The role of D-dimer and residual venous obstruction in recurrence of venous thromboembolism after anticoagulation withdrawal in cancer patients.

none5We assessed the predictive value of D-dimer (D-d) and residual venous obstruction (RVO), alone or in combination, for recurrent venous thromboembolism (VTE) over a 2-year follow-up in a cohort of 88 cancer patients after oral anticoagulant therapy (OAT) withdrawal following a first episode of proximal deep vein thrombosis of the lower limbs. RVO, determined by compression ultrasonography on the day of OAT suspension (T1), and abnormal D-d (cut-off value: 500 ng/mL), measured at T1 and 30+/-10 days afterwards, are independent risk factors for recurrent VTE in cancer patients.noneBenilde Cosmi; Cristina Legnani; Michela Cini; Giuliana Guazzaloca; Gualtiero PalaretiBenilde, Cosmi; Cristina, Legnani; Cini, Michela; Giuliana, Guazzaloca; Gualtiero, Palaret

D-dimer levels in combination with residual venous obstruction and the risk of recurrence after anticoagulation withdrawal for a first idiopathic deep vein thrombosis.

We assessed the predictive value of D-dimer levels in combination with residual venous obstruction (RVO) for recurrent venous thromboembolism (VTE) in a prospective cohort of outpatients after oral anticoagulant therapy (OAT) suspension for a first episode of idiopathic proximal deep vein thrombosis of the lower limbs during a 2-year follow-up. Patients (n=400) were enrolled on the day of OAT suspension when RVO was determined by compression ultrasonography (present in 48.6\% of patients). D-dimer (cut-off value: 500 ng/mL) was measured 30+/-10 days afterwards (abnormal in 56.4\% of patients). The overall recurrence rate was 16.7\% (67/400; 95\% confidence intervals - CI -: 13-21 \%). The multivariate hazard ratio (HR) for recurrence was 3.32 (95\% CI: 1.78-6.75; p0.05) for RVO compared to absent RVO. The recurrence rate was 5.7\% (95\% CI:2-13\%) and 10.4\% (95\% CI:6-18\%), respectively, for normal D-dimer either without or with RVO, 22.9\% (95\% CI: 14-33\%) and 25.9\% (95\% CI: 18-35\%), respectively, for abnormal D-dimer, either without or with RVO. When compared with normal D-dimer without RVO, the multivariate HR for recurrence was similar for abnormal D-dimer either with RVO (4.76 - 95\% CI:1.78-12.8) or without RVO (4.3-95\%:1.56-11.88). Abnormal D-dimer at one month after OAT withdrawal is an independent risk factor for recurrent VTE, while RVO at the time of OAT withdrawal, either with normal or abnormal D-dimer after one month, does not influence the risk of recurrence

High plasma levels of factor VIII and risk of recurrence of venous thromboembolism

The aim of this study was to evaluate the relationship between factor VIII (FVIII) levels, measured by chromogenic and clotting assays, and risk of venous thromboembolism (VTE) recurrence. A total of 564 patients underwent clinical follow-up after oral anticoagulant withdrawal (total follow-up = 924.4 years). Recurrent VTE developed in 39 of 309 (12.6%) patients with a first idiopathic VTE and in 14 of 255 (5.5%) patients whose first event was secondary. In patients with a first idiopathic VTE, the risk of recurrence was more than fivefold higher in patients with FVIII levels exceeding the 90th percentile [chromogenic FVIII: relative risk (RR) 5.43 (95% CI 1.76-16.8); clotting FVIII: RR 6.21 (95% CI 1.57-24.5)] after adjustment for all possible confounding variables. In patients with a first secondary VTE, the risk of recurrence was slightly higher in patients with high FVIII levels [chromogenic FVIII: RR 2.62 (95% CI 0.34-19.9); clotting FVIII: RR 1.74 (95% CI 0.25-12.1)], but, given the low number of recurrences, the 95% CI were very large. In conclusion, this study shows that high FVIII levels are associated with increased risk of VTE recurrence in patients with a first idiopathic VTE. Although the measurement of FVIII levels by a specific chromogenic assay might, in principle, be preferred to avoid the risk of aspecific clotting effects, no significant differences in results obtained by chromogenic or clotting methods were found

A Bridging Protocol in High-Thrombotic Risk Mechanical Valve Bearers Undergoing Surgery or Invasive Procedures

none8nononeDenas, Gentian; Testa, Sophie; Quintavalla, Roberto; Guazzaloca, Giuliana; Padayattil Jose, Seena; Zoppellaro, Giacomo; Bracco, Alessia; Pengo, VittorioDenas, Gentian; Testa, Sophie; Quintavalla, Roberto; Guazzaloca, Giuliana; PADAYATTIL JOSE, Seena; Zoppellaro, Giacomo; Bracco, Alessia; Pengo, Vittori

The SAME-TT2R2 score predicts the quality of anticoagulation control in patients with acute VTE: A real-life inception cohort study

none8nonePalareti, Gualtiero; Antonucci, Emilia; Lip, Gregory Y. H.; Testa, Sophie; Guazzaloca, Giuliana; Falanga, Anna; Pengo, Vittorio; Poli, DanielaPalareti, Gualtiero; Antonucci, Emilia; Lip, Gregory Y. H.; Testa, Sophie; Guazzaloca, Giuliana; Falanga, Anna; Pengo, Vittorio; Poli, Daniel

The influence of VKORC1 3730 G > A polymorphism on warfarin dose: reply

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Thrombophilia testing in the real-world clinical setting of thrombosis centres taking part in the italian start 2-register

BACKGROUND: Even though it rarely influences venous thromboembolism (VTE) treatment and the fact that it is generally discouraged, thrombophilia testing is still largely prescribed. We assessed: 1) whether/how frequently Italian thrombosis centres requested thrombophilia testing; 2) what results were obtained; and 3) if the results affected treatment and clinical results.MATERIALS AND METHODS: We examined data from 4,826 VTE patients enrolled by 19 clinical centres participating in the START 2-Register.RESULTS: 57.2% of patients were tested. Numbers varied widely among centres (2.9-99.7%). Thrombophilic alterations were recorded in 18.2% of patients and the percentage of positive results was inversely correlated with that of patients tested. Significantly less patients with deep vein thrombosis (DVT) were tested, whereas more were tested when the event was idiopathic, presenting as isolated pulmonary embolism (PE), or in unusual sites. Patients with thrombophilic alterations were younger, more frequently treated with direct oral anticoagulants (DOACs), with lower mortality and less frequently discontinued anticoagulation. DOACs were more frequently prescribed in patients with heterozygous Factor V (FV) Leiden or prothrombin mutations, whereas vitamin K antagonists were preferred in patients with inhibitor deficiencies, combined alterations or antiphospholipid syndrome (APLS). There was no difference in duration of treatment among those with or without alterations, though more APLS patients received an extended treatment course. Bleeding and thrombotic complications occurred with a similar and fairly low incidence in patients with or without thrombophilic alterations.DISCUSSION: Although general testing for thrombophilia in VTE patients is currently discouraged, more than half of the VTE patients included in the START2-Register were tested. However, there were marked differences in practice between Italian thrombosis centres. About 60% of all patients with alterations were treated with DOACs, confirming that DOACs can be a useful option for treatment of thrombophilic VTE patients, with the exclusion of those with APLS