scholarly journals 120 Safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with CKD: the Verona real-world experience

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Simone Fezzi ◽  
Gianluca Castaldi ◽  
Maddalena Widmann ◽  
Federico Marin ◽  
Alessandro Ruzzarin ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Therapy ◽  
Resistant Hypertension ◽  
Univariate Analysis ◽  
Daily Practice ◽  
Renal Sympathetic Denervation ◽  
High Risk Population ◽  
Significant Difference ◽  
Renal Artery Denervation

Abstract Aims To evaluate the safety and the efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension on top of medical therapy. Methods and results Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) monitoring were collected at baseline and 3, 6, and 12 months after RSD. Efficacy was assessed also in patients with an estimated glomerular filtration rate below 45 ml/min/1.73 m2. Patients were defined responders to RSD if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at the last follow-up available. Fifty-four patients with multiple comorbidities underwent RSD for uncontrolled-resistant hypertension from 2012 to 2021. Baseline office and ambulatory BP was 161.0/87.2 ± 24.1/15.6 mmHg and 155.4/87.5 ± 19.3/14.6 mmHg, respectively. At 12-month follow-up a significant reduction of office and ambulatory systolic BP, respectively by − 15.66 ± 29.73 mmHg (P < 0.01) and by − 11.3 ± 23.1 mmHg (P < 0.05), was noticed. BP reduction at 12-month follow-up among patients with eGFR <45 ml/min was similar to that obtained in patients with higher eGFR. Among patients treated before July 2020 with available follow-up (45/54) 36 patients (80%) were classified as responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of success of RSD at univariate analysis. Among responders and non-responders, the average medication number showed no significant difference at baseline and during follow-up. No major complications were observed and renal function was stable up to 12 months, even in patients with lowest eGFR at baseline. Conclusions RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction of systolic BP and a trend of reduction of the diastolic BP up to 12 months. 775 Figure

scholarly journals Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience

2021 ◽  
Author(s):  
Federico Marin ◽  
Simone Fezzi ◽  
Alessia Gambaro ◽  
Francesco Ederle ◽  
Gianluca Castaldi ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Therapy ◽  
Resistant Hypertension ◽  
Univariate Analysis ◽  
Daily Practice ◽  
Renal Sympathetic Denervation ◽  
High Risk Population ◽  
Safety And Efficacy ◽  
Renal Artery Denervation

Abstract Aims To evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy. Methods Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit. Results Forty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline. Conclusion RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months. Graphic abstract

scholarly journals Tibiotalocalcaneal Fusion Rate with a Novel Pseudoelastic Intramedullary Nail with NiTiNOL

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004
Author(s):  
Travis Dekker ◽  
John Steele ◽  
Beau Kildow ◽  
James DeOrio ◽  
Mark Easley ◽  
...  
Keyword(s):  
High Risk ◽  
Bone Resorption ◽  
Intramedullary Nail ◽  
Fusion Rate ◽  
High Risk Population ◽  
Risk Population ◽  
Non Union ◽  
Significant Difference ◽  
History Of

Category: Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is a salvage operation for patients with significant arthritis and deformity of ankle and subtalar joints. Despite overall clinic success, fusion across both joints continues to be a major challenge with nonunion rates reported up to 48% [Franceschi]. Aside from certain patient comorbidities, nonunion may result when compression across the joint is lost in the setting of bone resorption. The use of a pseudoelastic intramedullary nail has been shown to maintain compression across fusion site in response to bone resorption. The purpose of this study was to evaluate the fusion rate in a high-risk population at a tertiary care center using a psuedoelastic intramedullary nail with an internal nitinol element. Methods: After obtaining IRB approval, a retrospective review of consecutive patients that underwent procedures with TTC fusion with novel intramedullary nail system with super elastic internal nickel titanium (NiTiNOL, DynaNail, Medshape Inc, Atlanta, GA) was performed at a single academic institution. From 2014 to 2016, 58 patients were identified, 55 of which had minimum one year follow up or clinical and radiographic fusion (20 months average, range 6-41 months). The primary outcome was radiographic fusion analysis which was reviewed by three authors. Fusion was determined by consensus with criteria of 3 of 4 cortices with osseous bridging in asymptomatic patients[1, 2] or CT fusion based on Glazebrook et. al. criteria for hindfoot fusion[3, 4]. Average age of this cohort was 59 (SD= 16.3) years with BMI average 33.1 (SD= 8.87). Exclusion criteria include: follow-up less than 12 months in non-fused patients, and incomplete clinical or radiologic data. Results: The fusion rate in this high-risk population was 80.0% with the use of the NiTiNOL tibiotalocalcaneal nailing system. Univariate analysis demonstrated no significant difference (p>0.05) in fusion rates with patient comorbidities that portend to non-union: current or former history of tobacco use, diabetes mellitus, rheumatoid arthritis, nor patients with chronic kidney disease. The average BMI in the fusion group was 31.97 compared to 27.4 in the non-union group (p=0.016). There were 5 deep infections requiring reoperation with a single patient requiring a below the knee amputation. Seven patients required a second operation for removal of prominent interlocking screws. Conclusion: This preliminary data demonstrates fusion rates with this novel intramedullary device are consistent with historical data. These findings are encouraging in that this nailing system shows equal rates of fusion in patients with high risk comorbidities for non-union compared to historical controls demonstrating increased non-union rates in diabetics, patients with chronic renal failure and those with a history of smoking. This Tibiotalocalcaneal nailing system is safe and offers theoretical sustained compression with up to 6 mm of resorption or settling.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 876-877
Author(s):  
W. Zhu ◽  
T. De Silva ◽  
L. Eades ◽  
S. Morton ◽  
S. Ayoub ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Univariate Analysis ◽  
Diagnostic Delay ◽  
Cohort Differences ◽  
Phone Calls ◽  
Retrospective Audit ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Background:Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.Objectives:To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.Methods:We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.Results:3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).Conclusion:Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.Disclosure of Interests:None declared.

Abstract 481: Deactivation of the renin-angiotensin-aldosterone system (RAAS) lowers glycated Hemoglobin (HbA1c) in hypertensive patients with Atherosclerotic Renal Artery Stenosis (ARAS)

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Paola Caielli ◽  
Viola Sanga ◽  
Raffaella Motta ◽  
Michele Battistel ◽  
Lorenzo Calò ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Medical Therapy ◽  
Randomized Clinical Trials ◽  
Optimal Medical Therapy ◽  
Causative Role ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Contralateral Kidney ◽  
Significant Difference ◽  
The Difference

Background: blockade of the RAAS lowered the incidence of Diabetes Mellitus in randomized clinical trials, but whether the de-activation of the RAAS can elicit the same beneficial effect in patients with renovascular hypertension (RVH) is unknown. Aim: to verify if endovascular treatment (EVT) could improve glycemic control in patients with atherosclerotic RVH. Methods: in the METRAS study (http://clinicaltrials.gov/show/NCT01208714, a randomized clinical trial comparing the effect of EVT on top of optimal medical therapy versus medical therapy alone (OMT) on GFR of the ischemic and contralateral kidney in patients with atherosclerotic RVH), glycemic control, as assessed by HbA1c at baseline and repeatedly during follow-up, was a pre-specified secondary endpoint of the study. Results: between June 2010 and March 2014, 16 patients were randomly assigned to EVT plus optimal medical therapy (n = 9) or OMT alone (n = 7). At baseline the 2 groups showed no significant difference of age, clinical and demographical features. All the patients, except two in the EVT group, were on a RAAS blocker. At 2 years follow-up HbA1c increased in patients on OMT (59±12 mmol/mol) from baseline values (45±16 mmol/mol, p<0.001). By contrast, in the patients assigned to EVT HbA1c remained stable (42±7 mmol/mol at baseline vs 41±5 mmol/mol at follow-up; p = NS; p<0.001 vs OMT at follow-up). When analyzed after multivariate adjustment for age, HbA1c at enrollment, and presence/absence of DM, the difference between the arms remained highly significant (p<0.001). Conclusions: in patients with atherosclerotic RVH and chronic activation of the RAAS, deactivation of the RAAS by means of EVT was associated with no increase in plasma levels of HbA1c over long term follow-up. At variance, similar patients assigned to optimized medical therapy alone showed worsened glycemic control over time. These findings support the contention of a causative role of RAAS activation in the incidence/progression of DM.

scholarly journals Postoperative craniospinal radiotherapy of medulloblastoma in children and young adults

2003 ◽  
Vol 131 (5-6) ◽  
pp. 226-231
Author(s):  
Ivana Golubicic ◽  
Jelena Bokun ◽  
Marina Nikitovic ◽  
Jasmina Mladenovic ◽  
Milan Saric ◽  
...  
Keyword(s):  
High Risk ◽  
Brain Stem ◽  
Wilcoxon Test ◽  
Time Interval ◽  
Tumor Removal ◽  
Shunt Placement ◽  
Craniospinal Radiotherapy ◽  
Number Of Patients ◽  
Significant Difference

PURPOSE The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy) and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy). PATIENTS AND METHODS During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years), were treated with combined modality therapy and 72 of them were evaluable for the study end-points. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2%) have total, 8 (10.3%) near total and 41 (52.5%) partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days). Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7%) patients. The majority of them (46 73%) received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. RESULTS The follow-up period ranged from 1-12 years (median 3 years). Five-year overall survival (OS) was 51% and disease-free survival (DFS) 47% (Graph 1). During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p=0.0023) (Graph 2). Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p=0.0116). Significantly poorer survival was found in patients with meningitis developing in the postoperative period, with no patient living longer than two years (p=0.0134) (Graph 3). By analysis of OS and DFS in relation to presence of the malignant cells in liquor, statistically significant difference, i. e. positive CSF cytology was not obtained, which was of statistical importance for survival (p=0.8207). Neither shunt placement nor shunt type showed any impact on survival (p=0.5307 and 0.7119, respectively). Children younger than three years had significantly poorer survival compared to those older than 16 years (p=0.0473). Although there was a better survival rate in females than in males this was not statistically significant (p=0.2386).The analysis results of treatment showed that significantly better survival occurred in patients in whom total or subtotal tumor removal was possible (p=0.0022) (Graph 4). Patients who started radiotherapy within two months after surgery have better survival, but again this was not statistically significant, probably due to the small number of patients receiving delayed radiotherapy (p=0.2231)(Graph5). CONCLUSION Based on this factors standard and high risk group could be defined. Combined chemotherapy should to be investigated particularly for high risk subgroup. Future research should be done to define new therapeutic modalities (gene therapy, compounds active in tumor antiangiogenesis etc).

Abstract 78: Risk Factors Associated with Failure of Aggressive Medical Therapy in the SAMMPRIS Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Michael F Waters ◽  
Brian L Hoh ◽  
Michael J Lynn ◽  
Tanya N Turan ◽  
Colin P Derdeyn ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Medical Therapy ◽  
Primary Endpoint ◽  
Univariate Analysis ◽  
Baseline Risk ◽  
Medical Group ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

Background: The SAMMPRIS trial showed that aggressive medical therapy was more effective than stenting for preventing stroke in high-risk patients with symptomatic intracranial stenosis. However, 15% of patients in the medical group still had a primary endpoint (any stroke or death within 30 days of enrollment or stroke in the territory beyond 30 days) during a median follow-up of 32.7 months. We sought to determine baseline risk factors that were associated with a primary endpoint in the medical arm of SAMMPRIS. Methods: Data on 227 patients randomized to the medical group in SAMMPRIS were analyzed. Baseline demographic features, vascular risk factors, qualifying event, brain imaging and angiographic features were analyzed. The hazard ratio and p-value from a Cox proportional hazard regression model relating time until a primary endpoint to each factor were calculated. Results: Female gender, diabetes, stroke as the qualifying event (especially non-penetrator stroke), old infarct in the territory of the stenotic artery, and > 80% stenosis were associated (p < 0.10) with a higher risk of the primary endpoint on univariate analysis (see accompanying table) (multivariate analysis will be available by the time of ISC). Variables not associated with a higher risk of a primary endpoint in the medical arm included: age, race, antithrombotic therapy at the time of a qualifying event, time from qualifying event to enrollment (< 7 days vs. > 7 days), and location of stenosis. Conclusions: Several features were associated with an increased risk of the primary endpoint in the medical group in SAMMPRIS. On univariate analysis, the most important risk factors were an old infarct in the territory of the stenotic artery and stroke (especially non-penetrator stroke) as the qualifying event. These features will be useful for identifying particularly high-risk patients who should be targeted for future clinical trials testing alternative therapies to aggressive medical management.

scholarly journals Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shayan Moosa ◽  
Lindsay Bowerman ◽  
Ellen Smith ◽  
Mindy Bryant ◽  
Natalie Krovetz ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Population ◽  
Medical Center ◽  
Academic Medical Center ◽  
Readmission Rates ◽  
Academic Medical ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

scholarly journals Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Ischaemic Attack ◽  
Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

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