Emanuele Valeriani

Sapienza University of Rome

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Marcello Di Nisio

University of Chieti-Pescara

Silvia Spoto

Campus Bio Medico University Hospital

Walter Ageno

University of Insubria

Ettore Porreca

University of Chieti-Pescara

Sebastiano Costantino

Campus Bio Medico University Hospital

Francesco Violi

Clinica Mediterranea

Pasquale Pignatelli

Sapienza University of Rome

Massimo Ciccozzi

Università Campus Bio-Medico

Silvia Angeletti

Università Campus Bio-Medico

Matteo Candeloro

University of Chieti-Pescara

Cooperative Institutions

Policlinico S.Orsola-Malpighi

277

Azienda Ospedaliera Universitaria Senese

260

Ospedale San Paolo

259

IRCCS Ospedale San Raffaele

257

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

255

Istituti di Ricovero e Cura a Carattere Scientifico

146

Sapienza University of Rome

113

University of Milan

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Policlinico Umberto I

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Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study

Internal and Emergency Medicine (2024)

Carlotta Franchi Paolo Rossi Sara Mandelli Ilaria Ardoino Alessandro Nobili

10.1007/s11739-023-03528-w

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Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU

Scientific Reports (2020)

Silvia Spoto Edoardo Nobile Emanuele Paolo Rafano Carnà Marta Fogolari Damiano Caputo

Abstract Early diagnosis and treatment significantly reduce sepsis mortality. Currently, no gold standard has been yet established to diagnose sepsis outside the ICU. The aim of the study was to evaluate the diagnostic accuracy of sepsis defined by SIRS Criteria of 1991, Second Consensus Conference Criteria of 2001, modified Second Consensus Conference Criteria of 2001 (obtaining SIRS Criteria and SOFA score), Third Consensus Conference of 2016, in addition to the dosage of Procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM). In this prospective study, 209 consecutive patients with clinical diagnosis of sepsis were enrolled (May 2014–June 2018) outside intensive care unit (ICU) setting. A diagnostic protocol could include SIRS criteria or qSOFA score evaluation, rapid testing of PCT and MR-proADM, and SOFA score calculation for organ failure definition. Using this approach outside the ICU, a rapid diagnostic and prognostic evaluation could be achieved, also in the case of negative SIRS, qSOFA or SOFA scores with high post-test probability to reduce mortality and improve outcomes.

Procalcitonin

SOFA score

Gold standard (test)

Adrenomedullin

10.1038/s41598-020-73676-y

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Citations (33)

Editorial: Inflammation in ischemic heart disease: pathophysiology, biomarkers, and therapeutic implications

Frontiers in Cardiovascular Medicine (2024)

Luigi Cappannoli Mattía Galli Josip A. Borovac Emanuele Valeriani Francesco Maria Animati

Editorial: Inflammation in ischemic heart disease: pathophysiology, biomarkers, and therapeutic implications

Pathophysiology

10.3389/fcvm.2024.1469413

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Short versus long-term anticoagulation for left ventricular thrombosis resolution during vitamin k antagonist therapy

European Heart Journal (2023)

Emanuele Valeriani Daniele Pastori Giulia Astorri Walter Ageno Marco Paolo Donadini

Abstract Background The optimal duration of anticoagulant therapy to achieve thrombus resolution and prevent cardioembolic events in left ventricular thrombosis (LVT) has not yet been established. Purpose The purpose of our study is to evaluate the incidence of LVT resolution at 3 versus 12 months of vitamin K antagonists (VKAs) therapy. Methods Consecutive patients diagnosed with LVT and treated with VKAs for at least 12 months at 5 anticoagulant outpatient clinics in Italy were retrospectively included. The primary effectiveness outcome was on-treatment thrombus resolution while the secondary was objectively documented on-treatment acute ischemic stroke, peripheral embolism, and myocardial infarction at 12-months follow-up. Safety outcomes were on-treatment major and clinically relevant non-major bleedings at 12-months follow-up as defined by the ISTH criteria. Cumulative incidences of thrombus resolution with 95% confidence intervals (CIs) were calculated while other outcomes were descriptively reported. Multivariable Cox hazards models were calculated using age, sex, reduced left ventricular ejection fraction (EF < 35%), VKAs monotherapy, and time in therapeutic range (TTR) below 60% as covariates for thrombus persistence at 12-months of follow-up. Results Out of 95 patients, 87 were finally included (Table) and 8 excluded due to the lack of relevant data. Median age was 67 years and 75.9% were men. A total of 64.4% of patients had acute myocardial infarction as risk factor for LVT development while 21.8% and 5.7% of patients had dilated and primary hypertrophic cardiomyopathy, respectively. A reduced EF and atrial fibrillation were present in 77.0% and 19.5% of patients, respectively. All but one patient received warfarin with a median TTR of 54%, and 35.5% of patients did not receive concomitant antiplatelet therapy. All included patients received VKAs for at least 12-months. The 3 and 12 month cumulative incidences (Figure) of thrombus resolution were 34.5% (95% CI, 24.7%-44.5%) and 68.3% (95% CI, 57.2%-77.1%), respectively. At multivariable Cox regression analysis, the presence of a reduced EF appeared to be associated with a higher risk of thrombus persistence at 12-months follow-up (Hazard Ratio 3.09; 95% CI 1.27-7.55; p=0.013). During 12-months follow-up, two patients (2.3%) had acute ischemic stroke at 4 and 7 months from the start of VKAs therapy. Three patients (3.4%) had a major and 5 (5.7%) a clinically relevant non-major bleeding that occurred within the first three months of VKAs. Conclusions A 12-month course of anticoagulant therapy with VKA appeared to be effective and safe in patients with LVT and appeared to be associated with a higher cumulative incidence of LVT resolution than a 3-month course. A reduced left ventricular EF was associated with a higher risk of LVT persistence. Whether anticoagulant agents with improved ease-of-use and safety profile are effective in this setting remains undefined.Baseline patients' characteristicsCumulative incidences of LVT resolution

Left Ventricular Thrombus

Vitamin K antagonist

Cumulative incidence

Stroke

10.1093/eurheartj/ehad655.1372

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Anticoagulant Treatment for Splanchnic Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis

Thrombosis and Haemostasis (2021)

Emanuele Valeriani Marcello Di Nisio Nicoletta Riva Omri Cohen Ettore Porreca

Abstract Background Splanchnic vein thrombosis (SVT) is a common complication in patients with liver cirrhosis. The aim of this study was to evaluate the efficacy and safety of anticoagulant therapy for SVT in cirrhotic patients. Methods In this systematic review and meta-analysis, studies reporting on SVT recanalization and progression, recurrent venous thromboembolism (VTE), major bleeding, and overall mortality were searched in MEDLINE, EMBASE, and ClinicalTrial.gov up to December 2019. Pooled proportions and risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Results A total of 1,475 patients were included in 26 studies (23 observational and 3 randomized controlled trials). In patients receiving anticoagulant therapy, SVT recanalization occurred in 68% (95% CI, 62–74; 571/842 patients; 22 studies), SVT progression in 6% (95% CI, 4–9; 25/748 patients; 22 studies), recurrent VTE in 10% (95% CI, 4–22; 48/399 patients; 7 studies), major bleeding in 6% (95% CI, 4–10; 58/785 patients; 18 studies), and overall mortality in 9% (95% CI, 6–14; 68/787 patients; 17 studies). Anticoagulant treatment was associated with higher SVT recanalization (RR 3.19; 95% CI, 1.42–7.17), lower thrombosis progression (RR 0.28; 95% CI, 0.15–0.52), major bleeding (RR 0.52; 95% CI, 0.28–0.97), and overall mortality (RR 0.42; 95% CI, 0.24–0.73) compared with no treatment. Conclusion Anticoagulant therapy seems to improve vein recanalization and to reduce SVT progression, major bleeding, and overall mortality in cirrhotic patients with SVT. The incidence of recurrent VTE during anticoagulation remains substantial.

Portal vein thrombosis

10.1055/s-0040-1722192

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Citations (35)

Oxidative stress and atherosclerosis: Basic and clinical open issues

Kardiologia Polska (2024)

Francesco Violi Pasquale Pignatelli Emanuele Valeriani

10.33963/v.phj.100994

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Citations (1)

<p>A <em>Staphylococcus aureus</em> Coinfection on a COVID-19 Pneumonia in a Breast Cancer Patient</p>

International Journal of General Medicine (2020)

Silvia Spoto Emanuele Valeriani E. Riva Marina De Cesaris Giuseppe Tonini

Coronavirus disease 19 (COVID-19), due to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2), comprises a broad spectrum of clinical presentation ranging from flu-like syndrome to organ failure. The risk of coinfections is high and responsible for a worse prognosis, mainly in the case of bacterial involvement and in the presence of particular comorbidity. We present the clinical, laboratory, radiologic characteristic along with therapeutic management of a patient with COVID-19 and Staphylococcus aureus coinfection.A 55-year-old Caucasian woman was admitted to our hospital due to a two-day history of fever and acute dyspnea with severe respiratory failure worsened after the administration of atezolizumab and nab-paclitaxel. Her medical history comprehended a triple negative, BRCA1-related, PD-L1 positive right breast cancer with multiple bone metastasis, causing bone marrow infiltration-related severe pancytopenia. Her physical examination revealed scattered wheezes, rales, and bilateral dry crackles in the middle and lower lung fields and lower limb paresis. The body mass index was 30 kg/m2 and arterial blood gas evaluation revealed a stage III acute respiratory distress syndrome. Microbiological specimens revealed a Staphylococcus aureus positivity from endotracheal aspirate. The chest computed tomography (CT) scan showed the presence of large areas of parenchymal consolidation and aerial bronchogram, bilateral "ground glass" areas reaching the highest extension on the upper and middle zones. The high clinical and radiological suspicion of COVID-19 along with the negative result of nasopharyngeal specimen make necessary an endotracheal aspirate resulting positive for SARS-CoV2. Patient started an antimicrobial treatment and lopinavir-ritonavir plus hydroxychloroquine but, unfortunately, died five days after hospital admission.The high risk of mortality of our patient was due to viral-bacterial coinfection, advanced cancer status with active immunotherapy. This case highlights the need for a prompt clinical, laboratory, and radiological evaluation to allow a correct diagnosis and start a specific therapy.

Crackles

Atypical pneumonia

10.2147/ijgm.s261760

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Citations (10)

Quality of warfarin anticoagulation in adults with short bowel syndrome on home parenteral nutrition

VASA (2022)

Riccardo M. Fumagalli Umberto Aimasso Emanuele Valeriani Nicola Mumoli Marta Szlaszynska

Short Bowel Syndrome

10.1024/0301-1526/a001018

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Citations (2)

The management of anticoagulant treatment in non-valvular atrial fibrillation real-world patients

European Journal of Internal Medicine (2019)

Emanuele Valeriani Walter Ageno

Vitamin K antagonist

Stroke

10.1016/j.ejim.2019.03.012

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Low-Dose Rivaroxaban to Prevent Recurrences of Venous Thromboembolism in Cancer: A Real-Life Experience with a Focus on Female Patients

Journal of Clinical Medicine (2023)

Paolo Santini Carolina Mosoni Alessandro D’Errico Enrica Porceddu A. Lupascu

The way in which to prevent recurrent venous thromboembolism (VTE) is an unmet clinical need in cancer patients. International guidelines only provide conditional recommendations and do not specify which anticoagulant and dose should be used. In the last 2 years, we have been using low-dose rivaroxaban to prevent VTE recurrences in cancer patients. The results of this real-life experience are presented in this study.All patients had cancer and had previously completed a cycle of at least six months of full-dose anticoagulation for the treatment of a VTE index event, before receiving a prescription of low-dose rivaroxaban (10 mg once daily) for secondary prevention of VTE. Effectiveness and safety of this therapeutic regimen were evaluated in terms of VTE recurrences, major bleedings (MB), and clinically relevant non-major bleedings (CRNMB).The analysis included 106 cancer patients. Their median age was 60 years (IQR 50-69). Metastatic cancer was present in 87 patients (82.1%). Six patients (5.7%) had brain metastases. Over a median follow-up time of 333 days (IQR 156-484), the incidence of VTE recurrences was 3.8% (95%CI 1.0-9.4), with a recurrence rate of 4.0 per 100 person-years (95%CI 1.1-10.2). We observed no MB (0.0%) and three CRNMB (2.8%) (95%CI 0.6-8.1).Low-dose rivaroxaban is potentially effective and safe in cancer patients that require prevention of recurrent VTE. Large-scale studies are needed to confirm these findings.

Regimen

10.3390/jcm12196427

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