Olga Madridano

Hospital Universitario Infanta Sofía

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Manuel Monréal

Universidad Católica San Antonio de Murcia

Laurent Bertoletti

Inserm

J.B. López‐Sáez

Hospital Universitario Puerto Real

Remedios Otero

Hospital Universitario Virgen del Rocío

Carme Font

Hospital Clínic de Barcelona

Carmen Fernández‐Capitán

Hospital Universitario La Paz

Inna Tzoran

Rambam Health Care Campus

Fernando Uresandi

HM Hospitales

Raquel Barba

Universidad Rey Juan Carlos

Aitor Ballaz

Hospital de Galdakao

Cooperative Institutions

Universidad Católica San Antonio de Murcia

199

Hospital Universitari Germans Trias i Pujol

197

Universitat Autònoma de Barcelona

111

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Instituto de Salud Carlos III

Bayer (United States)

Hospital Universitario La Paz

Sanofi (Mexico)

Hospital General Universitario Gregorio Marañón

Instituto Ramón y Cajal de Investigación Sanitaria

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Outpatient management of cancer-related pulmonary embolism: Analysis of 562 consecutive patients from the EPIPHANY study.

Journal of Clinical Oncology (2014)

Paula Jiménez‐Fonseca Alberto Carmona‐Bayonas Carmen Beato L. Fáez Ángeles Vicente

9526 Background: Cancer is as a predictor of adverse outcomes in symptomatic pulmonary embolism (PE). Nowadays, the increasing diagnosis of incidental thrombosis in scheduled CT scans implies a change in PE presentation. Clinical guidelines suggest that home treatment is an appropriate alternative for selected low-risk PE-patients although specific data regarding this approach in cancer population remain scarce. The aim of the present report is to describe clinical characteristics, outcomes and feasibility of outpatient management of patients with cancer-related PEs. Methods: EPIPHANY is an ongoing multicenter observational study of consecutive cancer-related PEs (acute symptomatic and incidentally-found in scheduled CT scans) recruited from daily clinical practice with a minimum 3-month follow-up after PE. Outpatient management was considered on discharge from hospital less than 24 hours after PE diagnosis. Results: From January 2006 to September 2013 we enrolled 562 cancer patients with PE, 385 of whom (68%) were treated in hospital and 177 (32%) were managed as outpatients. Most patients treated at home (93%) had advanced cancer (TNM stages III-IV), most (77%) were being treated with chemotherapy or biological/targeted therapies and 6% underwent major surgery within 1 month. Patients treated at home more likely had an incidentally-detected PE (91% vs. 35%; p<0.001) and were ‘truly asymptomatic’ cases (86% vs. 30.5%; p<0.001) compared to patients treated with conventional hospitalization. The rate of major complications within 15 days of PE in patients treated at home was 3.4% (95% CI, 1.9-4.9%). Overall mortality rates were lower in outpatients at 30 days (2.3% vs. 21%; p<0.001) and 90 days (9.6% vs. 33%; p<0.001) of follow-up compared to patients treated in hospital. The most frequent cause of death was cancer progression in both groups. The rates of venous thromboembolic recurrences and major bleeding events at 30 and 90 days were comparable in both groups. Conclusions: Cancer-related PE can be managed at home in a high proportion of patients, especially those incidentally diagnosed. Further studies addressed to better define low risk patients in this setting should be developed.

10.1200/jco.2014.32.15_suppl.9526

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Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

JAMA Cardiology (2022)

Behnood Bikdeli César Caraballo Javier Trujillo‐Santos J.‐P. Galanaud Pierpaolo Di Micco

Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.

Post-thrombotic syndrome

Concomitant

10.1001/jamacardio.2022.1988

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Feasibility of a screening algorithm for chronic thromboembolic pulmonary hypertension: The OSIRIS study

Thrombosis Research (2023)

Remedios Otero José Luís Lobo Raquel López Carmen Fernández David Jiménez

Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term sequel to pulmonary embolism (PE) whose incidence varies according to different published studies. We have carried out this study to determine its incidence within 2 years after index pulmonary embolism and to study limitations to an early diagnosis.OSIRIS is a multicentre, longitudinal cohort study. Patients were followed for 3, 6, 12, and 24 months after pulmonary embolism using a structured three-step algorithm. A physician-centered questionnaire at least one positive response in a screening proceeded to the second step, transthoracic echocardiography. The third step consisted of ventilation/perfusion lung scintigraphy and right heart catheterisation. A transthoracic echocardiography was performed in patients without positive response in the screening questionnaire after 2 years. CTEPH diagnosis required haemodynamic confirmation by right heart catheterisation and mismatched perfusion defects on lung scintigraphy.A total of 1191 patients were enrolled in 18 Spanish hospitals. Cumulative CTEPH incidence after 2-years PE was: 2.49 % (95 % CI: 1.68-3.56) and the incidence rate of CTEPH was 1.1 cases per 1000 person-months (95 % CI: 0.725; 1.60). The CTEPH algorithm presented a lack of adherence of 29 %; patient and physician preferences posed barriers to the triage algorithm The screening questionnaire, in patients who completed the follow-up, shows a specificity of 91.3 % (89.0-93.2 %) and negative predictive value of 99.4 % (98.4-99.8 %)..OSIRIS provides practiced clinical based data on the chronic thromboembolic pulmonary hypertension incidence and identified barriers to the implementation of a 3-step triage algorithm for its detection.clinicaltrials.gov identifier: NCT03134898.

Triage

10.1016/j.thromres.2023.05.005

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A prognostic score to identify women at increased risk for abnormal uterine bleeding during anticoagulation for venous thromboembolism

Thrombosis Update (2023)

G. Sarlon-Bartoli Juan Criado Saskia Middeldorp José Antonio Nieto Carmen Díaz‐Pedroche

Little is known about the clinical characteristics of women at increased risk for abnormal uterine bleeding (UB) during anticoagulation for venous thromboembolism (VTE). We used the RIETE registry to identify the baseline characteristics of women developing abnormal UB during anticoagulation. We used logistic regression analysis to identify independent predictors for abnormal UB. Then, we built a prognostic score to identify at-risk women. From March 2001 through October 2022, there were 54,372 women with VTE. During anticoagulation (median, 181 days), 318 (0.6%) developed abnormal UB (major bleeding 88, clinically relevant non-major (CRNM) 230). On multivariable analysis, women aged <50 years, weighing >70 kg, with uterine cancer, recent UB, anemia, estrogen-related VTE, or receiving rivaroxaban or apixaban were at increased risk for abnormal UB. Using the prognostic score, 42,273 women (78%) were at low-risk, 8,828 (16%) intermediate-, and 3,271 (6.1%) at high-risk for abnormal UB. Their rates of abnormal UB were: 0.28 (95%CI: 0.23–0.35), 1.32 (95%CI: 1.07–1.61) and 7.12 (95%CI: 5.98–8.41) bleeds per 100 patient-years, respectively. The c-statistics was 0.80 (95%CI: 0.77–0.83). The rates of major UB were: 0.06 (95%CI: 0.04–0.09), 0.43 (95%CI: 0.30–0.60) and 1.85 (95%CI: 1.31–2.53) per 100 patient-years, respectively (c-statistics: 0.84; 95%CI: 0.80–0.89). The rates of CRNM uterine bleeding were: 0.21 (95%CI: 0.17–0.26), 0.85 (95%CI: 0.65–1.08), and 5.02 (95%CI: 4.09–6.10) bleeds per 100 patient-years, respectively (c-statistics: 0.78; 95%CI: 0.75–0.82). Using 7 variables easily available at admission, we built a prognostic score that reliably identified women with VTE at increased risk for abnormal UB during anticoagulation.

Apixaban

Uterine bleeding

10.1016/j.tru.2023.100148

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Citations (1)

Sex differences in treatment strategies for pulmonary embolism in older adults: The SERIOUS-PE study of RIETE participants and US Medicare beneficiaries

Vascular Medicine (2024)

Behnood Bikdeli Hannah Leyva Alfonso Muriel Zhenqiu Lin Gregory Piazza

Sex differences exist in risk factors and comorbidities of older adults (aged ⩾ 65 years) with pulmonary embolism (PE). Clinically relevant sex-based treatment disparities for PE have not been adequately addressed. The few existing show conflicting results due to small sample size (type II error) and suboptimal methods (overreliance on

10.1177/1358863x241292023

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Enoxaparin versus dalteparin or tinzaparin in patients with cancer and venous thromboembolism: The RIETECAT study

Research and Practice in Thrombosis and Haemostasis (2022)

Javier Trujillo‐Santos Dominique Farge José María Pedrajas Covadonga Gómez‐Cuervo Aitor Ballaz

10.1002/rth2.12736

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Citations (8)

C0119: Subsequent Arterial Events in Patients with Acute Venous Thromboembolism. Findings from the Riete Registry

Thrombosis Research (2014)

Olga Madridano Paolo Prandoni J. del Toro Andrea Marcela Parra Hernández M. Martín del Pozo

10.1016/s0049-3848(14)50054-0

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The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site

The American Journal of Medicine (2016)

Isabelle Mahé Jean Chidiac Laurent Bertoletti Carme Font Javier Trujillo‐Santos

10.1016/j.amjmed.2016.10.017

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Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

The American Journal of Medicine (2017)

Chatree Chai‐Adisaksopha Alfonso Iorio Mark Crowther Javier de Miguel‐Díez E. Salgado

10.1016/j.amjmed.2017.11.042

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

Journal of the American Heart Association (2021)

Behnood Bikdeli David Jiménez J. del Toro Gregory Piazza A. Rivas

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.

Stroke

10.1161/jaha.121.021467

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Citations (9)