المؤلفون: Antonio Baldi, Licia Denti, Kennedy R. Lees, Nicola Mumoli, Panagiotis Halvatsiotis, Massimo Del Sette, Alberto Chiti, Peter Vanacker, Marta Bellesini, Tiziana Tassinari, Paolo Bovi, Alessandro Padovani, Christina Rueckert, Jessica Barlinn, Dorjan Zabzuni, Cataldo D'Amore, Loris Poli, Maria Luisa De Lodovici, Federica Letteri, Odysseas Kargiotis, Manuel Cappellari, Prasanna Tadi, Turgut Tatlisumak, Cecilia Becattini, Ludovica Anna Cimini, Liisa Tomppo, Yuriy Flomin, Giancarlo Agnelli, Aikaterini Theodorou, Serena Monaco, Elena Ferrari, Rossana Tassi, Monica Acciarresi, Patrik Michel, Alessio Pieroni, Enrico Maria Lotti, Michele Venti, Walter Ageno, Sung Il Sohn, Leonardo Ulivi, Maurizio Paciaroni, Konstantinos Vadikolias, Jukka Putaala, Cindy Tiseo, Valeria Caso, Alessandro Pezzini, Giorgio Silvestrelli, Alfonso Ciccone, Francesco Corea, Lilla Szabó, Francesca Guideri, Martina Giuntini, Gianni Lorenzini, Efstathia Karagkiozi, Davide Imberti, Luca Masotti, Azmil H. Abdul-Rahim, Theodore Karapanayiotides, Alessia Lanari, Andrea Alberti, Simona Marcheselli, Vieri Vannucchi, Giuseppe Martini, Shadi Yaghi, Marialuisa Zedde, Michela Giustozzi, Karen L. Furie, Danilo Toni, Chrissoula Liantinioti, Dirk Deleu, Franco Galati, Elisa Giorli, Monica Carletti, Vanessa Gourbali, Michelangelo Mancuso, George Ntaios, George Athanasakis, Fabio Bandini, Vera Volodina, Nicola Giannini, Umberto Scoditti, Mario Maimone Baronello, Boris Doronin, Simona Sacco, Maria Giulia Mosconi, Georgios Tsivgoulis, László Csiba, Alberto Rigatelli, Kristian Barlinn, Konstantinos Makaritsis, Maurizio Acampa, Giovanni Orlandi

المصدر: Stroke: a journal of cerebral circulation

مصطلحات موضوعية: Male, anticoagulants, medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, Brain Ischemia, Dabigatran, Brain ischemia, Internal medicine, 80 and over, medicine, Humans, atrial fibrillation, Prospective Studies, Prospective cohort study, Blood Coagulation, Stroke, Aged, thrombolytic therapy, Aged, 80 and over, Advanced and Specialized Nursing, Rivaroxaban, business.industry, Warfarin, Atrial fibrillation, Thrombolysis, Middle Aged, medicine.disease, secondary prevention, thrombectomy, Anticoagulants, Atrial Fibrillation, Female, Reperfusion, Thrombectomy, Thrombolytic Therapy, Treatment Outcome, Cardiology, Neurology (clinical), Human medicine, Cardiology and Cardiovascular Medicine, business, medicine.drug

الوصف: Background and Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. Results: A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50–1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53–2.02]). Conclusions: Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation–related acute ischemic stroke, who started on oral anticoagulant.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dbb64851b2231b85dc18a1be47838478Test
https://hdl.handle.net/10067/1721020151162165141Test

المؤلفون: Paolo, Prandoni, Martin H, Prins, Anthonie W A, Lensing, Angelo, Ghirarduzzi, Walter, Ageno, Davide, Imberti, Gianluigi, Scannapieco, Giovanni B, Ambrosio, Raffaele, Pesavento, Stefano, Cuppini, Roberto, Quintavalla, Giancarlo, Agnelli, C, Pattacini

المصدر: Annals of internal medicine. 150(9)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, medicine.drug_class, Hemorrhage, Drug Administration Schedule, law.invention, Randomized controlled trial, law, Internal Medicine, Factor V Leiden, Secondary Prevention, Medicine, Humans, cardiovascular diseases, Vein, Aged, Ultrasonography, First episode, Aged, 80 and over, Venous Thrombosis, business.industry, Anticoagulant, Hazard ratio, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Prognosis, Thrombosis, Surgery, Venous thrombosis, medicine.anatomical_structure, Female, business, Follow-Up Studies

الوصف: BACKGROUND The optimal duration of oral anticoagulant therapy in patients with deep venous thrombosis (DVT) of the lower extremities remains uncertain. OBJECTIVE To assess whether tailoring the duration of anticoagulation on the basis of the persistence of residual thrombi on ultrasonography reduces the rate of recurrent venous thromboembolism (VTE) compared with the administration of conventional fixed-duration treatment in adults with proximal DVT. DESIGN Parallel, randomized trial from 1999 to 2006. Trained physicians who assessed outcomes were blinded to patient assignment status, but patients and providers were not. SETTING 9 university or hospital centers in Italy. PATIENTS 538 consecutive outpatients with a first episode of acute proximal DVT at completion of an uneventful 3-month period of anticoagulation. INTERVENTION Patients were randomly assigned (stratified by center and secondary vs. unprovoked DVT by using a computer-generated list that was accessible only to a trial nurse) to fixed-duration anticoagulation (no further anticoagulation for secondary thrombosis and an extra 3 months for unprovoked thrombosis) or flexible-duration, ultrasonography-guided anticoagulation (no further anticoagulation in patients with recanalized veins and continued anticoagulation in all other patients for up to 9 months for secondary DVT and up to 21 months for unprovoked thrombosis). For the primary outcome assessment, 530 patients completed the trial. MEASUREMENTS The rate of confirmed recurrent VTE during 33 months of follow-up. RESULTS Overall, 46 (17.2%) of 268 patients allocated to fixed-duration anticoagulation and 32 (11.9%) of 270 patients allocated to flexible-duration anticoagulation developed recurrent VTE (adjusted hazard ratio [HR], 0.64 [95% CI, 0.39 to 0.99]). For patients with unprovoked DVT, the adjusted HR was 0.61 (CI, 0.36 to 1.02) and 0.81 (CI, 0.32 to 2.06) for those with secondary DVT. Major bleeding occurred in 2 (0.7%) patients in the fixed-duration group and 4 (1.5%) patients in the flexible-duration group (P = 0.67). LIMITATIONS The trial lacked a double-blind design. The sample size was not powered to detect differences in bleeding between groups and to detect effectiveness of the intervention in the subgroups of patients with unprovoked and secondary DVT. Patients with previous thromboembolism, permanent risk factors for thrombosis, and thrombophilic abnormalities other than factor V Leiden and prothrombin mutation were excluded. CONCLUSION Tailoring the duration of anticoagulation on the basis of ultrasonography findings reduces the rate of recurrent VTE in adults with proximal DVT. PRIMARY FUNDING SOURCE None.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a861826f1204800516032f836ffe9e87Test
https://pubmed.ncbi.nlm.nih.gov/19949157Test

المؤلفون: Renzo Poggio, Maddalena Miccio, Cecilia Becattini, Mauro Silingardi, Pietro Zonzin, Walter Ageno, Giancarlo Agnelli, Paolo Prandoni, Maria Rita Taliani, Fernando Porro, Enrico Pogliani, Davide Imberti

المصدر: Scopus-Elsevier

مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, medicine.drug_class, Hemorrhage, Drug Administration Schedule, Pharmacotherapy, Risk Factors, Internal Medicine, medicine, Secondary Prevention, Humans, Aged, First episode, Aged, 80 and over, Acenocoumarol, business.industry, Anticoagulant, Respiratory disease, Warfarin, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Thrombosis, Surgery, Pulmonary embolism, Treatment Outcome, Withholding Treatment, business, Pulmonary Embolism, medicine.drug

الوصف: The optimal duration of oral anticoagulant treatment after a first episode of pulmonary embolism remains uncertain.To evaluate the long-term clinical benefit of extending a 3-month course of oral anticoagulant therapy to 6 months (pulmonary embolism associated with temporary risk factors) or to 1 year (idiopathic pulmonary embolism) in patients with a first episode of pulmonary embolism.Multicenter randomized study with independent, blinded assessment of the outcome events.19 Italian hospitals.326 patients who had had 3 months of oral anticoagulant therapy without experiencing recurrence or bleeding.The primary study outcome was recurrence of symptomatic, objectively confirmed venous thromboembolism.Among 165 patients assigned to extended anticoagulant therapy, 15 patients (9.1%) had a recurrence of venous thromboembolism (3.1% per patient-year; average follow-up, 34.9 months), as compared with 18 of 161 patients (11.2%) assigned to discontinue treatment (4.1% per patient-year; average follow-up, 32.7 months); the rate ratio was 0.81 (95% CI, 0.42 to 1.56). All but one of the recurrences occurred after anticoagulant treatment was discontinued. Nineteen recurrences (57.6%) were episodes of pulmonary embolism, two of which were fatal. Three major bleeding episodes were observed during extended anticoagulation (1.8%). Among patients with idiopathic venous thromboembolism, 11 of 90 patients assigned to extended anticoagulation and 11 of 91 patients assigned to discontinue treatment experienced a recurrence (relative risk, 0.99 [CI, 0.45 to 2.16]).Patients with pulmonary embolism have a substantial risk for recurrence after discontinuation of oral anticoagulation, regardless of treatment duration. Physicians should try to identify patients who are at high risk for recurrent venous thromboembolism and are therefore potential candidates for indefinite oral anticoagulant therapy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::af915e95bd87ad435617a4db354ef99eTest
http://hdl.handle.net/11577/1481208Test