Approach to leg edema

Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral) and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults

Statin use and bleeding risk during vitamin K antagonist treatment for venous thromboembolism: A multicenter retrospective cohort study

12nononenoneRiva, Nicoletta; Di Minno, Matteo N.D.; Mumoli, Nicola; Pomero, Fulvio; Franchini, Massimo; Bellesini, Marta; Lupoli, Roberta; Sabatini, Silvia; Borretta, Valentina; Bonfanti, Carlo; Ageno, Walter; Dentali, FrancescoRiva, Nicoletta; Di Minno, Matteo N. D.; Mumoli, Nicola; Pomero, Fulvio; Franchini, Massimo; Bellesini, Marta; Lupoli, Roberta; Sabatini, Silvia; Borretta, Valentina; Bonfanti, Carlo; Ageno, Walter; Dentali, Francesc

Approach to leg edema

Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral) and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults

Poor predictive value of contemporary bleeding risk scores during long-term treatment of venous thromboembolism: A multicentre retrospective cohort study

13nononeBleeding is a common and feared complication of oral anticoagulant therapy. Several prediction models have been recently developed, but there is a lack of evidence in patients with venous thromboembolism (VTE). The aim of this study was to validate currently available bleeding risk scores during long-term oral anticoagulation for VTE. We retrospectively included adult patients on vitamin K antagonists for VTE secondary prevention, followed by five Italian Anticoagulation Clinics (Cuneo, Livorno, Mantova, Napoli, Varese), between January 2010 and August 2012. All bleeding events were classified as major bleeding (MB) or clinically-relevant-non-major-bleeding (CRNMB). A total of 681 patients were included (median age 63 years; 52.0% female). During a mean follow-up of 8.82 (± 3.59) months, 50 bleeding events occurred (13 MB and 37 CRNMB), for an overall bleeding incidence of 9.99/100 patient-years. The rate of bleeding was higher in the first three months of treatment (15.86/100 patient-years) than afterwards (7.13/100 patient-years). The HAS-BLED showed the best predictive value for bleeding complications during the first three months of treatment (area under the curve [AUC] 0.68, 95% confidence interval [CI] 0.59–0.78), while only the ACCP score showed a modest predictive value after the initial three months (AUC 0.61, 95%CI 0.51–0.72). These two scores had also the highest sensitivity and the highest negative predictive value. None of the scores predicted MB better than chance. Currently available bleeding risk scores had only a modest predictive value for patients with VTE. Future studies should aim at the creation of a new prediction rule, in order to better define the risk of bleeding of VTE patients.Riva, Nicoletta; Bellesini, Marta; Di Minno, Matteo Nicola Dario; Mumoli, Nicola; Pomero, Fulvio; Franchini, Massimo; Fantoni, Chiara; Lupoli, Roberta; Brondi, Barbara; Borretta, Valentina; Bonfanti, Carlo; Ageno, Walter; Dentali, FrancescoRiva, Nicoletta; Bellesini, Marta; Di Minno, Matteo Nicola Dario; Mumoli, Nicola; Pomero, Fulvio; Franchini, Massimo; Fantoni, Chiara; Lupoli, Roberta; Brondi, Barbara; Borretta, Valentina; Bonfanti, Carlo; Ageno, Walter; Dentali, Francesc