Supervised exercise training in patients with lower extremity peripheral artery disease

The optimal first line management of patients with symptomatic chronic lower extremity peripheral artery disease (PAD) includes secondary prevention of cardiovascular risk factors, pharmacological treatment, and supervised exercise therapy (SET). SET programs have shown to be effective in improving walking performance, functional performance, and quality of life. However, despite a large body of evidence, and despite national and international guidelines recommending SET as first line therapy, SET remains largely underused in patients with chronic PAD. This position paper aims to describe how SET is perceived, its accessibility and structure through Europe. An anonymous web-based survey was used. It comprised 21 questions developed in conjunction with an angiologist and a clinical exercise physiologist specialist in vascular rehabilitation. We had 131 responders from 17 countries. For patients with PAD, SET programs exist only in 59% of European countries. SET reimbursement is available in 41% of countries. SET programs showed to be heterogeneous across countries. Thirty-four percent of the SET programs are PAD-dedicated, while 23% are part of a cardiac rehabilitation program. In addition, among existing SET programs, 65% are dedicated to symptomatic patients with PAD only, 9% to both asymptomatic and symptomatic, 8% to post-revascularized patients only, and 1% to asymptomatic patients with PAD only. Finally, 17% reported not knowing which patients are eligible for enrolment in a SET program. Duration, frequency, and modality of SET also varied from country to country. Overall, these data indicate that a large variability of SET availability and characteristics exists across Europe. Therefore, there is an urgent need to provide detailed guidance to deliver optimal exercise therapeutic care in patients with PAD

Clinical characteristics of italian patients with venous thromboembolism enrolled in the RIETE Registry

Introduction: The clinical characteristics, treatment strategies and outcome of patients with venous thromboembolism (VTE) may vary from country to country. Materials and methods: The RIETE (Registro Informatizado su la Enfermedad TromboEmbolica) is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. Our aim was to assess the influence of surgery and immobility for non-surgical reasons on 3-month outcomes of all Italian patients registered in the RIETE. Results: Through July 2008, 21,397 patients with acute VTE were registered in the RIETE. Of these, 896 (4.2%) were Italian, and 360 (40%) presented with pulmonary embolism (PE). Overall, 137 (15%) developed VTE after surgery; 156 (17%) developed VTE after >4 days of immobility, and 603 (67%) developed VTE in the absence of surgery or immobility. Most patients (83%) received initial therapy with low-molecular-weight heparin; 15% received unfractionated heparin. For long-term therapy, 63% of patients received vitamin K antagonists. The incidence of fatal PE during the first 3 months of therapy was 1.5% for patients with postoperative VTE, 7.7% for who developed VTE after immobility, and 1.2% for the remaining patients. The incidence of fatal bleeding among these patients was 1.5%, 1.9% and 0.3%, respectively. Of the 137 patients with postoperative VTE, 61% had received VTE prophylaxis. Of the 156 patients with recent immobility, 24% had received VTE prophylaxis. Conclusions: VTE arising after a period of immobility was associated with the highest rates of fatal PE and fatal bleeding during the first 3 months of therapy. The use of thromboprophylaxis in this population should be improved

Fatal Events in Cancer Patients Receiving Anticoagulant Therapy for Venous Thromboembolism.

In cancer patients treated for venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), analyzing mortality associated with recurrent VTE or major bleeding is needed to determine the optimal duration of anticoagulation.This was a cohort study using the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry database to compare rates of fatal recurrent PE and fatal bleeding in cancer patients receiving anticoagulation for VTE.As of January 2013, 44,794 patients were enrolled in RIETE, of whom 7911 (18%) had active cancer. During the course of anticoagulant therapy (mean, 181 ± 210 days), 178 cancer patients (4.3%) developed recurrent PE (5.5 per 100 patient-years; 95% CI: 4.8-6.4), 194 (4.7%) had recurrent DVT (6.2 per 100 patient-years; 95% confidence interval [CI]: 5.3-7.1), and 367 (8.9%) bled (11.3 per 100 patient-years; 95% CI: 10.2-12.5). Of 4125 patients initially presenting with PE, 43 (1.0%) died of recurrent PE and 45 (1.1%) of bleeding; of 3786 patients with DVT, 19 (0.5%) died of PE, and 55 (1.3%) of bleeding. During the first 3 months of anticoagulation, there were 59 (1.4%) fatal PE recurrences and 77 (1.9%) fatal bleeds. Beyond the third month, there were 3 fatal PE recurrences and 23 fatal bleeds.In RIETE cancer patients, the rate of fatal recurrent PE or fatal bleeding was much higher within the first 3 months of anticoagulation therapy

Predictors of use of direct oral anticoagulants in patients with venous thromboembolism : Findings from the Registro Informatizado Enfermedad Tromboembólica registry

Current guidelines recommend the use of direct oral anticoagulants (DOACs) for patients with venous thromboembolism (VTE). However little is known about the use of DOACs in daily practice. We used the RIETE registry to identify predictors of use of DOACs for initial and/or long-term therapy of VTE based on patient-related factors, institution-related factors or over time. Among 41,678 patients from March 2013 to September 2021, 12,286 (29%) used DOACs: for initial therapy 6,456; for long-term therapy 12,046. On multivariable analysis, independent predictors were: age 120 kg (OR: 0.64; 95% CI: 0.53-0.77), initial VTE presentation as pulmonary embolism (OR: 1.18; 95% CI: 1.13-1.25), recent bleeding (OR: 0.53; 95% CI: 0.45-0.63), renal insufficiency (OR: 0.44; 95% CI: 0.38-0.51), liver cirrhosis (OR: 0.32; 95% CI: 0.20-0.52), thrombocytopenia (OR: 0.40; 95% CI: 0.34-0.49), atrial fibrillation (OR: 1.58; 95% CI: 1.42-1.75) and prior VTE (OR: 1.14; 95% CI: 1.06-1.22). The DOACs were more likely used in other European countries (OR: 8.97; 95% CI: 8.49-9.49), America (OR: 6.35; 95% CI: 5.67-7.11) or in other countries of the world (OR: 2.99; 95% CI: 2.70-3.31) than in Spain, and progressively increased from 2013-2015 to 2016-2018 (OR: 2.78; 95% CI: 2.62-2.95) and 2019-2021 (OR: 6.36; 95% CI: 5.95-6.80). In this large multinational VTE registry, variations were observed in the use of DOACs according to patient or country factors, and over time. The safety, costs, and influence of the DOACs on VTE-related outcomes in daily practice warrant further investigation

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Gestion du patient sous antivitamine K (rôle du pharmacien d'officine)

Les antivitamines K (AVK) sont des médicaments soumis au risque hémorragique et thrombotique et qui possèdent une marge thérapeutique étroite. Le pharmacien doit bien les connaitre et adopter un suivi personnalisé du patient afin de prévenir la iatrogénie médicamenteuse. Une enquête a été menée, en 2009, afin d'évaluer les pratiques du pharmacien d'officine face à un patient sous AVK. L'enquête a été effectuée à distance sur les pharmaciens d'officine. Cent questionnaires ont été remplis entre février et avril 2009. Les pharmaciens d'officine de Midi-Pyrénées ont une gestion satisfaisante des anticoagulants, mais souhaiteraient s'impliquer dans l'éducation thérapeutique structurée du patient sous AVK, ce qui pourrait diminuer les accidents sous AVK encore trop nombreux.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Prise en charge diagnostique et thérapeutique de l'embolie pulmonaire au CHU de Toulouse (étude rétrospective sur un an)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Comparaison des performances du score de Wells pour les thromboses veineuses profondes entre des patients hospitalisés et des patients ambulatoires en Midi-Pyrénées (étude prospective)

Le diagnostic de thrombose veineuse profonde (TVP) est un important problème médical en raison de ses complications éventuelles. Pour limiter le recours aux examens complémentaires, des scores cliniques dont le score de Wells ont vu le jour. Le but de notre étude était de comparer les performances du score de Wells entre une population de patients hospitalisés et ambulatoires de Midi-Pyrénées. Les performances du score sont très proches pour le dépistage des TVP proximales chez les patients ambulatoires et chez les patients hospitalisés (sensibilité de 88,9% et 87,5%). Par contre, le score de Wells est plus performant chez les patients hospitalisés que chez les patients ambulatoires pour le dépistage des TVP distales (sensibilités de 81, 8% et 69,2%). En conclusion, le score de Wells est un outil aussi performant chez des patients ambulatoires que chez des patients hospitalisés pour le dépistage des TVP proximales. Pour confirmer ces résultats, des études similaires avec de plus grands effectifs et avec des médecins différents doivent être réalisées.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Maladie thromboembolique veineuse chez la femme enceinte (diagnostic et prise en charge à la Maternité du CHU de Toulouse)

La maladie thromboembolique veineuse (MTEV) est une pathologie rare mais grave. Notre thèse a pour but de colliger la survenue d'une MTEV (TVP, EP, TVP associée à une EP) au cours de la grossesse et en post-partum immédiat sur une période de 10 ans à la Maternité du CHU de Toulouse. Ce travail confirme que la plupart des évènements thromboemboliques veineux survenus pendant la grossesse est représentée par des TVP (50% spécifiquement au 3ème trimestre) mais cette tendance s'inverse en post-partum, période pendant laquelle l'EP reste l'évènement prépondérant. De plus, les TVP chez les femmes enceintes sont majoritairement localisées au niveau du membre inférieur gauche (66,1% de notre effectif) et sont majoritairement proximales (57,6%). Si l'on considère les facteurs de risque de MTEV, on retrouve des antécédents personnels de MTEV (23% de l'effectif), une thrombophilie biologique (17%) et les autres facteurs de risque (âge>35 ans 20%, obésité 11%, immobilisation hors chirurgie 16,7%). Seulement 56,3% des femmes enceintes ayant une suspicion d'EP ont bénéficié d'un examen complémentaire, ce qui nous surprend au vue de la gravité du diagnostic et des implications thérapeutiques. Au sein de la cohorte, seulement 8 patientes (12,1%) sur 15 (22,7%) ayant un antécédent personnel de MTEV ont bénéficié d'un traitement antithrombotique par contre, le traitement anticoagulant pendant (HBPM) et après la grossesse (AVK) est conforme aux recommandations. Au décours du devenir, on note une extension de TVP sous traitement et 3 épisodes de récidive ainsi que la survenue concomitante de 14 (21%) cas de pathologie vasculaire placentaire. Les accouchements ont été programmés dans 70% des cas. Aucun décès maternel et nouveau-né n'ont été constaté. En post-partum immédiat, on note 4 évènements type MTEV et 3 complications hémorragiques. Un travail complémentaire pourrait être réalisé en élaborant un groupe de comparaison de femmes enceintes ayant les mêmes caractéristiques que notre population. Cette étude a permis de renforcer la collaboration entre les médecins vasculaires et les obstétriciens du CHU de Toulouse afin de gérer au mieux la prise en charge de la maladie thromboembolique veineuse en grossesse.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF