Pub Date : 2025-06-01DOI: 10.1016/j.tru.2025.100213
Emmanouil S. Papadakis, Lucy A. Norris
{"title":"Optimizing end of life care in cancer Patients. Focus on antithrombotic treatment","authors":"Emmanouil S. Papadakis, Lucy A. Norris","doi":"10.1016/j.tru.2025.100213","DOIUrl":"10.1016/j.tru.2025.100213","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-22DOI: 10.1016/j.tru.2025.100210
M. Jansson , S. Själander , V. Sjögren , F. Björck , H. Renlund , A. Själander
Introduction
Direct oral anticoagulants (DOACs) used in nonvalvular atrial fibrillation (NVAF) are superior or non-inferior to warfarin in reducing the risk of stroke while at the same time having a similar or lower risk of bleeding. However, reduced doses are prescribed more often than expected from clinical practice and off-label underdosing is a frequent issue. The objective of this study was to compare effectiveness and safety between guideline and off-label dosing of DOACs.
Materials and methods
Auricula, a Swedish anticoagulation registry was used in identifying eligible patients from July 2011 to December 2017. The study cohort consisted of 47,355 patients with newly initiated DOAC (apixaban, dabigatran, or rivaroxaban) after exclusion of 92,316 patients due to concomitant venous thromboembolism, previous mechanical heart valve (MHV) or previous data entry in Auricula. The median durations of follow up were 403, 419, 373 and 209 days in the on-label standard dose cohort, off-label reduced dose cohort, on-label reduced dose cohort and the off-label standard dose cohort respectively. Endpoints (stroke and major bleeding) and baseline characteristics were collected from hospital administrative registers using ICD-10 codes or the Swedish Stroke register. Cohorts were compared using weighted adjusted Cox regression after full optimal matching based on propensity scores.
Results
Off-label underdosing of DOACs (n = 6,187, 9.7 %) was associated with higher risk of major bleeding HR 1.16 (95 % CI 1.05–1.27), other bleeding HR 1.16 (1.04–1.30), myocardial infarction HR 1.47 (1.20–1.80), ischemic stroke HR 1.25 (1.04–1.50) and all-cause mortality HR 1.52 (1.37–1.69) compared to on-label standard dosing (n = 35,065, 55.2 %). Among off-label underdosed DOACs, dabigatran was associated with higher risk of all-cause stroke 1.86 (1.07–3.23), ischemic stroke HR 1.97 (1.10–3.52) and all-cause stroke and systemic embolism HR 1.92 (1.11–3.32) compared to apixaban. Rivaroxaban was associated with major bleeding HR 1.70 (1.41–2.03), gastrointestinal bleeding HR 1.92 (1.33–2.77), and other bleeding HR 1.97 (1.57–2.47) compared to apixaban. The study could not show any differences comparing off-label overdosing of DOACs and on-label reduced dosing, besides lower risk of all-cause mortality HR 0.69 (0.52–0.93) in the overdosed patients.
Conclusions
In this large observational registry-based NVAF cohort, underdosing of DOACs is associated with higher risk of ischemic and all-cause stroke but also major bleeding when compared to on-label dosing. Underlying DOAC therapy may need to be tailored to the specific patient when choosing off-label reduced dosing since underdosed rivaroxaban is associated with higher risk of bleeding complications, and underdosed dabigatran is associated with higher risk of stroke complications, when comparing both with apixaban.
{"title":"Clinical outcomes of direct oral anticoagulant off-label dosing in nonvalvular atrial fibrillation","authors":"M. Jansson , S. Själander , V. Sjögren , F. Björck , H. Renlund , A. Själander","doi":"10.1016/j.tru.2025.100210","DOIUrl":"10.1016/j.tru.2025.100210","url":null,"abstract":"<div><h3>Introduction</h3><div>Direct oral anticoagulants (DOACs) used in nonvalvular atrial fibrillation (NVAF) are superior or non-inferior to warfarin in reducing the risk of stroke while at the same time having a similar or lower risk of bleeding. However, reduced doses are prescribed more often than expected from clinical practice and off-label underdosing is a frequent issue. The objective of this study was to compare effectiveness and safety between guideline and off-label dosing of DOACs.</div></div><div><h3>Materials and methods</h3><div>Auricula, a Swedish anticoagulation registry was used in identifying eligible patients from July 2011 to December 2017. The study cohort consisted of 47,355 patients with newly initiated DOAC (apixaban, dabigatran, or rivaroxaban) after exclusion of 92,316 patients due to concomitant venous thromboembolism, previous mechanical heart valve (MHV) or previous data entry in Auricula. The median durations of follow up were 403, 419, 373 and 209 days in the on-label standard dose cohort, off-label reduced dose cohort, on-label reduced dose cohort and the off-label standard dose cohort respectively. Endpoints (stroke and major bleeding) and baseline characteristics were collected from hospital administrative registers using ICD-10 codes or the Swedish Stroke register. Cohorts were compared using weighted adjusted Cox regression after full optimal matching based on propensity scores.</div></div><div><h3>Results</h3><div>Off-label underdosing of DOACs (n = 6,187, 9.7 %) was associated with higher risk of major bleeding HR 1.16 (95 % CI 1.05–1.27), other bleeding HR 1.16 (1.04–1.30), myocardial infarction HR 1.47 (1.20–1.80), ischemic stroke HR 1.25 (1.04–1.50) and all-cause mortality HR 1.52 (1.37–1.69) compared to on-label standard dosing (n = 35,065, 55.2 %). Among off-label underdosed DOACs, dabigatran was associated with higher risk of all-cause stroke 1.86 (1.07–3.23), ischemic stroke HR 1.97 (1.10–3.52) and all-cause stroke and systemic embolism HR 1.92 (1.11–3.32) compared to apixaban. Rivaroxaban was associated with major bleeding HR 1.70 (1.41–2.03), gastrointestinal bleeding HR 1.92 (1.33–2.77), and other bleeding HR 1.97 (1.57–2.47) compared to apixaban. The study could not show any differences comparing off-label overdosing of DOACs and on-label reduced dosing, besides lower risk of all-cause mortality HR 0.69 (0.52–0.93) in the overdosed patients.</div></div><div><h3>Conclusions</h3><div>In this large observational registry-based NVAF cohort, underdosing of DOACs is associated with higher risk of ischemic and all-cause stroke but also major bleeding when compared to on-label dosing. Underlying DOAC therapy may need to be tailored to the specific patient when choosing off-label reduced dosing since underdosed rivaroxaban is associated with higher risk of bleeding complications, and underdosed dabigatran is associated with higher risk of stroke complications, when comparing both with apixaban.</div></d","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hereditary antithrombin deficiency (HATD) is an autosomal dominant disorder that significantly increases the risk of venous thromboembolism (VTE) during pregnancy. Based on our experience with three previous cases and the Japanese clinical guidelines, we manage high-risk VTE in pregnant women with HATD using unfractionated heparin (UFH) and antithrombin (AT) supplementation from early pregnancy to the peripartum period. Herein, we report another case of HATD type 1 in pregnancy and evaluate changes in AT clearance. A 29-year-old woman had a history of pulmonary embolism (PE) at 14 years and a family history of HATD with AT activity of 47 % at baseline, which decreased to 31 % when she developed PE after an abortion. During her second pregnancy, she was treated with UFH and AT concentrate (ATC) with doses increasing from 50 to 100 IU/kg to achieve target AT activity levels of 50–60 % throughout pregnancy and 70 % during delivery. She delivered a healthy male infant at 39 weeks of gestation. She started to take warfarin on postpartum day 1, with an uneventful postpartum course. AT clearance, calculated using plasma AT antigen levels, showed notable increases in the first and late third trimesters, peaking around delivery and coinciding with elevated thrombin-antithrombin complex levels. These findings suggest increased AT consumption during these periods, which may contribute to unexpected decreases in AT activity. We propose close monitoring of AT activity and providing adequate ATC supplementation alongside anticoagulation throughout pregnancy, particularly during periods of elevated AT clearance, to minimize VTE risks in HATD patients.
{"title":"Antithrombin supplementation to prevent venous thromboembolism: A case of hereditary antithrombin deficiency with increased antithrombin clearance during pregnancy and peripartum","authors":"Ayako Kaneda-Takeuchi , Tomoaki Oda , Mei Kitamoto , Emiyu Fujiwara , Kenta Kawai , Megumi Narumi , Yoshimasa Horikoshi , Masako Matsumoto , Yukiko Kohmura-Kobayashi , Naomi Furuta-Isomura , Toshiyuki Uchida , Kazunao Suzuki , Naohiro Kanayama , Hiroaki Itoh , Naoaki Tamura","doi":"10.1016/j.tru.2025.100211","DOIUrl":"10.1016/j.tru.2025.100211","url":null,"abstract":"<div><div>Hereditary antithrombin deficiency (HATD) is an autosomal dominant disorder that significantly increases the risk of venous thromboembolism (VTE) during pregnancy. Based on our experience with three previous cases and the Japanese clinical guidelines, we manage high-risk VTE in pregnant women with HATD using unfractionated heparin (UFH) and antithrombin (AT) supplementation from early pregnancy to the peripartum period. Herein, we report another case of HATD type 1 in pregnancy and evaluate changes in AT clearance. A 29-year-old woman had a history of pulmonary embolism (PE) at 14 years and a family history of HATD with AT activity of 47 % at baseline, which decreased to 31 % when she developed PE after an abortion. During her second pregnancy, she was treated with UFH and AT concentrate (ATC) with doses increasing from 50 to 100 IU/kg to achieve target AT activity levels of 50–60 % throughout pregnancy and 70 % during delivery. She delivered a healthy male infant at 39 weeks of gestation. She started to take warfarin on postpartum day 1, with an uneventful postpartum course. AT clearance, calculated using plasma AT antigen levels, showed notable increases in the first and late third trimesters, peaking around delivery and coinciding with elevated thrombin-antithrombin complex levels. These findings suggest increased AT consumption during these periods, which may contribute to unexpected decreases in AT activity. We propose close monitoring of AT activity and providing adequate ATC supplementation alongside anticoagulation throughout pregnancy, particularly during periods of elevated AT clearance, to minimize VTE risks in HATD patients.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1016/j.tru.2025.100209
Imene Deneche , Camille Couffignal , Nassima Si Mohammed , Anette Arbjerg Højen , Carme Font , Stavros Konstantinides , Marieke Kruip , Luigi Maiorana , Sebastian Szmit , Denise Abbel , Laurent Bertoletti , Susanne Cannegieter , Adrian Edwards , Michelle Edwards , Alessandra Gava , Jacobijn Gussekloo , Miriam J. Johnson , Rashmi Kumar , Johan Langendoen , Kate Lifford , Isabelle Mahé
Introduction
To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4.
Methods
Findings from SERENITY WPs 1–3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70 % agreement. The steering committee will review and validate the results across the different rounds.
Results
Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial.
Conclusion
This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT.
{"title":"Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Protocol for a European Delphi study","authors":"Imene Deneche , Camille Couffignal , Nassima Si Mohammed , Anette Arbjerg Højen , Carme Font , Stavros Konstantinides , Marieke Kruip , Luigi Maiorana , Sebastian Szmit , Denise Abbel , Laurent Bertoletti , Susanne Cannegieter , Adrian Edwards , Michelle Edwards , Alessandra Gava , Jacobijn Gussekloo , Miriam J. Johnson , Rashmi Kumar , Johan Langendoen , Kate Lifford , Isabelle Mahé","doi":"10.1016/j.tru.2025.100209","DOIUrl":"10.1016/j.tru.2025.100209","url":null,"abstract":"<div><h3>Introduction</h3><div>To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4.</div></div><div><h3>Methods</h3><div>Findings from SERENITY WPs 1–3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70 % agreement. The steering committee will review and validate the results across the different rounds.</div></div><div><h3>Results</h3><div>Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial.</div></div><div><h3>Conclusion</h3><div>This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-03DOI: 10.1016/j.tru.2025.100208
Jonathan Victor Salazar-Ore , Angie Carolina Alonso-Ramírez , Gabriela Vanessa Flores-Monar , Emily Patricia Solarte-Zabaleta , Miguel Ángel Castaneda-Diaz , Ada Lizandra Motino-Villanueva , Anuj Manish-Kakkad , Camila Sanchez-Cruz , Ernesto Calderón-Martínez
Introduction
Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.
Methods
A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).
Results
Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.
Conclusion
Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.
感染性心内膜炎（IE）涉及心脏内膜和瓣膜的炎症，可导致栓塞事件等并发症。阿司匹林在预防这些事件中的作用是有争议的，由于担心出血风险，限制了它的使用。本荟萃分析评估了口服阿司匹林在预防IE患者栓塞事件及其不良后果方面的有效性。方法于2024年7月20日在PubMed/MEDLINE、Cochrane、Scopus、Web of Science、EMBASE和CINAHL上进行系统检索，比较阿司匹林与安慰剂或不治疗的研究。该协议已在PROSPERO （CRD42024573274）中注册。结果纳入5项研究，涉及1174名受试者，其中3项由于数据限制符合meta分析。栓塞事件发生率的研究结果不一致：一项不包括既往阿司匹林治疗的随机临床试验（RCT） （OR 1.62, [0.68-3.86], p = 0.29）和一项检查长期使用阿司匹林的再分析（OR 0.80, [0.36-1.78], p = 0.582）未发现显著降低，而另一项研究报告可能降低（OR 0.65, [0.43-0.98], p = 0.04）。在两项研究中，阿司匹林组的出血率呈上升趋势，尽管没有统计学意义。死亡率数据也各不相同；一项研究发现阿司匹林使用者死亡率较高，而另一项研究发现慢性抗血小板治疗死亡率较低，特别是入院后早期开始治疗。结论：阿司匹林可能减少IE患者的栓塞事件，但由于研究结果不一，证据仍不确定。阿司匹林显示出血风险和死亡率无显著增加，因此不建议常规使用阿司匹林预防IE栓塞，强调需要进一步研究以阐明其潜在作用。
{"title":"Efficacy of oral aspirin in prevention of embolic events in infective endocarditis: A systematic review and meta analysis","authors":"Jonathan Victor Salazar-Ore , Angie Carolina Alonso-Ramírez , Gabriela Vanessa Flores-Monar , Emily Patricia Solarte-Zabaleta , Miguel Ángel Castaneda-Diaz , Ada Lizandra Motino-Villanueva , Anuj Manish-Kakkad , Camila Sanchez-Cruz , Ernesto Calderón-Martínez","doi":"10.1016/j.tru.2025.100208","DOIUrl":"10.1016/j.tru.2025.100208","url":null,"abstract":"<div><h3>Introduction</h3><div>Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).</div></div><div><h3>Results</h3><div>Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.</div></div><div><h3>Conclusion</h3><div>Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-08DOI: 10.1016/j.tru.2025.100207
Lasse Myllylahti , Jari Haukka , Eero Hirvensalo , Riitta Lassila
Objectives
Previous research suggest that venous thromboembolism (VTE) -related mortality have been declining over the recent decades, despite the increasing trend of pulmonary embolism (PE) incidence. There is evidence of some regional differences in VTE incidence. We wanted to evaluate the national and regional 21st century VTE incidence in Finland, as well as respective national VTE mortality trends.
Patients and methods
In this nationwide registry study, anonymous participants were patients with VTE diagnoses (I26 or I80) during hospital visits or VTE-related documentation of primary cause of death. To assess incidence, we recorded VTE-related hospital visits from the HILMO registry of the Finnish Institute for Health and Welfare. To assess mortality, we recorded deaths with a VTE diagnosis as a primary cause of death from the registries of Statistics Finland. Additionally, we acquired the data about pulmonary CT angiographies from STUK, which is the radiation and nuclear safety authority in Finland.
Results
At the national level, the PE incidence doubled during the study period, while the incidence rates of deep vein thrombosis remained stable. Some regional variances in VTE incidence were encountered. The usage of radiological examinations to diagnose PE have become more frequent during the study period. The mortality for VTE peaked in 2004, following the clear declining trend during the follow-up period.
Conclusion
Despite the remarkable increase in PE incidence, the mortality rates have been constantly declining from 2004. These results are valuable for the future epidemiological research of VTE.
{"title":"National and regional incidence patterns of venous thromboembolism in Finland during 1998–2021 with corresponding mortality trends in 1998–2019","authors":"Lasse Myllylahti , Jari Haukka , Eero Hirvensalo , Riitta Lassila","doi":"10.1016/j.tru.2025.100207","DOIUrl":"10.1016/j.tru.2025.100207","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous research suggest that venous thromboembolism (VTE) -related mortality have been declining over the recent decades, despite the increasing trend of pulmonary embolism (PE) incidence. There is evidence of some regional differences in VTE incidence. We wanted to evaluate the national and regional 21st century VTE incidence in Finland, as well as respective national VTE mortality trends.</div></div><div><h3>Patients and methods</h3><div>In this nationwide registry study, anonymous participants were patients with VTE diagnoses (I26 or I80) during hospital visits or VTE-related documentation of primary cause of death. To assess incidence, we recorded VTE-related hospital visits from the HILMO registry of the Finnish Institute for Health and Welfare. To assess mortality, we recorded deaths with a VTE diagnosis as a primary cause of death from the registries of Statistics Finland. Additionally, we acquired the data about pulmonary CT angiographies from STUK, which is the radiation and nuclear safety authority in Finland.</div></div><div><h3>Results</h3><div>At the national level, the PE incidence doubled during the study period, while the incidence rates of deep vein thrombosis remained stable. Some regional variances in VTE incidence were encountered. The usage of radiological examinations to diagnose PE have become more frequent during the study period. The mortality for VTE peaked in 2004, following the clear declining trend during the follow-up period.</div></div><div><h3>Conclusion</h3><div>Despite the remarkable increase in PE incidence, the mortality rates have been constantly declining from 2004. These results are valuable for the future epidemiological research of VTE.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1016/j.tru.2025.100203
Aykut Yucal, Mustafa Burak Sayhan
Introduction
Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.
Method
Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.
Results
Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as >1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).
Conclusion
An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.
{"title":"Novel method for pulmonary embolism prognosis: Right to left ventricular volume ratio (RLVR) on pulmonary angiography (CTPA)","authors":"Aykut Yucal, Mustafa Burak Sayhan","doi":"10.1016/j.tru.2025.100203","DOIUrl":"10.1016/j.tru.2025.100203","url":null,"abstract":"<div><h3>Introduction</h3><div>Right ventricular dysfunction is the main cause of mortality in patients with acute massive pulmonary embolism (PE) and early diagnosis is extremely important. This study aimed to investigate whether the right/left ventricular volume ratio (RLVR) calculated using pulmonary angiography (CTPA) is a valuable tool for PE prognosis.</div></div><div><h3>Method</h3><div>Clinical, echocardiographic and pulmonary angiography data of cases diagnosed with pulmonary embolism in the emergency department between January 2021 and December 2023 were retrospectively evaluated. Patients were stratified according to the presence of massive PE, one month mortality and pulmonary embolism severity index (PESI) score. Clinical, laboratory and radiographic parameters were compared to search for prognostic factors.</div></div><div><h3>Results</h3><div>Of the 210 patients, the mean age was 67 ± 15 years, 46 % were male, and 42 % had massive PE. The right/left ventricular volume ratio was significantly higher in patients with massive PE, in those who died within one month after admission; and in patients with PESI Class III. When the cut-off value of right/left ventricular volume ratio was accepted as >1.7, its predictive value for acute PE mortality was higher than other CTPA and echocardioraphy measurements (AUC = 0.706).</div></div><div><h3>Conclusion</h3><div>An increased right/left ventricular volume ratio on CTPA, a valuable tool for diagnosing right ventricular dysfunction, is associated with a worse prognosis in subjects with pulmonary thromboembolism.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.tru.2025.100204
Lucy A. Norris (Editors in Chief), Emmanouil S. Papadakis (Editors in Chief)
{"title":"Multimorbidity and VTE","authors":"Lucy A. Norris (Editors in Chief), Emmanouil S. Papadakis (Editors in Chief)","doi":"10.1016/j.tru.2025.100204","DOIUrl":"10.1016/j.tru.2025.100204","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"18 ","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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