Author Interviews, JAMA, Thromboembolism / 17.09.2014

Dr. Marc Carrier, MD MSc Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute Physician, Hematology (Thrombosis), The Ottawa Hospital Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of OttawaMedicalResearch.com Interview with: Dr. Marc Carrier, MD MSc Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute Physician, Hematology, The Ottawa Hospital Associate Professor, Department of Medicine, Faculty of Medicine, and Research Chair in Venous Thromboembolism and Cancer (Tier 2) at the University of Ottawa MedicalResearch.com: What are the main findings of this study? Dr. Carrier: Venous thromboembolism (VTE), comprised of deep vein thrombosis and pulmonary embolism, is the third leading cause of cardiovascular death. There are many anticoagulant treatments available but there is little guidance about which treatment is most effective and safe. This systematic review and network meta-analysis evaluated eight different treatment options for acute Venous thromboembolism.  Forty-five trials were included in the analysis and there were no significant differences in clinical or safety outcomes associated with most treatment options when compared to the combination of LMWH-VKA..
Author Interviews, BMJ, Clots - Coagulation, Surgical Research / 13.08.2014

MedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special SurgeryMedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special Surgery Medical Research: What are the main findings of the study? Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events.
Author Interviews, Clots - Coagulation, JAMA / 21.07.2014

Riyaz Bashir MD, FACC, RVT Associate Professor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140MedicalResearch.com Interview with Riyaz Bashir MD, FACC, RVT Associate Professor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine, Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140 Medical Research: What is the background for this study? Dr. Bashir : Blood clots of legs called deep vein thrombosis (DVT) is a very common disease that occurs in about 1.0 person per 1000 population per year. This condition is responsible for more than 600,000 hospitalizations each year in the United States and approximately 6% of these patients will die within 1 month of the diagnosis. Amongst these patients 20% - to 50% will go on to develop chronic leg pains, swelling, heaviness, skin discoloration, and ulcers, in spite of conventional treatment with Blood thinning medications (anticoagulation) and compression stockings.This condition, which is called Post-thrombotic syndrome PTS markedly impairs the quality of life of these patients and is a significant economic burden (2.4 billion dollars and 200 million work days lost annually in US) on the society.In fact, many of these people lose their jobs because of the disability it causes. Several small studies have shown that early clot removal by minimally invasive catheter-based clot busting procedure called Catheter-directed thrombolysis (CDT) leads to a significant reduction in Post-thrombotic syndrome along with improvements in quality of life. Unfortunately, due to the small number of patients in these studies, we did not have any data about the safety of this treatment option. This has led to conflicting recommendations by various medical societies like the American College of Chest Physicians recommending against its use while the American Heart Association recommends Catheter-directed thrombolysis as first-line treatment for these patients. In light of these conflicting directives, we reviewed the frequency and safety of CDT versus conventional treatment in these patients with blood clots above the knees in the United States using Nationwide Inpatient Sample database from 2005 to 2010.
Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, Thromboembolism / 10.07.2014

Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, MIMedicalResearch.com Interview with: Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, MI Medical Research: What are the main findings of the study? Dr. Cooke: We determined that when patients who are hospitalized for pulmonary embolism (PE), a blood clot in the lung, approximately 1 in 5 will be admitted to an intensive care unit (ICU). However, the chances that a patient will go to an ICU is highly dependent upon which hospital they are admitted to. For example, some hospitals admitted only 3% of patients with pulmonary embolism to an ICU while others admitted almost 80%. Importantly, the differences in how hospitals use their ICU for patients with pulmonary embolism was not entirely related to the patient’s need for life support measures, the things that the ICU is designed to deliver. For example, the ICU patients in high ICU-use hospitals tended to receive fewer procedures, including mechanical ventilation, arterial catheterization, central lines, and medications to dissolve blood clots. This suggest that high utilizing hospitals are admitting patients to the ICU with weaker indications for ICU admission.
AHA Journals, Author Interviews, Thromboembolism / 09.07.2014

Kirstine Kobberøe Søgaard, MD Department of Clinical Epidemiology, Aarhus University Hospital, DenmarkMedicalResearch.com Interview with: Kirstine Kobberøe Søgaard, MD Department of Clinical Epidemiology, Aarhus University Hospital, Denmark Medical Research: What are the main findings of the study? Response: Venous thromboembolism (VTE) is mainly considered an acute illness with a high mortality right after the event, whereas knowledge on the impact on long-term survival has been sparse. In our study, we used nationwide data on VTE since 1977, and included 128,223 patients with VTE and 640,760 individuals from the general population without a VTE diagnosis. We had complete follow-up data on individual patient level and were able to link information from other hospital admissions and thereby obtain each patient’s entire hospital history, as well as death statistics with specific cause of death. We confirmed the high mortality immediately after the thromboembolic event, but more interestingly, we found that mortality remained increased during the entire follow-up period of 30 years, with venous thromboembolism as an important cause of death among patients with deep venous thrombosis and/or pulmonary embolism.
Author Interviews, Clots - Coagulation, JAMA, Vaccine Studies / 09.07.2014

MedicalResearch.com Interview with: Nikolai Madrid Scheller Department of Epidemiology Research Statens Serum Institut, Copenhagen Medical Research: What are the main findings of the study? Answer: In a large and comprehensive study of more than 1.5 million women including more than 500,000 HPV vaccinated there was no association between HPV vaccination and blood clots.
Author Interviews, Cancer, Thromboembolism / 07.07.2014

MedicalResearch.com Interview with: Dr. Liang He Department of Anesthesiology Yan’an Hospital of Kunming City, kunming, 650051, China MedicalResearch: What are the main findings of this study? Dr. He: We evaluated the prognostic value of plasma heart-type fatty acid binding protein (H-FABP) in patients with acute pulmonary embolism (PE) with the guidelines of acute PE of European Society Cardiology (ESC). We found that higher H-FABP level (above 6 or 7 ng/ml) was associated with an increased of 30-d mortality and complicated clinical events, from six studies of 85 articles included. H-FABP has the potential to be a novel prognostic marker that can help optimize patient management strategies and risk-stratification algorithms in the population of patients with acute pulmonary embolism. However, few studies had been specifically designed to answer our research questions.
Author Interviews, Clots - Coagulation, Genetic Research / 18.06.2014

MedicalResearch.com Interview with: David Ldr_david_l_brown. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 MedicalResearch: What are the main findings of the study? Dr. Brown: This meta-analysis of randomized controlled trials showed that using a genotype-based warfarin dosing algorithm did not improve the process or outcomes of anticoagulation compared to using a clinical dosing algorithm.
Author Interviews, JAMA, Thromboembolism / 17.06.2014

Jay Giri, MD MPH Assistant Professor, Perelman School of Medicine Director, Peripheral Intervention Interventional Cardiology & Vascular Medicine Cardiovascular Division University of PennsylvaniaMedicalResearch Interview with: Jay Giri, MD MPH Assistant Professor, Perelman School of Medicine Director, Peripheral Intervention Interventional Cardiology & Vascular Medicine Cardiovascular Division University of Pennsylvania MedicalResearch: What are the main findings of the study? Dr. Giri: Use of thrombolytics was associated with lower all-cause mortality and increased rates of intracranial hemorrhage.  These results were also seen in intermediate-risk pulmonary embolism.  Finally, it appeared that patients under age 65 might be at less bleeding risk from thrombolytics.
Blood Clots, General Medicine, UCSD / 19.05.2014

MedicalResearch.com Interview withTimothy Fernandes, M.D., M.P.H. University of California, San Diego - La Jolla, CA Timothy Fernandes, M.D., M.P.H. University of California, San Diego La Jolla, CA MedicalResearch: What are the main findings of this study? Dr. Fernandes: The fibrinopeptides are cleaved off of fibrinogen by thrombin during the generation of a new clot. These small molecules are excreted into the urine and we have developed a urine assay to measure the level of FPB. We examined the performance of urine FPB as a screening test for acute pulmonary embolism, blood clots that travel to the lungs. The study group consisted of 344 patients: 61 (18%) with pulmonary embolism and 283 (83%) without. At a threshold of 2.5 ng/ml, urine FPB demonstrated sensitivity of 75.4% (95% CI: 62.4-85.2%), specificity of 28.9% (95% CI: 23.8-34.7%), and negative likelihood ratio of 0.18 (0.11-0.29), weighted by prevalence in the sample population. However, the thresholds of 5 ng/ml and 7.5 ng/ml had sensitivities of only 55.7% (95% CI: 42.5-68.2%), and 42.6% (30.3-55.9%), respectively. The urine fibrinopeptide B assay at a cut-off of 2.5 ng/ml had a sensitivity of 75.4% for detecting pulmonary embolism. For diagnosis of PE, this sensitivity is comparable to previously published values for the first generation plasma latex and whole blood D-dimer assays (not as well and the D dimer ELISA assay).
Author Interviews, Blood Clots, CHEST / 18.05.2014

Scott C. Woller, MD Co-Director Thrombosis Program Intermountain Medical Center Associate Professor of Internal Medicine University of Utah School of Medicine Murray, UT 84157-7000MedicalResearch.com Interview with Scott C. Woller, MD Co-Director Thrombosis Program Intermountain Medical Center Associate Professor of Internal Medicine University of Utah School of Medicine Murray, UT 84157-7000 Dr. Woller: By way of background, D-dimer, a simple blood test that is used to investigate the diagnosis of suspected pulmonary embolism (PE), and it increases with age.  Recent research suggests that the use of an age-adjusted d-dimer threshold may improve diagnostic efficiency without compromising safety. We wished to assess the safety of using an age-adjusted d-dimer threshold in the work-up of patients with suspected pulmonary embolism. MedicalResearch:  What are the main findings of the study? Dr. Woller: In this retrospective cohort study we identified 923 patients age > 50 years who presented to our emergency department with suspected pulmonary embolism, and had their pretest probability of PE calculated along with a d-dimer performed. All patients underwent computed tomography pulmonary angiography (CTPA). We observed that among patients unlikely to have PE, adoption of an age-adjusted D-dimer cut-off (compared with a conventional D-dimer cut-off) reduced the need for CTPA in an additional 18.3% of patients, and was associated with a low 90-day rate of failure to diagnose PE.
Author Interviews, Thromboembolism / 17.04.2014

Craig M. Lilly, M.D. Professor of Medicine Departments of Medicine, Anesthesiology, and Surgery, University of Massachusetts Medical School, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, Worcester, MAMedicalResearch.com Interview with: Craig M. Lilly, M.D. Professor of Medicine Departments of Medicine, Anesthesiology, and Surgery, University of Massachusetts Medical School, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, Worcester, MA MedicalResearch.com: What are the main findings of the study? Dr. Lilly: Critically ill adults with clinicians that chose to manage them with prophylactic anticoagulation were more likely to survive their hospitalization than patients that received venous thrombosis prophylaxis with mechanical devices or were not treated with venous thrombosis prophylaxis.
Author Interviews, Biomarkers, JAMA, Thromboembolism / 19.03.2014

Marc Righini, MD Division of Angiology and Hemostasis Geneva University Hospital, Geneva, SwitzerlandMedical Research.com Interview with: Marc Righini, MD Division of Angiology and Hemostasis Geneva University Hospital, Geneva, Switzerland   MedicalResearch.com: What are the main findings of this study? Dr. Righini: The study shows that when compared with a fixed D-Dimer cutoff of 500 ng/ml, the combination of pretest clinical probability assessment with age-adjusted D-dimer cut-off was associated  with a larger number of patients in whom Pulmonary Embolism  could be excluded, with a low likelihood of recurrent VTE. The benefit was the most important in patients  75 years or older, in whom using the age-adjusted cutoff instead of the 500 ng/ml cutoff increased five-fold the proportion of patients in whom PE could be excluded on the basis of D-dimer measurement.
Clots - Coagulation, OBGYNE, Stroke / 20.02.2014

Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City.MedicalResearch.com Interview with: Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City. MedicalResearch.com: What are the main findings of the study? Dr. Kamel: The risk of thrombotic events remains higher than normal for twice as long after childbirth as previously thought. However, the absolute risk in any given patient is low, especially after the first 6 weeks.
Author Interviews, Blood Clots, Case Western, Cleveland Clinic, JAMA / 24.11.2013

Ilke Sipahi, MD Department of Cardiology Acibadem University Medical School, Istanbul, Turkey Harrington Heart and Vascular Institute, University Hospitals Case Medical Cente Case Western Reserve University School of Medicine, Cleveland, OhioMedicalResearch.com Interview with: Ilke Sipahi, MD Department of Cardiology Acibadem University Medical School, Istanbul, Turkey Harrington Heart and Vascular Institute, University Hospitals Case Medical Cente, Case Western Reserve University School of Medicine, Cleveland, Ohio MedicalResearch.com: Were you surprised at the extreme difference between these 2 analyses? Answer: I was surprised. However, it is not unusual to find completely contradictory results in medical studies. I was more surprised at the fact that FDA paid more attention to it administrative observational dataset rather than the huge large randomized clinical trials, all showing excess GI bleeds with dabigatran (Pradaxa). Anyone who is even slightly familiar with the medical literature knows that randomized trials are the gold standard in medical studies.
Author Interviews, Blood Clots, Kidney Disease / 24.11.2013

Frits R. Rosendaal PhD Department of Clinical Epidemiology Leiden University Medical Center, Leiden, The NetherlandsMedicalResearch.com Interview with: Frits R. Rosendaal PhD Department of Clinical Epidemiology Leiden University Medical Center, Leiden, The Netherlands MedicalResearch.com: What are the main findings of the study? Answer: In our study, we  found that moderately to severely decreased kidney function was associated with a 2.6-fold (95%CI 2.0-3.5) increased risk of venous thrombosis as compared with normal kidney function. Several hemostatic factors showed a procoagulant shift with decreasing kidney function, most notably factor VIII and von Willebrand factor. We showed that the increased risk of venous thrombosis in chronic kidney disease could not be explained by confounding factors such as body mass index, diabetes, hospitalization, or corticosteroid use. However, we found that factor VIII and von Willebrand factor fully explained the increased risk of venous thrombosis associated with impaired kidney function.
Author Interviews, Blood Clots, BMJ / 24.11.2013

MedicalResearch.com Interview with: Alyshah Abdul Sultan, doctorate student Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, Nottingham NG5 1PB, UK MedicalResearch.com: What are the main findings of the study? Answer: Overall, we found that hospitalisation during pregnancy was associated with an excess risk of 16.6 cases per 1,000 person-years compared with time outside hospital (17.5-fold increase in risk). There was also an excess risk of 5.8 cases per 1,000 person years in the 28 days after discharge with VTE events more likely to occur in the third trimester of pregnancy and in women aged 35 years and over.
Author Interviews, Blood Clots / 13.11.2013

MedicalResearch.com Interview with: Matteo Nicola Dario Di Minno, MD Dept. of Clinical Medicine and Surgery Regional Reference Center for Coagulation Disorders Federico II University, Naples, ItalyMedicalResearch.com: Matteo Nicola Dario Di Minno, MD Dept. of Clinical Medicine and Surgery Regional Reference Center for Coagulation Disorders Federico II University, Naples, Italy   MedicalResearch.com: What are the main findings of the study?
 Answer: In our study, patients with unprovoked VTE treated for a definite time with oral anticoagulants (ie, 3–12 months) had annual recurrence rates >5% in the presence of both overt and mild antithrombin deficiency and <5% with normal antithrombin levels, with these differences being statistically significant. Although these findings should be confirmed in further studies, a life-long oral anticoagulation might be considered in patients with unprovoked VTE.
Author Interviews, Blood Clots, Gender Differences / 01.11.2013

MedicalResearch.com Interview with: Dr. W.M. Lijfering, MD, PhD Department of Clinical Epidemiology, C7-P-89 Leiden University Medical Center PO Box 9600 2300 RC LeidenDr. W.M. Lijfering, MD, PhD Department of Clinical Epidemiology, C7-P-89 Leiden University Medical Center PO Box 9600 2300 RC Leiden   MedicalResearch.com: What are the main findings of the study? Dr. Lijfering: In this study we found that the risk of a first venous thrombosis* is two-fold higher in men than in women once female reproductive risk factors for venous thrombosis are taken into account (odds ratio 1.9, 95% CI 1.7-2.2). These results were found in all age categories (18-70 years) and were not affected by adjustment for body mass index and smoking, or by excluding participants with malignancy.
Author Interviews, Blood Clots, JAMA / 13.10.2013

Mila Ju, MD Resident, Division of Vascular Surgery Northwestern University 676 N. Saint Clair St., Ste 650 Chicago, IL 60611MedicalResearch.com Interview with: Mila Ju, MD Resident, Division of Vascular Surgery Northwestern University 676 N. Saint Clair St., Ste 650 Chicago, IL  60611 MedicalResearch.com: What are the main findings of the study? Dr. Ju: By using combined data from Hospital Compare, American Hospital Association, and Medicare claims databases, we found that better hospital venous thromboembolism (VTE) prophylaxis adherence rates were weakly associated with worse risk-adjusted VTE event rates. Moreover, hospitals with higher intensity of detecting VTE with imaging studies (such as venous duplex, chest computer tomography, etc.) had more VTE events (13.5 in highest VTE imaging quartile vs 5.0 in lowest VTE imaging quartile) per 1000 discharges. Our study suggests that VTE rates might be influenced by surveillance bias and not reflecting the true quality of care provided by the hospitals.
Author Interviews, Clots - Coagulation, Surgical Research / 16.08.2013

MedicalResearch.com Interview with: Dr. Takahisa Fujikawa, MD, PhD, FACS. Director, Dept of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, JAPAN. MedicalResearch.com: What are the main findings of the study? Answer: A total of consecutive 1,075 patients undergoing abdominal laparoscopic surgery between 2005 and 2011, including 715 basic and 360 advanced laparoscopic surgeries, were reviewed. The perioperative management protocol consists of interruption of antiplatelet therapy (APT) one week before surgery and early postoperative re-institution in low thromboembolic risk patients (n=160, iAPT group), whereas preoperative APT was maintained in patients with high thromboembolic risk or emergent situation (n=52, cAPT group). Perioperative and outcome variables of cAPT and iAPT groups, including bleeding and thromboembolic complications, were compared to those of patients without APT (non-APT group, n=863).
  • No case suffering excessive intraoperative bleeding due to continuation of APT was observed. There were 10 postoperative bleeding complications (0.9%) and 3 thromboembolic events (0.3%), but surgery was free of both complications in cAPT group. No significant differences were found between the groups in operative blood loss, blood transfusion rate, and the occurrence of bleeding and thromboembolic complications.
  • Multivariable analyses showed that multiple antiplatelet agents (p=0.015) and intraoperative blood transfusion (p=0.046) were significant prognostic factors for postoperative bleeding complications.  Increased thromboembolic complications were independently associated with high New York Heart Association class (p=0.019) and history of cerebral infarction (p=0.048), but not associated with APT use.
OBGYNE, Thromboembolism / 24.07.2013

MedicalResearch.com Interview with: Sheree Boulet, DrPH, MPH Assisted Reproductive Technology Surveillance and Research Team Women's Health and Fertility Branch Division of Reproductive Health Centers for Disease Control and Prevention MedicalResearch.com: What are the main findings of the study? Dr. Boulet: Between 1994-2009, the rate of pregnancy-related hospitalizations with venous thromboembolism (VTE) increased by 14%. We also found that the prevalence of hypertension, obesity, diabetes, and heart disease increased over the same time period for pregnancy hospitalizations with VTE.
Author Interviews, Clots - Coagulation, NEJM / 08.03.2013

Author Interview: Sam Schulman M.D., FRCPC(C) Professor, Division of Hematology and Thromboembolism, Department of Medicine Associate Professor, Medicine, Karolinska Institute, Stockholm, Sweden Director, Clinical Thromboembolism Program Hamilton Health Sciences, Hamilton General Hospital, Hamilton, OntarioMedicalResearch.com  Author Interview: Sam Schulman M.D., FRCPC(C) Professor, Division of Hematology and Thromboembolism, Department of Medicine Associate Professor, Medicine, Karolinska Institute, Stockholm, Sweden Director, Clinical Thromboembolism Program Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario MedicalResearch.com: What are the main findings of the study? Response: Similar effect of dabigatran  as warfarin, 92% risk reduction compared to placebo. The risk of bleeding is reduced by almost 50% compared to warfarin but in comparison with placebo there is an increased risk of minor bleeding. No routine coagulation monitoring or dose adjustments are required, making the treatment convenient for patients and physicians.