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  • 1
    Online Resource
    Online Resource
    Risk Factors of Cardiovascular Death after Venous Thromboembolism: Results from a Prospective Cohort Study
    Georg Thieme Verlag KG ; 2022
    In:  Thrombosis and Haemostasis Vol. 122, No. 10 ( 2022-10), p. 1744-1756
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 122, No. 10 ( 2022-10), p. 1744-1756
    Abstract: Background Cardiovascular deaths (CVDTs) are more frequent in patients with venous thromboembolism (VTE) than in the general population; however, risk factors associated with this increased risk of CVDT in patients with VTE are not described. Methods To determine the risk factors of CVDT in patients with VTE from a multicenter prospective cohort study, Fine and Gray subdistribution hazard models were conducted. Results Of the 3,988 included patients, 426 (10.7%) died of CVDT during a median follow-up of 5 years. The risk factors of CVDT after multivariate analyses were: age of 50 to 65 years (vs. 〈 50 years, hazard ratio [HR]: 3.22, 95% confidence interval [CI] : 1.67–6.62), age 〉 65 years (vs. 〈 50 years, HR: 7.60, 95% CI: 3.73–15.52), cancer-associated VTE (vs. transient risk factor-related VTE, HR: 1.73, 95% CI: 1.15–2.61), unprovoked VTE (vs. transient risk factor-related VTE, HR: 1.42, 95% CI: 1.02–2.00), past tobacco use (vs. never, HR: 1.43, 95% CI: 1.06–1.94), current tobacco use (vs. never, HR: 1.87, 95% CI: 1.15–3.01), hypertension (HR: 2.11, 95% CI: 1.51–2.96), chronic heart failure (HR: 2.28, 95% CI: 1.37–3.79), chronic respiratory failure (HR: 1.72, 95% CI: 1.02–2.89), and atrial fibrillation (HR: 1.67, 95% CI: 1.06–2.60). The risk of CVDT was significantly reduced with direct oral anticoagulants (vs. vitamin-K antagonists) and with longer duration of treatment ( 〉 3 months). Conclusion Risk factors of CVDT after VTE include some traditional cardiovascular risk factors and other risk factors that are related to characteristics of VTE, and patients' comorbidities.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0042-1748889
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Risk Factors for Major Adverse Cardiovascular Events and Major Adverse Limb Events after Venous Thromboembolism: A Large Prospective Cohort Study
    Georg Thieme Verlag KG ; 2022
    In:  Seminars in Thrombosis and Hemostasis Vol. 48, No. 04 ( 2022-06), p. 465-480
    Details
    In: Seminars in Thrombosis and Hemostasis, Georg Thieme Verlag KG, Vol. 48, No. 04 ( 2022-06), p. 465-480
    Abstract: Background There is an increased risk of arterial events including major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after venous thromboembolism (VTE). However, their risk factors remain little explored. Methods We aimed to determine the risk factors for MACE (acute coronary syndrome/stroke/cardiovascular death) and MALE (limb ischemia/critical limb ischemia/non-traumatic amputation/any limb revascularization) after VTE. Competing risk models (Fine-Gray) were used in a multicenter prospective cohort of 4,940 patients (mean age: 64.6 years and median follow-up: 64 months). Results MACE occurred in 17.3% of participants (2.35% per patient-years) and MALE in 1.7% (0.27% per patient-years). In multivariable analysis, the identified risk factors for MACE were the age of 50 to 65 years (vs. 〈 50 years, hazard ratio [HR]: 2.00, 95% confidence interval [CI] : 1.38–2.91), age 〉 65 years (vs. 〈 50 years, HR 4.85, 95% CI: 3.35–7.02), pulmonary embolism + deep vein thrombosis (DVT) (vs. isolated-DVT, HR: 1.25, 95% CI: 1.02–1.55), unprovoked-VTE (vs. transient risk factor associated-VTE, HR: 1.29, 95% CI: 1.04–1.59), current tobacco use (vs. never, HR: 1.45, 95% CI: 1.07–1.98), hypertension (HR: 1.61, 95% CI: 1.30–1.98), past history of symptomatic atherosclerosis (HR: 1.52, 95% CI: 1.17–1.98), heart failure (HR: 1.71, 95% CI: 1.21–2.42), atrial fibrillation (HR: 1.55, 95% CI: 1.15–2.08), and vena cava filter insertion (HR: 1.46, 95% CI: 1.03–2.08). The identified risk factors for MALE were the age of 50–65 years (vs. 〈 50 years, HR: 3.49, 95% CI: 1.26–9.65) and atrial fibrillation (HR: 2.37, 95% CI: 1.15–4.89). Conclusions Risk factors for MACE and MALE after VTE included some traditional cardiovascular risk factors, patient's comorbidities, and some characteristics of VTE.
    Type of Medium: Online Resource
    ISSN: 0094-6176 , 1098-9064
    URL: Article
    DOI: 10.1055/s-0042-1748152
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2072469-X
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  • 3
    Online Resource
    Online Resource
    Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous Thromboembolism
    Georg Thieme Verlag KG ; 2023
    In:  Seminars in Thrombosis and Hemostasis Vol. 49, No. 07 ( 2023-10), p. 688-701
    Details
    In: Seminars in Thrombosis and Hemostasis, Georg Thieme Verlag KG, Vol. 49, No. 07 ( 2023-10), p. 688-701
    Abstract: After first episodes of venous thromboembolism (VTE), patients are at increased risk of recurrent VTE and arterial thrombotic events (ATE) compared with the general population, two disorders that are influenced by anticoagulation. However, risk factors of these conditions occurring during and after anticoagulation are little described. Using cause-specific hazard regression models, we aimed to determine risk factors of the composite outcome recurrent VTE/ATE, and separately recurrent VTE or ATE, during and after anticoagulation in patients with first episodes of VTE from a prospective cohort. Hazard ratios (HRs) are given with 95% confidence intervals (CIs). A total of 2,011 patients treated for at least 3 months were included. A total of 647 patients had recurrent VTE/ATE (incidence: 4.69% per patient-years) during overall follow-up (median: 92 months). Of these events, 173 occurred during anticoagulation (incidence: 3.67% per patient-years). Among patients free of events at the end of anticoagulation, 801 had a post-anticoagulation follow-up ≥3 months; and 95 had recurrent VTE/ATE (incidence: 1.27% per patient-years). After adjustment for confounders, cancer-associated VTE (HR: 2.64, 95% CI: 1.70–4.11) and unprovoked VTE (HR: 1.95, 95% CI: 1.35–2.81) were the identified risk factors of recurrent VTE/ATE during anticoagulation (vs. transient risk factor–related VTE). Risk factors of recurrent VTE/ATE after anticoagulation included 50 to 65 years of age (vs.  〈  50, HR: 1.99, 95% CI: 1.04–3.81), older than 65 years (vs.  〈  50, HR: 5.28, 95% CI: 3.03–9.21), and unprovoked VTE (vs. transient risk factor–related VTE, HR: 2.06, 95% CI: 1.27–3.34). Cancer-associated VTE and unprovoked VTE are the main risk factors of recurrent VTE/ATE during anticoagulation, while older age and unprovoked VTE mainly predict the risk of these events after anticoagulation.
    Type of Medium: Online Resource
    ISSN: 0094-6176 , 1098-9064
    URL: Article
    DOI: 10.1055/s-0042-1757899
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2072469-X
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  • 4
    Online Resource
    Online Resource
    Endovascular Management of Brain Arteriovenous Malformations
    Georg Thieme Verlag KG ; 2023
    In:  Seminars in Neurology Vol. 43, No. 03 ( 2023-06), p. 323-336
    Details
    In: Seminars in Neurology, Georg Thieme Verlag KG, Vol. 43, No. 03 ( 2023-06), p. 323-336
    Abstract: Due to the risk of cerebral hemorrhage, and its related morbidity–mortality, brain arteriovenous malformations (bAVMs) are a rare and potentially life-threatening disease. Despite this, there is only one randomized controlled trial on bAVM management, A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA). The results of the ARUBA trial favor a noninterventional approach in the case of an unruptured bAVM; however, implementation of these findings is challenging in daily practice. Instead, management of bAVM relies on multidisciplinary discussions that lead to patient-specific strategies based on patient preferences, local expertise, and experience in referral centers. Considering the diverse patterns of presentation and numerous treatment modalities, implementing standardized guidelines in this context proves challenging, notwithstanding the recommendations or expert opinions offered. Endovascular treatment (EVT) of bAVM can be curative, or can serve as an adjunct treatment prior to surgery or radiosurgery (“pre-EVT”). EVT practice is in constant evolution (i.e., venous approach, combination with surgery during the same anesthesia, etc.). Liquid embolic agents such as ethylene vinyl alcohol (EVOH) copolymer and cyanoacrylates (CYA), and their method of injection to increase bAVM occlusion have also benefited from technical evolutions such as the use of adjunctive flow arrest techniques (mini balloons, pressure cooker technique, and multiple catheters). Further research is necessary to evaluate the advantages and disadvantages of EVT for bAVM.
    Type of Medium: Online Resource
    ISSN: 0271-8235 , 1098-9021
    URL: Article
    DOI: 10.1055/a-2105-6614
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2072477-9
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