
    Journal of Thrombosis and Thrombolysis 09/2014; 40(1). DOI:10.1007/s11239-014-1136-8