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Aurélien Delluc,
Stéphanie Montavon,
Olivier Canceil,
Marc Carpentier,
Emmanuel Nowak,
Bernard Mercier,
Luc Bressollette,
Sylvie Etienne,
Michel Walter, Dominique Mottier,
Karine Lacut
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ABSTRACT: INTRODUCTION: Incidence and risk factors of venous thromboembolism (VTE) are well established in surgical and medical settings, but data in psychiatric units are lacking. The aim of this study was to estimate the incidence of VTE in hospitalized psychiatric patients, and to assess the risk factors for VTE in this specific population. MATERIALS AND METHODS: All consecutive adult patients, admitted for a psychiatric disorder for at least seven days in psychiatric units were considered for inclusion. Patients were evaluated for signs and symptoms of VTE during hospitalization. At Day 10, all participants were interviewed and a systematic compression ultrasonography of the lower limbs was performed. Patients were followed-up until Day 90. RESULTS: Among the 471 included patients, 449 were evaluable at Day 10, and 458 were followed-up until Day 90. Ten deep vein thromboses (DVT) were diagnosed by Day 10 leading to an incidence of VTE of 2.2% (95% CI, 1.1%-4.1%). Six additional symptomatic VTE occurred between Day 10 and Day 90, leading to a 3.5% incidence at Day 90 (95% CI, 2.0%-5.6%). The main factors associated with VTE were age, bed rest, and diagnosis of dementia. The incidence of VTE in patients aged 75 or over with a diagnosis of dementia reached 8.2% at Day 10 and 12.5% at Day 90. CONCLUSIONS: The incidence of VTE in psychiatric units appeared low. However, in older patients, especially those with dementia, the incidence of VTE increased considerably. Further studies are needed to confirm these results.
Thrombosis Research 10/2012; · 2.44 Impact Factor
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ABSTRACT: INTRODUCTION: Several studies have suggested that statins may lower the risk of venous thromboembolism (VTE), whereas fibrates may increase this risk. However, no studies have evaluated whether lipid-lowering drugs (LLD) use was associated with the risk of VTE recurrence. MATERIALS AND METHODS: In a prospective cohort study, we followed-up all patients who had been treated for a first unprovoked VTE event in our centre. The association between LLD exposure and risk of recurrence of VTE after discontinuation of anticoagulation was analyzed with Cox proportional hazards model with adjustment for age, sex, body mass index, site of thrombosis, antiplatelets use, and duration of anticoagulation before inclusion in the study. RESULTS: 432 patients (median age 65.5years interquartile range 45.0-75.0, 174 men) were followed up for a median of 29.5months after discontinuation of anticoagulation. Sixty patients (13.9%) had recurrent VTE. During follow-up, 48 patients (11.1%) received statins, 36 patients (8.3%) received fibrates. In multivariate analysis, the risk of recurrent VTE associated with statin exposure was 1.02 (95% confidence interval 0.36-2.91) and 2.15 (95% confidence interval 1.01-4.61) for fibrate exposure. CONCLUSION: Our results suggest an association between fibrate intake and an increased risk of recurrent VTE, whereas statin intake was not associated with recurrent VTE. Larger studies are needed to validate these results.
Thrombosis Research 08/2012; · 2.44 Impact Factor
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ABSTRACT: Low molecular weight heparins (LMWHs) and vitamin K antagonists make up the cornerstone of therapy for patients with venous thromboembolism (VTE) but have drawbacks making their use difficult in daily practice. Current research focuses on the development of new anticoagulant drugs that could be administered orally at a fixed dose, with fewer food and drug interactions and no need for monitoring or dose adjustment. Several new drugs are tested in noninferiority trials, either as a single-drug approach treatment (e.g., rivaroxaban or apixaban), or after an initial course of LMWH (e.g., dabigatran or edoxaban). Published clinical trials demonstrate that rivaroxaban and dabigatran are noninferior to conventional treatment in patients with VTE. Several issues remain challenging for physicians, such as the lack of antidote and of routinely available monitoring tests. To what extent new anticoagulant drugs will change clinical practice is not yet well defined. They may facilitate outpatient management of VTE. They might also improve the risk-benefit balance of prolonged anticoagulation and therefore modify the optimal duration of anticoagulation in VTE patients.
Seminars in Respiratory and Critical Care Medicine 04/2012; 33(2):191-8. · 2.43 Impact Factor
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ABSTRACT: Besides their effects on atherogenesis, lipids and lipoproteins could contribute to the development of venous thromboembolism (VTE). This association has been investigated in a few studies with conflicting results.
Plasma levels of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein A-I and apolipoprotein B were measured in 467 patients with a first unprovoked VTE event diagnosed between May 2000 and December 2004 and in 467 age and sex matched controls. The association between these parameters and VTE was determined in non-users of lipid lowering drugs (LLD), in statin users and in fibrate users in a quartile-based analysis. We repeated this stratified analysis within each stratum of men and women.
The median age of patients was 73 years [interquartile range 58-80], 41.5% were men. Among the 934 patients of the study, 100 were treated with statin, 91 with fibrate and 743 were not receiving LLD. Among non users of LLD, high levels of apolipoprotein B were associated with VTE (OR 1.82, 95% CI 1.19-2.79) after adjustment for age and body mass index. Elevated LDL-cholesterol levels were associated with VTE only in men (OR 2.32, 95% CI 1.07-5.01). High levels of LDL/HDL-cholesterol and apolipoprotein B/apolipoprotein A-I ratios were associated with VTE (OR 2.76, 95% CI 1.69-4.50 and OR 1.86, 95% CI 1.16-2.97 respectively) but this effect was mainly observed in men. There was no association between lipid parameters and VTE in statin users and in fibrate users.
Our results are in line with the new concept of a global cardiovascular disease combining atherosclerosis and VTE.
Atherosclerosis 01/2012; 220(1):184-8. · 3.79 Impact Factor
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Grégoire Le Gal,
Geneviève Kercret,
Khalil Ben Yahmed,
Luc Bressollette,
Helia Robert-Ebadi,
Louise Riberdy,
Patrick Louis,
Aurélien Delluc,
Marie-Luce Labalette,
Mohamed Baba-Ahmed,
Henri Bounameaux, Dominique Mottier,
Marc Righini
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ABSTRACT: To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis.
Prospective outcome study.
Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland.
226 pregnant and postpartum women referred for suspected deep vein thrombosis.
A single proximal and distal compression ultrasonography was performed. All women with a negative complete compression ultrasonography result did not receive anticoagulant therapy and were followed up for a three month period.
Symptoms of venous thromboembolism, second compression ultrasonography or chest imaging, a thromboembolic event, and anticoagulant treatment.
16 women were excluded, mainly because of associated suspected pulmonary embolism. Deep vein thrombosis was diagnosed in 22 out of the 210 included women (10.5%). 10 patients received full dose anticoagulation despite a negative test result during follow-up. Of the 177 patients without deep vein thrombosis and who did not receive full dose anticoagulant therapy, two (1.1%, 95% confidence interval 0.3% to 4.0%) had an objectively confirmed deep vein thrombosis during follow-up.
The rate of venous thromboembolic events after single complete compression ultrasonography in pregnant and postpartum women seems to be within the range of that observed in studies in the non-pregnant population. These data suggest that a negative single complete compression ultrasonography result may safely exclude the diagnosis of deep vein thrombosis in this setting.
clinicaltrials.gov NCT00740454.
BMJ (Clinical research ed.). 01/2012; 344:e2635.
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ABSTRACT: This study evaluated the impact of body mass index (BMI) on venous thromboembolism (VTE) site and assessed a possible interaction between BMI and prothrombotic risk factors in patients included in the EDITH (Etude des Déterminants et Interactions de le THrombose veineuse) study. A cross-sectional study was used to compare the site of unprovoked VTE according to BMI categories in 1077 patients and a matched case-control study (732 pairs) assessed the joint effect of BMI and prothrombotic mutations on VTE risk. The cross sectional analysis showed that the proportion of patients with pulmonary embolism was higher in overweight (63%) and obese (63·5%) patients than among patients with a BMI<25kg/m(2) (55%), P=0·02 and P=0·05 respectively. No interaction was found between F5 G1691A (factor V Leiden) and BMI for VTE risk (P=0·90). There was a significant interaction between F2 G20210A and BMI (P=0·02). The risk of VTE associated with BMI was 1·7 [95% confidence interval (CI): 0·8-3·7], 4·36 (95%CI: 1·49-12·78) and 12·03 (95%CI: 1·53-94·29) in patients with BMI<25kg/m(2) , 25≤BMI<30 and ≥30kg/m(2) respectively after adjustment for age and oestrogen use. This study showed that BMI may play a role in determining the site of VTE and may interact with F2 G20210A but not with F5 G1691A for the risk of VTE.
British Journal of Haematology 06/2011; 154(4):486-91. · 4.94 Impact Factor
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ABSTRACT: Among cancers, pancreatic cancer is known to be associated with a higher incidence of venous thromboembolism (VTE). The aim of the study was to determine the implication of circulating tissue factor (TF) in VTE related to active pancreatic cancer. One hundred and sixty-four consecutive patients who participated to the Etude des Determinants et Interactions de la Thrombose veineuse (EDITH) study between January 2005 and August 2007 for symptomatic VTE related to active pancreatic cancer (n = 8), active cancer of other location (n = 42) or classified as unprovoked (n = 114) were included. TF activity (TFa) was measured in a one-stage kinetic chromogenic method. There were no differences of median TFa levels between patients with VTE related to cancer of other type than pancreas [2.01 pmol/l range (0.05-43.92)] and patients with unprovoked VTE [1.78 pmol/l (range 0.05-63.72), P = 0.21]. Median TFa levels were higher in patients with VTE related to pancreatic cancer [12.67 pmol/l (range 0.05-112.04)] than in patients with VTE related to cancer of other type [2.01 pmol/l (range 0.05-43.92), P = 0.02]. Higher levels of circulating TFa during the course of pancreatic cancer may explain the higher incidence of VTE associated with this type of cancer.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 03/2011; 22(4):295-300. · 1.25 Impact Factor
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ABSTRACT: Compared with 537 parous controls with no history of pregnancy loss, a lower thrombomodulin-related inhibition of the endogenous thrombin potential was measured in 264 cases with previous unexplained pregnancy loss, especially when losses occurred between 9 and 12 weeks of gestation. Adjusting age, protein S, factor VIII, factor V Leiden, and prothrombin G20210A did not change the results.
Fertility and sterility 12/2010; 95(5):1813-5.e1. · 3.97 Impact Factor
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ABSTRACT: Factors that predict the risk of venous thromboembolism in the first-degree relatives of patients with unprovoked venous thromboembolism are uncertain but important for counseling. We aimed to identify risk factors for, and quantify the risk of, venous thromboembolism in first-degree relatives of patients (index case patients) with a first episode of unprovoked venous thromboembolism.
In a cross-sectional study, using a standardized method and without knowledge of whether patients or their relatives had thrombophilia, we assessed the prevalence of previous venous thromboembolism in 1,916 first-degree relatives of 378 unselected patients with a first episode of unprovoked venous thromboembolism. Patient characteristics, and the presence of factor V Leiden or the G20210A prothrombin gene mutation in patients, were assessed as predictors of venous thromboembolism in patient's relatives.
There were 102 previous episodes of venous thromboembolism in the first-degree relatives (prevalence, 5.3%). Thrombosis at a young age in patients was the strongest predictor of venous thromboembolism in relatives, with an adjusted odds ratio (OR) for younger patients (ie, patients < 45 years of age when venous thromboembolism occurred; lowest quartile) compared with older patients (ie, patients > 71 years of age; highest quartile) of 3.27 (95% CI, 1.68 to 6.38). The presence of factor V Leiden or the G20210A prothrombin gene in patients was a weak independent predictor of venous thromboembolism in relatives (adjusted OR, 1.48; 95% CI, 0.94 to 2.33).
Unprovoked venous thromboembolism at a young age is associated with a substantially increased risk of venous thromboembolism in patients' families.
Chest 07/2009; 136(6):1537-45. · 5.25 Impact Factor
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Haematologica 08/2008; 93(7):1117-8. · 6.42 Impact Factor
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Thrombosis and Haemostasis 05/2008; 99(4):793-4. · 5.04 Impact Factor
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Marc Righini,
Grégoire Le Gal,
Drahomir Aujesky,
Pierre-Marie Roy,
Olivier Sanchez,
Franck Verschuren,
Olivier Rutschmann,
Michel Nonent,
Jacques Cornuz,
Frédéric Thys,
Cédric Petit Le Manach,
Marie-Pierre Revel,
Pierre-Alexandre Poletti,
Guy Meyer, Dominique Mottier,
Thomas Perneger,
Henri Bounameaux,
Arnaud Perrier
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ABSTRACT: Multislice CT (MSCT) combined with D-dimer measurement can safely exclude pulmonary embolism in patients with a low or intermediate clinical probability of this disease. We compared this combination with a strategy in which both a negative venous ultrasonography of the leg and MSCT were needed to exclude pulmonary embolism.
We included 1819 consecutive outpatients with clinically suspected pulmonary embolism in a multicentre non-inferiority randomised controlled trial comparing two strategies: clinical probability assessment and either D-dimer measurement and MSCT (DD-CT strategy [n=903]) or D-dimer measurement, venous compression ultrasonography of the leg, and MSCT (DD-US-CT strategy [n=916]). Randomisation was by computer-generated blocks with stratification according to centre. Patients with a high clinical probability according to the revised Geneva score and a negative work-up for pulmonary embolism were further investigated in both groups. The primary outcome was the 3-month thromboembolic risk in patients who were left untreated on the basis of the exclusion of pulmonary embolism by diagnostic strategy. Clinicians assessing outcome were blinded to group assignment. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00117169.
The prevalence of pulmonary embolism was 20.6% in both groups (189 cases in DD-US-CT group and 186 in DD-CT group). We analysed 855 patients in the DD-US-CT group and 838 in the DD-CT group per protocol. The 3-month thromboembolic risk was 0.3% (95% CI 0.1-1.1) in the DD-US-CT group and 0.3% (0.1-1.2) in the DD-CT group (difference 0.0% [-0.9 to 0.8]). In the DD-US-CT group, ultrasonography showed a deep-venous thrombosis in 53 (9% [7-12]) of 574 patients, and thus MSCT was not undertaken.
The strategy combining D-dimer and MSCT is as safe as the strategy using D-dimer followed by venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism. An ultrasound could be of use in patients with a contraindication to CT.
The Lancet 05/2008; 371(9621):1343-52. · 38.28 Impact Factor
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ABSTRACT: There are very few data assessing a family history of venous thromboembolism (VTE) as a risk factor for VTE. This question is nonetheless of interest as inherited risk factors are involved but at least partly unknown.
The E.D.I.TH. study is a prospective hospital-based case-control study. The family history was assessed by using a standard questionnaire, considering the total number of the first-degree relatives and the number of these relatives who had suffered from VTE. We analysed 698 first VTE cases and their matched controls, 507 pairs without and 191 pairs with a major acquired risk factor (active malignancy, surgery or plaster cast in the past three months, pregnancy or delivery in the past three months).
A family history of VTE was associated with VTE occurrence, irrespective of carrying or not factor V Leiden mutation or G20210A prothrombin gene mutation and irrespective of the presence or absence of major acquired risk factors; adjusted conditional odds ratio: 2.7 (95%CI, 1.8-3.8).
A family history might well be considered when estimating type and duration of prophylaxis for VTE specifically in patients with active cancer or who experienced surgery. Family history of VTE could be added to a prior VTE history to define a concept of clinical thrombophilia which is not necessarily related to carrying a known inherited risk factor.
Thrombosis Research 03/2008; 122(5):624-9. · 2.44 Impact Factor
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ABSTRACT: This trial sought to assess the influence of omeprazole on clopidogrel efficacy.
Clopidogrel has proved its benefit in the treatment of atherothrombotic diseases. In a previous observational study, we found clopidogrel activity on platelets, tested by vasodilator-stimulated phosphoprotein (VASP) phosphorylation, to be diminished in patients receiving proton pump inhibitor (PPI) treatment.
In this double-blind placebo-controlled trial, all consecutive patients undergoing coronary artery stent implantation received aspirin (75 mg/day) and clopidogrel (loading dose, followed by 75 mg/day) and were randomized to receive either associated omeprazole (20 mg/day) or placebo for 7 days. Clopidogrel effect was tested on days 1 and 7 in both groups by measuring platelet phosphorylated-VASP expressed as a platelet reactivity index (PRI). Our main end point compared PRI value at the 7-day treatment period in the 2 groups.
Data for 124 patients were analyzed. On day 1, mean PRI was 83.2% (standard deviation [SD] 5.6) and 83.9% (SD 4.6), respectively, in the placebo and omeprazole groups (p = NS), and on day 7, 39.8% (SD 15.4) and 51.4% (SD 16.4), respectively (p < 0.0001).
Omeprazole significantly decreased clopidogrel inhibitory effect on platelet P2Y12 as assessed by VASP phosphorylation test. Aspirin-clopidogrel antiplatelet dual therapy is widely prescribed worldwide, with PPIs frequently associated to prevent gastrointestinal bleeding. The clinical impact of these results remains uncertain but merits further investigation.
Journal of the American College of Cardiology 02/2008; 51(3):256-60. · 14.16 Impact Factor
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ABSTRACT: The thrombin generation test appears to be a highly sensitive and specific test in the detection of thrombophilia in patients with venous thromboembolism. We aimed to determine the accuracy of the thrombin generation test to detect factor V Leiden and/or other prothrombotic states in first-degree relatives of patients with venous thromboembolism and factor V Leiden. Sixty-two first-degree relatives of 21 index cases were tested for factor V Leiden, the G20210A prothrombin gene mutation and thrombin generation. Information about oestrogen therapy and previous VTE was also collected. The normalized Thrombomodulin sensitivity ratio (n-TMsr) was defined as the ratio of endogenous thrombin potential determined in the presence and absence of thrombomodulin which was normalized against the same ratio determined in normal control plasma. The mean n-TMsr was 1.37 (+/- 0.33) in the 45 relatives with one or more prothrombotic state (factor V Leiden, G20210A prothrombin mutation, oestrogen therapy or hormonal therapy) and 1.02 (+/- 0.34) in the 17 relatives without prothrombotic state (p = 0.001). The positive predictive value was 90.3 (95%CI, 73.1-97.4). In relatives with an abnormal n-TMsr, the adjusted odds ratio for having a prothrombotic state was 8.3 (95%CI, 1.9-36.9) and the adjusted odds ratio for having the factor V Leiden was 14.3 (95%CI, 2.9-71.2). An abnormal thrombin generation test appears highly predictive for having factor V Leiden and/or other prothrombotic states in first-degree relatives of patients with venous thromboembolism and factor V Leiden.
Thrombosis and Haemostasis 02/2008; 99(1):223-8. · 5.04 Impact Factor
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ABSTRACT: Previous studies reported that statin use was associated with a decreased risk of venous thromboembolism (VTE), whereas no association was found between fibrate use and VTE. This report aims to test the hypothesis that part of these contrasting associations is related to total homocysteine level (tHcy).
This report from a case-control study included 677 cases hospitalised with confirmed VTE and no major acquired risk factor of VTE and their 677 controls. Statin and fibrate exposure was defined as a current use of drugs at admission. Fasting serum tHcy was measured in all patients.
The estimated odds ratio for VTE related to statin use was 0.53 (CI 95% 0.37-0.78), whereas it was 1.88 (CI 95% 1.29-2.74) for fibrate use. No difference was found for tHcy levels between patients who were current users of statin compared to non users (17.7 micromol/L+/-7.3 in users vs 18.4 micromol/L+/-8.4 in non users, p=0.50). In contrast, fibrate users had a significant higher mean level of tHcy than non users (23.2 micromol/L+/-8.7 in users vs 18.4 micromol/L+/-8.4 in non users, p<0.0001). Nevertheless, adjustment on tHcy level did not alter significance and strength of the association between fibrates and VTE (1.66, CI 95% 1.07-2.59).
Statin use was associated with a significant decreased risk of VTE, whereas fibrate use was associated with a significant increased risk of VTE. This last association was independent of tHcy levels.
Thrombosis Research 02/2008; 122(3):314-9. · 2.44 Impact Factor
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ABSTRACT: Primary prophylaxis with the use of an effective and safe intervention appears the best approach of venous thromboembolism (VTE) management in medical elderly patients, the most affected by VTE. With increasing life expectancy, prevention of VTE, particularly in elderly patients, will arise as a major public health problem. Few well designed clinical trials evaluating thromboprophylaxis in medical settings were conducted in the specific population of geriatric patients. However, among the several pharmacological treatments evaluated, low molecular weight heparins enoxaparin 40 mg daily or dalteparin 5000 IU daily appeared effective and safe in the prevention of VTE in elderly patients. Despite available data, and recommendations for VTE prevention in medical patients, thromboprophylaxis is underused or misused in practice. Heterogeneity of clinical studies, selected populations, concern about bleeding, and lack of a clear clinical benefit are some of the reasons that could explain the gap between theory and practice. In this review, after a brief report of epidemiologic data and specificities of VTE in elderly patients, the authors discuss the available results of VTE primary prevention trials for elderly medical patients, the limitations of these data, and the challenges to improve the practice and to reduce the incidence of this frequent but preventable disease.
Clinical Interventions in Aging 02/2008; 3(3):399-411. · 2.08 Impact Factor
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ABSTRACT: To assess whether guidelines for the management of suspected PE, recommending that ventilation/perfusion (V/Q) scintigraphy should be followed by other imaging in case of non-diagnostic result, and interpreted along with the clinical probability, are applied in daily practice.
Two-year audit study.
Tertiary hospital in France.
All patients referred to the nuclear medicine department for a suspected pulmonary embolism (PE), with a low clinical probability, a positive D-Dimer test, and a low V/Q scintigraphy.
We reviewed medical records to collect data on further diagnostic strategy and therapeutic management.
Thromboembolic risk during a three-month follow up in patients who did not undergo anticoagulation therapy on the basis of a negative diagnostic work up.
Of the 456 selected patients, PE was excluded on the basis of a low pretest probability and a low V/Q scintigraphy probability without further testing in 184 (group 1). In the other 272 patients (group 2), 4 venous thromboembolism (VTE) events were diagnosed by leg vein ultrasonography and/or computed tomography pulmonary angiography. In patients who did not receive anticoagulant treatment during follow up, one patient from group 1 (0.6%, 95% confidence interval 0.1 to 3.3) and two patients from group 2 (0.9%, 95% CI 0.2 to 3.2) had an acute venous thromboembolic event.
Different attitudes are adopted by physicians in patients with a low clinical probability and a low V/Q scintigraphy probability, without impact on safety, as assessed by a non-significant difference in the three-month thromboembolic risks between these two groups.
Thrombosis Research 01/2008; 122(4):450-4. · 2.44 Impact Factor
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Alexander T Cohen,
Giancarlo Agnelli,
Frederick A Anderson,
Juan I Arcelus,
David Bergqvist,
Josef G Brecht,
Ian A Greer,
John A Heit,
Julia L Hutchinson,
Ajay K Kakkar, Dominique Mottier,
Emmanuel Oger,
Meyer-Michel Samama,
Michael Spannagl
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ABSTRACT: Venous thromboembolism (VTE) is often asymptomatic, mis-diagnosed, and unrecognized at death, and there is a lack of routine postmortem examinations. These factors are thought to result in marked underestimates ofVTE incidence. The objective of our study was to estimate the total burden of VTE within the European Union (EU) per annum. An epidemiological model was constructed to estimate the number of community- and hospital-acquired incidents and recurrent cases (attack rate) of nonfatal VTE and VTE-related deaths, as well as incident and prevalent cases of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (PH) occurring in the EU per annum. Individual models were developed for six EU countries. The models were populated with data from published literature and, where necessary, expert opinions. The findings were tested using probabilistic sensitivity analyses. The estimated total number of symptomaticVTE events (range based on probabilistic sensitivity analysis) per annum within the six EU countries was 465,715 (404,664-538,189) cases of deep-vein thrombosis, 295,982 (242,450-360,363) cases of pulmonary embolism (PE), and 370,012 (300,193-483,108) VTE-related deaths. Of these deaths, an estimated 27,473 (7%) were diagnosed as being antemortem; 126,145 (34%) were sudden fatal PE, and 217,394 (59%) followed undiagnosed PE. Almost three-quarters of all VTE-related deaths were from hospital-acquired VTE. VTE is a major health problem in the EU, with over one million VTE events or deaths per annum in the six countries examined. Given the availability of effective VTE prophylaxis, many of these events and deaths could have been prevented. These results have important implications for the allocation of healthcare resources.
Thrombosis and Haemostasis 11/2007; 98(4):756-64. · 5.04 Impact Factor
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ABSTRACT: Recent studies highlight the contribution of antiplatelet therapy to clinical severity and increased mortality of intracerebral hemorrhage (ICH) but results are discrepant. The aim of this report was to evaluate the association between antiplatelet drug use preceding the onset of ICH and the mortality, assessed at regular intervals, among patients with acute ICH. We analyzed data from a randomized study which enrolled consecutive patients with a documented acute ICH to evaluate the efficacy of intermittent pneumatic compression of the legs in venous thrombosis prevention. Clinical characteristics and treatment used before the onset of ICH were checked at the time of inclusion. Mortality was assessed at regular intervals until 3 months after ICH diagnosis. Among 138 patients included in this report, 30 were current users of antiplatelet therapy at the time of ICH; they were significantly older and less frequently heavy drinkers than non-users of antiplatelet drugs. Mortality rates were 20% at 8 days, 40% at 1 month, and 47% at 3 months among antiplatelet drug users compared with 6.5%, 13% and 19% among non-users. The corresponding estimated risks for mortality related to antiplatelet drug use were 3.6 (95% CI 1.1-12), 4.5 (95% CI 1.8-11), and 3.6 (95% CI 1.5-8.6). Adjusted for age, hypertension and alcohol over use, antiplatelet therapy remained significantly associated with an increased mortality rate of acute ICH. Current antiplatelet drug use preceding the onset of ICH is associated with increased short-term ICH mortality, independently of age.
Fundamental and Clinical Pharmacology 07/2007; 21(3):327-33. · 1.80 Impact Factor
