C W Francis

Duke University, Durham, North Carolina, United States

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Publications (293)

  • [Show abstract] [Hide abstract] ABSTRACT: The risk for venous thromboembolism (VTE) is increased in cancer and particularly with chemotherapy, and it portends poorer survival among patients with cancer. However, many fundamental questions about cancer-associated VTE, or Trousseau syndrome, remain unanswered. This report summarizes the proceedings of a working group assembled by the NCI and NHLBI in August 2014 to explore the state of the science in cancer-associated VTE, identify clinically important research gaps, and develop consensus on priorities for future research. Representing a convergence of research priorities between the two NIH Institutes, the workshop addressed epidemiologic, basic science, clinical, and translational issues in cancer-associated VTE. Cancer Res; 76(13); 3671-5. ©2016 AACR.
    Article · Jul 2016 · Cancer Research
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    [Show abstract] [Hide abstract] ABSTRACT: Monitoring warfarin with Fiix-prothrombin time (Fiix-PT), which is only affected by coagulation factors II and X, stabilizes anticoagulation and reduces thromboembolism compared to PT/INR monitoring. We compared outcome in nonvalvular atrial fibrillation (NVAF) patients treated with Fiix-warfarin, direct oral anticoagulants (DOACs), or PT-warfarin. A systematic efficacy and safety assessment by retrieving data from the Fiix trial and the four major phase III DOAC trials in NVAF. Prespecified outcomes included stroke and systemic embolism (SSE), SSE and myocardial infarction (MI), major bleeding (MB), composite major vascular events (SSEMI and MB; CMVE), and deaths. We calculated relative risk, 95% CI, and 95% confidence limits (CL) for each outcome and performed meta-analysis using fixed- and random-effects modeling. There were 613 and 628 observation years with Fiix-warfarin and PT-warfarin in the Fiix trial, and 70 628 and 57 962 with DOACs and PT-warfarin in DOAC trials. Populations were comparable although death rates were lower in the Fiix trial. Compared to pooled PT-warfarin, Fiix-warfarin reduced SSE (RR 0.54;95% CI 0.26–1.10/95% CL <1.00), SSEMI (0.51;0.26–0.99/<0.90), MB (RR 0.63;0.37–1.07/<0.99), and CMVE (RR 0.66;0.43–1.00/<0.94). Vascular death was lower (RR 0.13;0.04–0.47/<0.42). Compared to pooled DOACs, Fiix-warfarin consistently had lower point estimates for the RR for efficacy and safety, but only significant for lower death rates (vascular death RR 0.14;0.04–0.49/<0.43). Meta-analysis comparing Fiix-warfarin and DOACs with PT-warfarin consistently found Fiix-warfarin to have the lowest point estimates for efficacy. Monitoring warfarin with Fiix-PT reduces risk of vascular events in NVAF patients as much as DOACs. Warfarin monitored with Fiix-PT is an improved anticoagulant.
    Full-text Article · May 2016 · International journal of laboratory hematology
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    [Show abstract] [Hide abstract] ABSTRACT: Background. Retrospective studies have suggested an association between cancer-associated venous thromboembolism (VTE) and patient survival.Weevaluated a previously validated VTE Clinical Risk Score in also predicting early mortality and cancer progression. Methods. A large, nationwide, prospective cohort study of adults with solid tumors orlymphoma initiating chemotherapy was conducted from 2002 to 2006 at 115 U.S. practice sites. Survivalandcancer progressionwereestimatedbythemethod of Kaplan and Meier. Multivariate analysis was based on Cox regression analysis adjusted for major prognostic factors including VTE itself. Results. Of 4,405 patients, 134 (3.0%) died and 330 (7.5%) experienced disease progression during the first 4 months of therapy (median follow-up 75 days). Patients deemed high risk (n = 540, 12.3%) by the Clinical Risk Score had a 120-day mortality rate of 12.7% (adjusted hazard ratio [aHR] 3.00, 95% confidence interval [CI] 1.4-6.3), and intermediate-risk patients (n = 2,665, 60.5%) had a mortality rate of 5.9% (aHR 2.3, 95% CI 1.2-4.4) compared with only 1.4% for low-risk patients (n = 1,200, 27.2%). At 120 days of follow-up, cancer progression occurred in 27.2% of high-risk patients (aHR 2.2, 95% CI 1.4-3.5) and 16.4% of intermediate-risk patients (aHR 1.9, 95% CI 1.3-2.7) compared with only 8.5% of low-risk patients (p < .0001). Conclusion. The Clinical Risk Score, originally developed to predict the occurrence of VTE, is also predictive of early mortality and cancer progression during the first four cycles of outpatient chemotherapy, independent from other major prognostic factors including VTE itself. Ongoing and future studies will help determine the impact of VTE prophylaxis on survival.
    Full-text Article · Apr 2016 · The Oncologist
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    L R Letertre · B R Gudmundsdottir · C W Francis · [...] · P T Onundarson
    [Show abstract] [Hide abstract] ABSTRACT: Background: Assaying anticoagulants is usefulin emergency situations or prior to surgery. Different specific assays are currently needed depending on anticoagulant. Objectives: We hypothesized that levels of warfarin, dabigatran, rivaroxaban, apixaban and heparins could be measured with the dilute prothrombin time (dPT) and dilute Fiix-PT (dFiix-PT), using highly diluted thromboplastin (TP). The latter test is affected only by reduced levels of active factors II and X but corrects test plasma for other deficiencies METHODS: Increasing TP dilutions were used to identify suitable dilutions to measure dabigatran, rivaroxaban, apixaban, unfractionated heparin and enoxaparin. Calibrators containing known amounts of direct oral anticoagulants (DOACs) were used to make standard curves. Citrated plasma samples were obtained from patients taking warfarin or DOACs with known drug concentrations as determined by specific assays. Results: The dFiix-PT at a TP dilution of 1:1156 could be used to measure all of the drugs tested at therapeutic concentrations except for fondaparinux. The dPT achieved the same, but required two TP dilutions (1:750 and 1:300). Warfarin effect could be assessed using dFiix-PT at 1:1156 with a PT ratio identical to the INR. Six different TPs yielded similar results, but two were less sensitive. Dabigatran, rivaroxaban and apixaban could be accurately measured in patient samples using both dilute PT assays but a better correlation was consistently observed between the dFiix-PT and specific assays than with the dPT. Conclusion: The dFiix-PT using a single dilution of TP may be suitable to assess the anticoagulant effect of warfarin, dabigatran, rivaroxaban, apixaban, heparin and enoxaparin. This article is protected by copyright. All rights reserved.
    Full-text Article · Feb 2016 · Journal of Thrombosis and Haemostasis
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    P. T. Onundarson · C. W. Francis · O. S. Indridason
    [Show abstract] [Hide abstract] ABSTRACT: Background Rapid fl uctuations in factor VII during warfarin anticoagulation change the international normalised ratio (INR) but contribute little to the antithrombotic eff ect. We aimed to assess non-inferiority of anticoagulation stabilisation with a warfarin monitoring method aff ected only by factors II and X (Fiix-prothrombin time [Fiix-PT]) compared with standard PT-INR monitoring that includes factor VII measurement as well.
    Full-text Article · Dec 2015
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    [Show abstract] [Hide abstract] ABSTRACT: Background: Transfusion of ABO non-identical platelets has been associated with fatal haemolytic reactions, increased red cell transfusion needs and other adverse effects, but the practice of ABO matching in platelet transfusion is controversial. Immune complexes can be formed from the anti-A and/or anti-B antibodies and ABO soluble antigen(s) present in donor and recipient plasma after ABO non-identical transfusions. We hypothesized that these immune complexes affect recipient red cell structural integrity, platelet function and haemostasis. Study design and methods: Haemolysis, platelet function and haemostatic function were assessed before and after incubation of recipient red cells, platelets and whole blood with normal saline controls, ABO-identical plasma controls or in vitro-generated ABO-immune complexes. Results: ABO-immune complexes caused significantly increased haemolysis (P < 0·001), inhibition of platelet function (P = 0·001) and disruption of clot formation kinetics (P < 0·005) in both group A and O recipient samples. Conclusions: Substantial changes in platelet function, red cell integrity and haemostasis occur after in vitro exposure to immune complexes. These in vitro findings may explain, in part, previously observed associations of ABO non-identical platelet transfusions with adverse effects including increased red cell transfusion needs, organ failure and mortality.
    Full-text Article · Nov 2015 · Vox Sanguinis
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    [Show abstract] [Hide abstract] ABSTRACT: Background Rapid fluctuations in factor VII during warfarin anticoagulation change the international normalised ratio (INR) but contribute little to the antithrombotic effect. We aimed to assess non-inferiority of anticoagulation stabilisation with a warfarin monitoring method affected only by factors II and X (Fiix-prothrombin time [Fiix-PT]) compared with standard PT-INR monitoring that includes factor VII measurement as well. Methods The Fiix trial was a single centre, double-blind, prospective, non-inferiority, randomised controlled clinical trial. Ambulatory adults on warfarin with an INR target of 2-3 managed by an anticoagulation dosing service using software-assisted dosing at the National University Hospital of Iceland, Reykjavik, Iceland, were eligible for inclusion in this study. We excluded patients undergoing electroconversion and nursing home residents. Patients were randomly assigned (1: 1) to either the Fiix-PT monitoring group or the PT monitoring group by block randomisation. A blinded research INR (R-INR) based on results of the respective test was reported to the dosing staff. Participants were contacted by a study nurse at 4-week intervals to elicit information about thromboembolism or bleeding otherwise unknown to the anticoagulation management centre. The primary efficacy outcome was a composite of objectively diagnosed non-fatal and fatal arterial or venous thromboembolism, including myocardial infarction and transient ischaemic attacks, assessed in all eligible patients who were randomised (intention-to-monitor population). The safety endpoint was major bleeding or other clinically relevant bleeding, assessed in the per-protocol population. We assumed a 3% annual thromboembolism incidence and a non-inferiority margin of 2.5%. This trial is registered with ClinicalTrials.gov, number NCT01565239. Findings Between March 1, 2012, and Feb 28, 2014, we enrolled 1156 patients. 573 patients were assigned to Fiix-PT and 575 to PT-INR monitoring after exclusion of four patients from each group for various reasons. Median follow-up was 1.7 years (IQR 1.1-1.9). During days 1-720, ten (1.2% per patient year) thromboembolic events occurred in the Fiix-PT group versus 19 (2.3% per patient year) in the PT group (relative risk [RR] 0.52, 95% CI 0.25-1.13; p(non-inferiority) < 0.0001). Major bleeding occurred in 17 of 571 patients in the Fiix group (2.2% per patient year) versus 20 of 573 patients in the PT group (2.5% per patient year; RR 0.85, 0.45-1.61; p(non-inferiority) = 0.0034). Anticoagulation stability was improved with Fiix-PT monitoring as manifested by fewer tests, fewer dose adjustments, increased time in range and less INR variability than reported with standard PT monitoring. Interpretation Monitoring of warfarin with Fiix-PT improved anticoagulation and dosing stability and was clinically non-inferior to PT monitoring. Results from this trial suggest that during vitamin K antagonist treatment INR monitoring could be replaced by Fiix-PT and that this would lead to at least a non-inferior clinical outcome compared with monitoring with PT-INR.
    Full-text Article · May 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Cardiac-related clinical practice guidelines have become an integral part of the practice of cardiology. Unfortunately, these guidelines are often long, complex, and difficult for practicing cardiologists to use. Guidelines should be condensed and their format upgraded, so that the key messages are easier to comprehend and can be applied more readily by those involved in patient care. After presenting the historical background and describing the guideline structure, we make several recommendations to make clinical practice guidelines more user-friendly for clinical cardiologists. Our most important recommendations are that the clinical cardiology guidelines should focus exclusively on (1) class I recommendations with established benefits that are supported by randomized clinical trials and (2) class III recommendations for diagnostic or therapeutic approaches in which quality studies show no benefit or possible harm. Class II recommendations are not evidence based but reflect expert opinions related to published clinical studies, with potential for personal bias by members of the guideline committee. Class II recommendations should be published separately as "Expert Consensus Statements" or "Task Force Committee Opinions," so that both majority and minority expert opinions can be presented in a less dogmatic form than the way these recommendations currently appear in clinical practice guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.
    Article · Mar 2015 · The American Journal of Cardiology
  • Charles Francis · Craig Kessler · Samuel Z Goldhaber · [...] · Lord Ajay Kakkar
    [Show abstract] [Hide abstract] ABSTRACT: Background Venous thromboembolism (VTE) treatment in patients with cancer has a high rate of recurrence and bleeding complications. Guidelines recommend low molecular weight heparin (LMWH) for at least 3-6 months and possibly indefinitely for patients with active malignancy. There are, however, few data supporting LMWH treatment beyond 6 months. The primary aim of the DALTECAN study (NCT00942968) was to determine the safety of dalteparin between 6 and 12 months in cancer-associated VTE.Methods Patients with active cancer and newly diagnosed VTE were enrolled in a prospective, multicenter study and received subcutaneous dalteparin for 12 months. The rates of bleeding and recurrent VTE were evaluated at months 1, 2-6, and 7-12.FindingsOf 334 patients enrolled, 185 and 109 completed 6 and 12 months of therapy. 49.1% had deep vein thrombosis (DVT); 38.9% had pulmonary embolism (PE); and 12.0% had both on presentation. The overall frequency of major bleeding was 10.2% (34/334). Major bleeding occurred in 3.6% (12/334) in the first month, and 1.1% (14/1237) and 0.7% (8/1086) per patient-month during months 2-6 and 7-12, respectively. Recurrent VTE occurred in 11.1% (37/334); the incidence rate was 5.7% (19/334) for month 1, 3.4% (10/296) during months 2-6, and 4.1% (8/194) during months 7-12. 116 patients died, four due to recurrent VTE and two due to bleeding.InterpretationMajor bleeding was less frequent during dalteparin therapy beyond 6 months. The risk of developing major bleeding complications or VTE recurrence was greatest in the first month of therapy and lower over the subsequent 11 months.This article is protected by copyright. All rights reserved.
    Article · Mar 2015 · Journal of Thrombosis and Haemostasis
  • Alok A. Khorana · Deborah Rubens · Charles W. Francis
    [Show abstract] [Hide abstract] ABSTRACT: Background The utility of screening for venous thromboembolism (VTE) in cancer patients is unknown. We evaluated this in a prospective cohort study of cancer patients initiating a new chemotherapy regimen and deemed high-risk (score ≥ 3) based on a validated Risk Score. Methods Patients were evaluated with baseline and Q4 (± 1) week serial ultrasonography for up to 16 weeks; additionally, computed tomography scans for restaging were also evaluated for VTE. Results The study population comprised 35 patients. Pancreatic and gastro-esophageal cancers were the most common diagnoses. Of these, 8 (23%) developed a VTE. This included 5 patients with DVT alone (14%), 1 patient with PE alone (3%) and 2 (6%) with both. Ultrasound examinations identified asymptomatic DVT in 9.3% of patients at baseline; 0% at weeks 4 and 8 and 5.6% at week 12. Restaging CT scans identified asymptomatic PE in one patient at week 6 and in one patient at week 9 with subsequent DVT at week 10. Conclusions Screening for asymptomatic VTE has not been previously used as a clinical strategy in ambulatory cancer patients. We report that one-tenth of patients at baseline had occult DVT and in this high-risk population, screening at baseline may be of value.
    Article · Sep 2014 · Thrombosis Research
  • Gregory C. Connolly · Richard P. Phipps · Charles W. Francis
    [Show abstract] [Hide abstract] ABSTRACT: Platelets have a newly appreciated and important role in many cancer related processes including tumor growth and metastases, angiogenesis, and promotion of a hypercoagulable state. Cancer patients commonly experience venous thromboembolism (VTE), a leading cause of mortality and a source of considerable morbidity and cost. The role of platelets in arterial thrombosis is well-established, but emerging evidence supports the concept that platelets are also involved in initiation of VTE. This is particularly true in cancer-associated thrombosis as extensive new evidence shows that thrombocytosis and platelet activation are predictive biomarkers of VTE. The role of therapeutic anti-platelet agents has been proven effective at preventing VTE in non-cancer patients, and there is early data suggesting benefit in cancer patients as well. This review summarizes platelet-related predictive biomarkers of cancer-associated thrombosis, platelet mediated mechanisms for VTE promotion in cancer patients, and antiplatelet agents in prevention of VTE.
    Article · Jun 2014 · Seminars in Oncology
  • Gregory C Connolly · Charles W Francis
    [Show abstract] [Hide abstract] ABSTRACT: Cancer-associated thrombosis accounts for almost one-fifth of all cases of venous thromboembolism (VTE) and is a leading cause of death, morbidity, delays in care, and increased costs. Our understanding of risk factors for cancer-associated thrombosis has expanded in recent years, and investigators have begun to use biomarkers and clinical prediction models to identify those cancer patients at greatest risk for VTE. The Khorana Risk Model, which is based on easily obtained biomarkers and clinical factors, has now been validated in several studies. Recent clinical trials of prophylaxis and treatment of VTE in cancer patients are reviewed here. In addition, consensus guidelines and expert opinion regarding management of VTE in specific challenging situations are presented.
    Article · Dec 2013 · Hematology
  • [Show abstract] [Hide abstract] ABSTRACT: PURPOSE Using the previously described clinical risk score for venous thromboembolism (VTE) (Khorana et a, Blood 2008) to identify high risk patients, this study evaluates the utility of screening for thrombosis in a prospective cohort of initially asymptomatic cancer patients initiating outpatient chemotherapy. METHOD AND MATERIALS Asymptomatic cancer patients initiating a new chemotherapy regimen & found to be high-risk for VTE based on a predictive risk model (score ≥3) were enrolled on an ongoing prospective cohort study with informed consent. Patients were evaluated with a baseline & an every 4 (± 1) week serial US study for up to 16 weeks. Additionally, CT scans obtained for restaging purposes were also evaluated for VTE. RESULTS Of the 35 high-risk patients enrolled, 8 (23%) were found to have VTE, 5 patients w/ DVT alone (14%), 1 w/ PE alone (3%) & 2 (6%) w/ both. 32 patients underwent a baseline US & 3 asymptomatic DVTs were identified (9%), w/ 1 patient also having an asymptomatic PE detected on staging CT. Subsequent US were performed in 23 patients at week 4 (0DVT), 21 patients at week 8 (0DVT) &18 patients at week 12 (1 DVT, 6%). An additional 2 patients developed symptomatic DVT between screens. Restaging CT scans identified an asymptomatic PE in a patient at week 6 & an asymptomatic PE in a patient at week 9. Of the patients w/ isolated DVT, 2 had isolated unilateral calf clot, 2 had unilateral calf & thigh clot, &1 had unilateral upper extremity clot. CONCLUSION In this prospective observational study, 23% of cancer outpatients deemed high-risk for VTE developed clot at a rate much higher than found in both normal & acutely ill hospitalized populations (0.5 & 6% respectively). This study confirms the validity of the previously described risk score developed by Khorana et al & makes this model highly predictive of identifying patients at risk for VTE. In addition, these findings suggest that screening US for asymptomatic clot should be considered in high-risk patients based on this risk score. This study highlights the importance of VTE screening in the calf, w/ 50% of patients w/ VTE having calf clot & 25% having isolated unilateral calf clot, indicating that this region should be included in the assessment of DVT. CLINICAL RELEVANCE/APPLICATION Screening ultrasonography for asymptomatic thrombosis should be considered in high-risk patients based on this risk score with the goal of reducing the morbidity and mortality assocated with VTE.
    Conference Paper · Dec 2013
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    [Show abstract] [Hide abstract] ABSTRACT: Stored red blood cells (RBCs) release hemoglobin (Hb) that leads to oxidative damage, which may contribute to thrombosis in susceptible transfusion recipients. Oxidative stress stimulates the generation of a new class of lipid mediators called F2 -isoprostanes (F2 -IsoPs) and isofurans (IsoFs) that influence cellular behavior. This study investigated RBC-derived F2 -IsoPs and IsoFs during storage and their influence on human platelets (PLTs). F2 -IsoP and IsoF levels in RBC supernatants were measured by mass spectrometry during storage and after washing. The effects of stored supernatants, cell-free Hb, or a key F2 -IsoP, 8-iso-prostaglandin F2α (PGF2α ), on PLT function were examined in vitro. F2 -IsoPs, IsoFs, and Hb accumulated in stored RBC supernatants. Prestorage leukoreduction reduced supernatant F2 -IsoPs and IsoFs levels, which increased again over storage time. Stored RBC supernatants and 8-iso-PGF2α induced PLT activation marker CD62P (P-selectin) expression and prothrombotic thromboxane A2 release. Cell-free Hb did not alter PLT mediator release, but did inhibit PLT spreading. Poststorage RBC washing reduced F2 -IsoP and IsoF levels up to 24 hours. F2 -IsoPs and IsoFs are produced by stored RBCs and induce adverse effects on PLT function in vitro, supporting a potential novel role for bioactive lipids in adverse transfusion outcomes. F2 -IsoP and IsoF levels could be useful biomarkers for determining the suitability of blood components for transfusion. A novel finding is that cell-free Hb inhibits PLT spreading and could adversely influence wound healing. Poststorage RBC washing minimizes harmful lipid mediators, and its use could potentially reduce transfusion complications.
    Full-text Article · Nov 2013 · Transfusion
  • [Show abstract] [Hide abstract] ABSTRACT: It is unclear what proportion of VTE events in lung cancer patients are incidentally discovered and whether incidental events affect mortality. We conducted a retrospective cohort study of lung cancer patients seen at the University of Rochester between January 1, 2006 and December 31, 2008 with the goal of quantifying and characterizing VTE events. Multiple clinical variables and mortality outcomes were compared using Kaplan-Meier survival analysis and multivariate Cox proportional hazards. The study population consisted of 207 subjects with lung cancer. The median age was 66 years and 55% were female (n = 115). Thirty-one patients (14.9%) experienced at least 1 VTE event with 32.2% (10/31) of these incidentally discovered. Incidental events comprised 29.4% (n = 5) of pulmonary embolisms, 11.1% (n = 2) of deep vein thrombosis, and 100% (n = 3) of visceral events. The median survival for patients with incidental VTE was 23.4 months (95% confidence interval [CI], 4.8-32.1) compared with 45.8 months (95% CI, 34.1-56.8) in patients without VTE (HR 2.4; 95% CI, 1.2-4.9; P = .01), but in a subgroup analysis of stage IV patients overall survival was not significantly different (HR, 0.94; P = .33). Patients with clinically suspected VTE had the lowest median survival at 13.1 months (95% CI, 6.4-18.9) which was significantly lower than patients without VTE (HR, 2.7; 95% CI, 1.6-4.5; P = .002), but not significantly different from patients with incidental VTE (HR, 1.2; 95% CI, 0.4-2.0; P = .7). In multivariate analysis, occurrence of VTE (HR, 2.3; 95% CI, 1.3-3.8; P = .002) was significantly associated with mortality when adjusting for age, stage, and histology. One-third of VTE events in lung cancer patients are incidentally discovered and VTE has negative clinical effect in lung cancer patients.
    Article · Jul 2013 · Clinical Lung Cancer
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    Full-text Dataset · Jul 2013
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    [Show abstract] [Hide abstract] ABSTRACT: Purpose: To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Methods: PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts. Results: Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations. Recommendations: Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low-molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.
    Full-text Article · May 2013 · Journal of Clinical Oncology
  • [Show abstract] [Hide abstract] ABSTRACT: An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement.
    Article · May 2013 · Progress in cardiovascular diseases
  • Article: Response.
    Yngve Falck-Ytter · Clive Kearon · Elie Akl · Charles Francis
    Article · Mar 2013 · Chest
  • Yngve Falck-Ytter · Clive Kearon · Elie Akl · Charles Francis
    Article · Mar 2013 · Chest

Publication Stats

14k Citations


  • 2008-2010
    • Duke University
      Durham, North Carolina, United States
    • University Center Rochester
      • Department of Environmental Medicine
      Rochester, Minnesota, United States
  • 1984-2006
    • University of Rochester
      • • Division of Hospital Medicine
      • • Division of General Medicine
      • • Division of Cardiology
      Rochester, NY, United States
    • Columbia University
      New York, New York, United States
  • 2003
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2002
    • University of Rochester Medical Center
      Rochester, New York, United States
  • 2000
    • Swarthmore College
      • Department of Engineering
      Swarthmore, Pennsylvania, United States
  • 1989
    • Cleveland Clinic
      Cleveland, Ohio, United States