Author Interviews, Clots - Coagulation, NEJM, Thromboembolism / 02.04.2019

MedicalResearch.com Interview with: Yaseen M. Arabi, M.D Intensive Care Department Ministry of National Guard Health Affairs Riyadh, Saudi Arabia  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is a complication of critical illness. Studies have demonstrated that despite pharmacologic thromboprophylaxis with unfractionated heparin or low-molecular weight heparin, 5-20% of critically ill patients develop deep vein thrombosis (DVT). The PREVENT trial evaluated whether adjunctive intermittent pneumatic compression reduces incident proximal lower limb DVT as detected on twice-weekly lower limb ultrasonography in critically ill patients receiving pharmacologic thromboprophylaxis with unfractionated heparin or low-molecular-weight heparin. The trial was conducted in 20 sites in Saudi Arabia, Canada, Australia and India and included 2003 patients. The trial found no difference in the primary end point of proximal leg DVT. The addition of intermittent pneumatic compression to pharmacologic thromboprophylaxis did not result in a lower incidence of pulmonary embolism or a composite outcome of venous thromboembolism or death from any cause at 28 days when compared to pharmacologic thromboprophylaxis alone. (more…)
Author Interviews, BMJ, Endocrinology, Heart Disease, Hormone Therapy, Menopause, Thromboembolism / 11.01.2019

MedicalResearch.com Interview with: Yana Vinogradova, PhD Research Fellow Department of Primary Care School of Medicine University of Nottingham University Park, Nottingham MedicalResearch.com: What is the background for this study?   Response: The study targeted middle age women going through menopause.  This is the stage of life when women naturally reach the end of their reproductive life and their hormones gradually decrease.  Some women experience unpleasant effects such as hot flushes, night sweats, mood swings, memory and concentration loss, headaches.  Quality of life may be severely affected.  Hormone replacement therapy uses a class of drugs, which, like all drugs, have side effects.   VTE is a serious side effect which can have a lethal outcome. There are different preparations of hormones available for such women.  Some of them were extensively studied in a large American Trial Women’s Health Initiative and showed the risk of VTE to be twice as high for women who took them.  However, these well-studied drugs are mostly prescribed in America.  The more popular drugs in Europe and the UK have been much less studied, so it was unclear how they compared.  (more…)
Author Interviews, Cost of Health Care, Hematology, J&J-Janssen, Thromboembolism / 04.12.2018

MedicalResearch.com Interview with: Paul Burton MD, PhD, FACC Vice President, Medical Affairs Internal Medicine Janssen Scientific Affairs, LLC. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Despite being largely preventable, venous thromboembolism (VTE) is the second leading cause of death in people with cancer. The risk of VTE is five times greater in people with cancer than those without cancer, and that risk is magnified in those receiving certain types of chemotherapy, in the newly diagnosed and in those with more advanced, metastatic disease. This 6,194-patient study examined economic burden associated with VTE, and found patients newly diagnosed with cancer who are at a higher risk of a VTE had significantly higher all-cause and VTE-related health care costs compared to patients with a lower risk of VTE. (more…)
Annals Internal Medicine, Author Interviews, Emory, Endocrinology, Heart Disease, Sexual Health, Thromboembolism / 10.07.2018

MedicalResearch.com Interview with: Michael Goodman, MD, MPH Professor of Epidemiology Director, MD/MPH program Emory University School of Public Health Atlanta, GA  30322 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a concern that hormone therapy may be associated with higher risk of certain cardiovascular problems such as heart attacks, stroke and formation of blood clots (“venous thromboembolism”). To study this concern we examined data on 4,960 transgender and gender non-conforming people enrolled in Kaiser Permanente health systems in Georgia, Northern California, and Southern California. They were matched to 48,686 cisgender men and 48,775 cisgender women.  Below are the main findings
  • Rates of venous thromboembolism in all transwomen were approximately twice as high as the rates among cisgender men or cisgender women. The data for stroke and myocardial infarction demonstrated little difference between transwomen and cisgender men, but 80% to 90% higher rates among transwomen compared to cisgender women.
  • When the analyses focused specifically on transwomen who started therapy with female hormone estrogen at Kaiser Permanente, the incidence of both venous thromboembolism and stroke was more clearly elevated relative to either reference group.  There was evidence that incidence of both of these conditions among transwomen was particularly increased two to six years after estrogen initiation. By contrast, the association between estrogen therapy and myocardial infarction was less evident due to relatively few observed events.
  • Transmen did not appear to have significantly higher rates of venous thromboembolism, ischemic stroke, or myocardial infarction than their non-transgender counterparts, but this group was rather young and included a relatively small proportion of participants who initiated their hormone therapy during the study.
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Author Interviews, JAMA, Thromboembolism, University of Michigan / 31.05.2018

MedicalResearch.com Interview with: Paul Grant, MD Associate Professor of Medicine Associate Chief Medical Information Officer Director, Perioperative and Consultative Medicine Division of Hospital Medicine Department of Internal Medicine Michigan Medicine University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that hospitalized medical patients are at risk for venous thromboembolism VTE, but the severity of patient risk can vary significantly. National guidelines have consistently stated that low-risk patients should not receive VTE prophylaxis beyond early ambulation. In this retrospective cohort study, we analyzed data from 52 hospitals participating in the Michigan Hospital Medicine Safety consortium. Trained medical record abstractors at each hospital collected data from 44,775 medical patients including VTE risk factors, type of VTE prophylaxis administered, and contraindications to pharmacologic prophylaxis. Individual patient risk of VTE was determined using the Padua risk assessment model. Of the 32,549 low-risk patients, 77.9% received excess venous thromboembolism prophylaxis as either pharmacologic prophylaxis (30.6%), mechanical prophylaxis (20.8%), or both (26.5%). In the 12,226 high-risk patients, VTE prophylaxis was underused in 22% of patients. The rates of inappropriate prophylaxis varied considerably by hospital.  (more…)
Author Interviews, Hematology, NEJM, Orthopedics, Thromboembolism / 22.02.2018

MedicalResearch.com Interview with: Dr. David R. Anderson, MD, FRCPC, FACP Faculty of Medicine Dean, Professor Dean, Faculty of Medicine Division of Hematology, Department of Medicine & Nova Scotia Health Authority MedicalResearch.com: What is the background for this study? What are the main findings? Response: Blood clots in the lungs (pulmonary embolism) and veins of the legs (deep vein thrombosis) are well recognized complications following total hip and knee arthroplasty surgeries.  Prior to the routine use of antithrombotic prophylaxis, pulmonary embolism was the most common cause of death following these procedures.  Oral anticoagulants such as rivaroxaban are commonly prescribed for the indication of preventing blood clots following total hip or knee arthroplasty.  For maximal benefit these agents are continued following surgery for up to five weeks following total hip arthroplasty and for two weeks following total knee arthroplasty. There is evidence that aspirin has some benefit for the prevention of deep vein thrombosis and pulmonary embolism following total hip or knee arthroplasty.  However there is less evidence for its benefit than for oral anticoagulants.  We reasoned that aspirin would potentially be an attractive alternative for extended out of hospital prophylaxis following total hip or knee arthroplasty for patients who received a short course (5 days )of rivaroxaban following surgery.  Aspirin would be attractive for this indication because of its low cost, ease of use, and low rates of side effects. Our study demonstrated that in a randomized controlled trial involving a large group (over 3400) of patients undergoing total hip or knee arthroplasty that extended therapy with aspirin was comparable to rivaroxaban for the prevention of deep vein thrombosis and pulmonary embolism following surgery.  Low rates of complications (< 1%) were observed with both treatment arms.  We also found that rates of clinically important bleeding complications (the most common side effect with antithrombotic drugs) were uncommon and similar with the two agents. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, Thromboembolism / 29.03.2017

MedicalResearch.com Interview with: Paul Burton, MD, PhD, FACC Vice President, Medical Affairs Janssen MedicalResearch.com: What is the background for this study? What are the main findings? Response: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects more than 900,000 Americans each year; one-third of these occurrences are fatal. Once a person experiences a VTE, they are at risk of having another occurrence. Guidelines currently recommend anticoagulant therapy with a non-vitamin K antagonist oral anticoagulant (NOAC), like XARELTO® (rivaroxaban), for three months or longer. Once anticoagulant therapy is stopped, up to 10 percent of people will experience a recurrence during the first year and up to 20 percent within three years. In people who decide to stop anticoagulant therapy, guidelines currently suggest using aspirin for long-term prevention of recurrent VTE rather than no aspirin at all. The Phase 3 EINSTEIN CHOICE study was designed to compare the efficacy and safety of XARELTO® to aspirin for continued VTE management in people who experienced an initial VTE. The study met its primary endpoint, finding both XARELTO® doses (10 mg or 20 mg once daily) to be superior to aspirin 100 mg once daily in preventing recurrent VTE, with no significant impact on safety. Specifically, XARELTO® 10 mg reduced the risk of recurrent VTE by 74 percent and XARELTO® 20 mg by 66 percent. Rates of major bleeding were comparable and low across all treatment groups. These results were presented at the American College of Cardiology's 64th Annual Scientific Session (ACC.17) during a Joint ACC/Journal of American Medical Association Late-Breaking Clinical Trials session and published simultaneously in The New England Journal of Medicine. (more…)
Author Interviews, Lancet, Lipids, Thromboembolism / 21.01.2017

MedicalResearch.com Interview with: Setor Kunutsor BSc MD MPhil(cantab) PhD(cantab) Research Fellow/Epidemiologist Musculoskeletal Research Unit University of Bristol School of Clinical Sciences Southmead Hospital MedicalResearch.com: What is the background for this study? Response: Statins are well established for the prevention of cardiovascular disease and this is based on their ability to lower levels of circulating lipids in the blood. However, statins are also known to have pleotropic effects and these include potential protective effects on multiple disease conditions. Based on their anti-inflammatory and antithrombotic properties, there have been suggestions that statins may prevent venous thromboembolism (VTE) (which comprises of pulmonary embolism and deep vein thrombosis). The evidence is however uncertain. Several studies utilizing both observational cohort and randomized controlled designs have been conducted to evaluate whether statin therapy or use is associated with a reduction in the incidence of VTE, but the results have been inconclusive. In a recent review that was published in 2012, Rahimi and colleagues pooled the results of several randomized controlled trials (RCTs), but found no significant reduction in the risk of VTE with statin therapy [REF]. Given the publication of new studies since this study was published and the existing uncertain evidence on the effect of statins on VTE, we decided it was time to bring all the evidence together and evaluate if statin therapy really did have a protective effect on the risk of venous thromboembolism. (more…)
Author Interviews, NEJM, Orthopedics, Surgical Research, Thromboembolism / 06.12.2016

MedicalResearch.com Interview with: Suzanne C. Cannegieter, M.D., Ph.D. Einthoven Laboratory Leiden University Medical Center The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients who undergo arthroscopic knee surgery and patients who are treated with casting of the lower leg are at increased risk for venous thromboembolism (VTE). It is uncertain whether thromboprophylaxis is effective in these situations to prevent VTE. For both indications, several trials have been performed to evaluate the effectiveness of anticoagulant prophylaxis. However, an overall risk–benefit balance could not be established because of methodologic shortcomings; hence, there has been reluctance to establish international guidelines regarding the use of anticoagulant therapy for either of these indications. (more…)
Author Interviews, BMJ, Clots - Coagulation, Testosterone, Thromboembolism / 03.12.2016

MedicalResearch.com Interview with: Dr. Carlos Martinez Institute for Epidemiology, Statistics and Informatics GmbH Frankfurt, Germany, MedicalResearch.com: What is the background for this study? Response: A 10-fold increase in testosterone prescriptions per capita in the United States and a 40-fold increase in Canada in men has occurred over the first decade of this century, mainly for sexual dysfunction and/or decreased energy. Recognised pathological disorders of the male reproductive system remain the sole unequivocal indication for testosterone treatment but there has been increasing use in men without pathological hypogonadism. A variety of studies and meta-analyses have provided conflicting evidence as to the magnitude of the risk of cardiovascular events including venous thromboembolism in men on testosterone treatment. In June 2014, the US Food and Drug Administration and Health Canada required a warning about the risk of venous thromboembolism to be displayed on all approved testosterone products. Studies have reported contradictory results on an association between testosterone use and the risk of venous thromboembolism. The effect of timing and duration of testosterone use on the risk of venous thromboembolism was not studied and may explain some of these contradictory findings. (more…)
Author Interviews, Lancet, Outcomes & Safety, Thromboembolism, Transfusions / 28.11.2016

MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS Research Associate Professor Research Director, Patient Safety Enhancement Program Department of Internal Medicine University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Thromboembolism / 27.10.2016

MedicalResearch.com Interview with: Truven Health AnalyticsJay Margolis, PharmD Sr. Research Scientist Truven Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vitamin K antagonists (VKAs), most commonly warfarin, had been the only orally available anticoagulants available for the last 60 or so years. While highly effective, use of these agents was often problematic due to their narrow therapeutic index, need for routine coagulation monitoring, and interactions with food and other drugs. Recently introduced new oral anticoagulants (NOACs), particularly rivaroxaban, had been shown in clinical trials to provide comparable efficacy to the VKAs without the need for routine coagulation monitoring. There have been few studies outside of clinical trials showing benefits that translate to real-world populations. In our study using real-world data from a large sample of geographically and demographically diverse US hospitals, patients hospitalized for incident venous thromboembolisms (VTE) initiating oral anticoagulant treatment with rivaroxaban had significantly shorter hospital stays and lower hospitalization costs compared with warfarin-treated patients. (more…)
Accidents & Violence, Author Interviews, Clots - Coagulation, JAMA, Surgical Research, Thromboembolism / 03.10.2016

MedicalResearch.com Interview with: Charles A. Karcutskie IV, MD, MA Postdoctoral Research Fellow University of Miami Miller School of Medicine Department of Surgery Divisions of Trauma, Surgical Critical Care, and Burns MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research group at the Ryder Trauma Center have recently done several studies showing various differences in outcomes and risk based on mechanism of injury. Additionally, venous thromboembolism (VTE) is another topic that our group has focused on in the past several years. Because trauma patients are inherently at a higher risk for VTE due to the nature of their injury, we questioned whether the most important risk factors for VTE were different after blunt or penetrating trauma. At our institution, we assess VTE risk with the Greenfield Risk Assessment Profile, which is a list of several risk factors that each have weight toward an overall risk score. We took these risk factors and analyzed them individually based on mechanism of injury. We found that the factors that contribute to the VTE risk are different based on injury mechanism: After blunt trauma, transfusion status, neurologic status, and pelvic fracture contributed most. After penetrating trauma, vascular injury, severe abdominal injury, and age 40-59 years contributed most. This tells us that mechanism of injury may need to be incorporated into the risk assessment in order to discover the highest risk patients. (more…)
Author Interviews, Blood Clots, CHEST, OBGYNE, Surgical Research, Thromboembolism / 27.09.2016

MedicalResearch.com Interview with: Marc Blondon, MD Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Venous thromboembolism, a condition including deep vein thrombosis (blood clots) and pulmonary embolism, is more common in older than younger patients. However, pregnancy and particularly the postpartum period are times at greater risk of blood clots in women. It is important to understand the risk and the risk factors for thrombosis in the postpartum period to guide the use of preventive measures such as heparin, an anticoagulant treatment, or leg compression devices. Our study summarizes the evidence on the link between C-sections and blood clots from the past 35 years. Our meta-analysis demonstrates that:
  • C-section carries a 4-fold increased risk of blood clots in the postpartum period, compared with vaginal deliveries ;
  • that this risk is most prominent but not restricted to emergency C-section ;
  • and that women who undergo elective C-section are also at higher risk than women who have a vaginal delivery.
  • Importantly, we estimated an absolute risk of blood clots after a C-section of 2-4 per 1000 pregnancies: on average, 3 out of 1000 women after C-section will develop a blood clot.
(more…)
Author Interviews, Genetic Research, Opiods, Pain Research, Thromboembolism / 14.07.2016

MedicalResearch.com Interview with: Brian Meshkin Founder and CEO of Proove Biosciences Editor’s note: Proove Biosciences, Inc introduced three new evidence-based tests to support better clinical decision-making for difficult-to-treat conditions that are influenced by genetics. These conditions include substance abuse, fibromyalgia and venous thromboembolism. The tests are especially relevant in light of the House of Representatives passing the Comprehensive Addiction Recovery Act (CARA) bill on July 8, 2016 to combat the opioid epidemic. MedicalResearch.com: Would you update our readers on the significance and implications of the CARA Act? What is the role of genetics in addiction? What is the background for the Proove Addiction™ Profile? How does it aid in addiction management? Response: CARA is a national piece of legislation to expand access to treatment for drug overdoses and addiction. It also includes some other provisions meant to help address the opioid epidemic. However, there are some serious implications. First, it does not contain any funding, so it is a bit of a “Potemkin Village”. It is also a bit of a façade because it does not address 50% of the equation. According to the definition of addiction from the American Society of Addiction Medicine (ASAM) and the National Institutes of Drug Abuse (NIDA), about half of substance abuse is due to genetic factors. If you are studying for a test and ignoring half of the material, chances are you are not going to do well on the test. As doctors are confronted with the challenges of objectively assessing pain and knowing which patients are at risk for abuse, they must consider genetics. The Proove Opioid Risk test combines genetic markers and phenotypic variables into an algorithm to effectively identify patients at low, moderate and high risk for opioid abuse. By knowing this information, a physician can make better decisions about opioids. For low risk patients, a physician can safely prescribe and a patient does not need to fear the opioid prescription they are given – as this is about 50% of the population. For those at moderate risk, a physician can use a greater level of vigilance to monitor those patients with abuse-deterrent formulations, regular urine drug screens, opioid contracts, and other tools to monitor their use. For the small number of patients – less than 10% - that are at high risk, a physician can use alternative forms of pain relief such as interventional procedures or non-opioid analgesics to provide the needed relief to patients. The Proove Addiction Profile builds on this commitment, by providing genetic data points related to other disorders, such as addictions to alcohol, heroin, cocaine and others. Unfortunately, many patients who screen positive for aberrant behavior, such as having an illicit drug in their urine, are often discharged from care by their doctor. This just gets them lost in the system. By running the Proove Addiction Profile in addition to a urine drug screen, a doctor can better understand the genetic factors associated with the aberrant behavior and refer the troubled patient to an addiction specialist for treatment. (more…)
Author Interviews, JACC, Thromboembolism, Yale / 01.03.2016

MedicalResearch.com Interview with: Behnood Bikdeli MD Department of Internal Medicine and Center for Outcomes Research and Evaluation (CORE) Yale University School of Medicine New Haven, CT 06510  Medical Research: What is the background for this study? What are the main findings? Response: The idea of closing the path of inferior vena cava (IVC) to prevent blood clots migrating to the pulmonary circulation and causing a pulmonary embolism (PE) has been around for over 150 years. We were aware than many practitioners might think of IVC filters for that reason, and specifically with the introduction of retrievable filters in recent years; that have made it more palatable for referring physicians. However, there is a paucity of high-quality data to suggest the efficacy of IVC filters. The two existing large trials did not show a mortality benefit from use of filters, and the guidelines have very narrow indications for use of IVC filters in patients who have already had a pulmonary embolism. Having said that, we wondered whether despite the absence of high-quality comparative effectiveness data, filters might be commonly used in patients with PE, particularly among older adults who are a vulnerable population (at higher risk of PE, at higher risk of PE complications; but also less likely to receive other advanced therapies for PE). Our study common use of IVC filters among older adults in the US; with over 75% relative increase in use of IVC filters from 1999 to 2010 (from ~5000 patients with PE in 1999 to ~9000 patients with PE in 2010). We also noted wide regional variations in the use of IVC filters (e.g. highest in the South Atlantic and lowest in the Mountain region). Such differences fundamentally persisted over time. In addition, we noted declining short-term and 1-year mortality rates in patients with pulmonary embolism over time, irrespective of whether or not they received an IVC filter. (more…)
Author Interviews, Heart Disease, JAMA, Thromboembolism / 01.09.2015

Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg DenmarkMedicalResearch.com Interview with: Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg Denmark Medical Research: What is the background for this study? What are the main findings? Response: In recent years, use of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death has extended beyond the original disease state (atrial fibrillation) for which it was proposed. In addition, it is recognized that the cluster of multiple stroke risk factors included within the CHA2DS2-VASc score increases the risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation is present. Thus, there is a need to study the extent to which concomitant atrial fibrillation modifies the pattern of the association between CHA2DS2-VASc score and the risk of ischemic stroke, thromboembolism, and death in patients with heart failure.
  • Our principal findings were that patients with heart failure had a high risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation was present.
  • Second, the CHA2DS2-VASc score was able to modestly predict these endpoints, and had a moderately high negative predictive value at 1-year follow-up.
  • Third, at high CHA2DS2-VASc scores (≥4), patients with heart failure without atrial fibrillation had high absolute risk of ischemic stroke, thromboembolism, and death, and the absolute risk increased in a comparable manner in patients with heart failure with and without atrial fibrillation, exhibiting a clear dose-response relationship. Indeed, the absolute risk of thromboembolic complications was higher among patients without atrial fibrillation compared to patients with concomitant atrial fibrillation at high CHA2DS2-VASc score (≥4).
(more…)
Author Interviews, Kaiser Permanente, Thromboembolism / 29.05.2015

MedicalResearch.com Interview with: Nathan Clark, PharmD Clinical pharmacy supervisor, anticoagulation and anemia management services and Thomas Delate, PhD Clinical research scientist Kaiser Permanente Colorado MedicalResearch: What is the background for this study? What are the main findings? Response: Patients with a history of blood clots are commonly prescribed warfarin, an anticoagulant, to decrease the body’s ability to form additional clots. Clinicians typically stop the use of warfarin in patients to reduce the risk of serious bleeding when invasive procedures, such as colonoscopy or orthopedic surgery are scheduled. However, when warfarin interruptions occur, patients are exposed to an increased risk of blood clots three to five days before and five or more days after invasive procedures. Bridge therapy with another, faster acting anticoagulant is often initiated in an attempt to reduce the patients’ risk for developing blood clots during that gap. Bridging has been a part of standard therapy for venous thromboembolism (VTE) patients undergoing invasive procedures for many years. But only limited data outlining the rates of bleeding and VTE recurrence were available to help clinicians analyze the risks and benefits of bridge therapy. We examined the electronic medical records of 1,178 patients with VTE who underwent 1,812 invasive diagnostic or surgical procedures between January 2006 and March 2012 that required the interruption of warfarin therapy. Study patients were categorized into three groups based on their annual risk of VTE recurrence without anticoagulant therapy. Within those groups, a total of 555 patients – 28.7 percent of low-risk, 33.6 percent of moderate-risk and 63.2 percent of high-risk patients – received bridging anticoagulant therapy. The 1,257 patients who did not receive bridge therapy interrupted their warfarin use and received no other anticoagulants during the perioperative period. The use of bridge therapy resulted in a 17-fold higher risk of bleeding without a significant difference in the rate of blood clot formation compared to patients who didn’t receive bridge therapy. In addition, there were no significant differences in the rates of blood clot occurrence or death between the bridged and non-bridged patient groups. (more…)
Author Interviews, BMJ, OBGYNE, Pharmacology, Thromboembolism / 27.05.2015

MedicalResearch.com Interview with: Yana Vinogradova, Research Fellow Division of Primary Care School of Medicine University of Nottingham Medical Research: What is the background for this study? What are the main findings? Response: Combined oral contraceptives are an effective method of birth control but do have measurable side effects.  One – common to all combined contraceptives and sometimes fatal – is an increased risk of venous thromboembolism (VTE).  A number of earlier studies investigated VTE risks for different types of hormonal contraceptives, but all were performed some years ago or had insufficient data to analyse newer preparations, while some included only healthy users and others did not adequately control for lifestyle and health issues.  The data used for this study were representative of the UK population and covered all currently prescribed drugs, with results adjusted for the widest possible range of available relevant factors. We found that the venous thromboembolism risks of combined oral contraceptives appear to fall into two distinct groups.  Newer drugs containing gestodene, desogestrel, drospirenone or cyproterone were associated with risks of VTE between 1.5 and 1.8 times higher than both the older compositions containing norethisterone or levonorgestrel and the relatively newer norgestimate.  While our findings are statistical associations between different compositions and venous thromboembolism risks, they do represent more comprehensive and reliable information for doctors making evidence-based prescribing decisions. (more…)
Author Interviews, Cancer Research, Lancet, Thromboembolism / 08.10.2014

MedicalResearch.com Interview with: Prof Martin H Prins MD Maastricht University Medical Centre, Maastricht, Netherlands Medical Research: What are the main findings of the study? Dr. Prins: Patients with active cancer, i.e. a cancer that was diagnosed or treated within 6 months before the episode, that was recurrent or metastatic, or that was diagnosed during treatment, who had a symptomatic episode of venous thromboembolism, were included in this pooled subgroup analysis of the Einstein DVT and PE studies. The incidence of recurrent venous thromboembolism was similar between groups. It occurred in 16 (5%) of 354 patients allocated to rivaroxaban and 20 (7%) of 301 patients allocated to enoxaparin and vitamin K antagonist (hazard ratio [HR] 0•67, 95% CI 0•35 to 1•30). Clinically relevant bleeding was also similar and occurred in 48 (14%) of 353 patients receiving rivaroxaban and in 49 (16%) of 298 patients receiving standard therapy (HR 0•80, 95% CI 0•54 to1•20). However, major bleeding was less frequent among rivaroxaban recipients and occurred in eight (2%) of 353 patients receiving rivaroxaban and in 15 (5%) of 298 patients receiving standard therapy (HR 0•42, 95% CI 0•18 to 0•99). Mortality was also similar. (more…)
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.. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)