scholarly journals A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms

2021 ◽  
Vol 5 (1) ◽  
pp. 113-121
Author(s):  
Eva N. Hamulyák ◽  
Joost G. Daams ◽  
Frank W. G. Leebeek ◽  
Bart J. Biemond ◽  
Peter A. W. te Boekhorst ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Observational Studies ◽  
Randomized Trials ◽  
Myeloproliferative Neoplasms ◽  
Recurrence Risk ◽  
Antithrombotic Treatment ◽  
Statistical Heterogeneity ◽  
History Of ◽  
Recurrent Vte

Abstract Patients with myeloproliferative neoplasms (MPNs), polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have an increased risk of thrombosis. Risk of recurrent thrombosis can be reduced with antithrombotic therapy and/or cytoreduction, but the optimal long-term management in patients with MPN with a history of venous thromboembolism (VTE) is unknown, and clinical practice is heterogeneous. We performed a systematic review and meta-analysis of randomized trials and observational studies evaluating anticoagulant and/or antiplatelet therapy, with or without cytoreduction, in MPN patients with a history of VTE. A total of 5675 unique citations were screened for eligibility. No randomized trials were identified. Ten observational studies involving 1295 patients with MPN were included in the analysis. Overall, 23% had an arterial or recurrent venous thrombotic event on follow-up. The recurrence risk was lowest for patients on oral anticoagulation plus cytoreduction (16%); 55 of 313 (18%) with vitamin K antagonists (VKA) and 5 of 63 (8%) with direct oral anticoagulants (DOACs). In 746 analyzed patients, the risk of recurrent VTE ranged up to 33% (median 13%) and was low in 63 DOAC plus cytoreduction-treated patients (3.2%). All types of antithrombotic treatments were associated with a lower risk of recurrent VTE when combined with cytoreduction. Most studies had a high risk of bias, whereas clinical and statistical heterogeneity led to inconsistent and imprecise findings. In summary, evidence on the optimal antithrombotic treatment of VTE in patients with MPN is based on observational studies only with low certainty for all strategies. Our data suggest that a combination of anticoagulation and cytoreduction may provide the lowest recurrence risk.

Do Patients with a Family or Personal History of Venous Thromboembolism have an Increased Risk of Recurrence?

2021 ◽  
Author(s):  
Jonas Florin ◽  
Odile Stalder ◽  
Christine Baumgartner ◽  
Marie Méan ◽  
Nicolas Rodondi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Recurrence Risk ◽  
Personal History ◽  
Dose Effect ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
History Of ◽  
Risk Factors For Recurrence ◽  
Recurrent Vte ◽  
Observation Period

Abstract Background A family (FH) and personal history (PH) of venous thromboembolism (VTE) are commonly evaluated risk factors for recurrence. We examined the association between FH/PH of VTE and the risk of recurrence and whether a stronger history status (i.e., both FH/PH vs. no FH/PH) carries an increased recurrence risk. Methods We prospectively followed 813 patients aged ≥ 65 years with acute VTE from 9 Swiss hospitals. We classified patients into four groups: no FH/PH, FH only, PH only, and both FH/PH. The primary outcome was recurrent VTE during the full observation period. We examined the association between FH/PH status and the time to VTE recurrence using competing risk regression, adjusting for confounders and periods of anticoagulation. Results Of 813 patients with VTE, 59% had no FH/PH, 11% a FH only, 24% a PH only, and 7% had both a FH and PH of VTE. Overall, 105 patients had recurrent VTE during the full observation period. After adjustment, patients with a FH only (subhazard ratio [SHR] 0.8, 95% confidence interval [CI] 0.4–1.7), PH only (SHR 1.5, 95% CI 0.9–2.5), and both FH/PH (SHR 1.4, 95% CI 0.6–3.1) did not have an increased risk of recurrent VTE compared with those without FH/PH. When we considered the period after the completion of initial anticoagulation only, the results were similar. Conclusion Our findings indicate that in patients with acute VTE, a FH and/or PH of VTE does not convey an increased risk of recurrent VTE. In particular, we did not find a “dose–effect” relationship between FH/PH status and VTE recurrence.

scholarly journals Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review

2019 ◽  
Vol 46 (2) ◽  
pp. E14 ◽  
Author(s):  
Bradley Kolb ◽  
Hassan Fadel ◽  
Gary Rajah ◽  
Hamidreza Saber ◽  
Ali Luqman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Observational Studies ◽  
English Language ◽  
Randomized Trials ◽  
Occlusive Disease ◽  
Cognitive Outcomes ◽  
Thomson Reuters ◽  
Before And After

OBJECTIVESteno-occlusive diseases of the cerebral vasculature have been associated with cognitive decline. The authors performed a systematic review of the existing literature on intracranial steno-occlusive disease, including intracranial atherosclerosis and moyamoya disease (MMD), to determine the extent and quality of evidence for the effect of revascularization on cognitive performance.METHODSA systematic search of PubMed/MEDLINE, the Thomson Reuters Web of Science Core Collection, and the KCI Korean Journal Database was performed to identify randomized controlled trials (RCTs) in the English-language literature and observational studies that compared cognitive outcomes before and after revascularization in patients with steno-occlusive disease of the intracranial vasculature, from which data were extracted and analyzed.RESULTSNine papers were included, consisting of 2 RCTs and 7 observational cohort studies. Results from 2 randomized trials including 142 patients with symptomatic intracranial atherosclerotic steno-occlusion found no additional benefit to revascularization when added to maximal medical therapy. The certainty in the results of these trials was limited by concerns for bias and indirectness. Results from 7 observational trials including 282 patients found some cognitive benefit for revascularization for symptomatic atherosclerotic steno-occlusion and for steno-occlusion related to MMD in children. The certainty of these conclusions was low to very low, due to both inherent limitations in observational studies for inferring causality and concerns for added risk of bias and indirectness in some studies.CONCLUSIONSThe effects of revascularization on cognitive performance in intracranial steno-occlusive disease remain uncertain due to limitations in existing studies. More well-designed randomized trials and observational studies are needed to determine if revascularization can arrest or reverse cognitive decline in these patients.

scholarly journals Systematic review of the relationship between comorbidity and out-of-hospital cardiac arrest outcomes

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031655 ◽  
Author(s):  
David Majewski ◽  
Stephen Ball ◽  
Judith Finn
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Current Evidence ◽  
Cochrane Library ◽  
Neurological Outcomes ◽  
Statistical Heterogeneity ◽  
Comorbidity Burden ◽  
History Of ◽  
The Impact ◽  
Hospital Cardiac Arrest

ObjectivesTo assess the current evidence on the effect pre-arrest comorbidity has on survival and neurological outcomes following out-of-hospital cardiac arrest (OHCA).DesignSystematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Data sourcesMEDLINE, Ovid Embase, Scopus, CINAHL, Cochrane Library and MedNar were searched from inception to 31 December 2018.Eligibility criteriaStudies included if they examined the association between prearrest comorbidity and OHCA survival and neurological outcomes in adult or paediatric populations.Data extraction and synthesisData were extracted from individual studies but not pooled due to heterogeneity. Quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale.ResultsThis review included 29 observational studies. There were high levels of clinical heterogeneity between studies with regards to patient recruitment, inclusion criteria, outcome measures and statistical methods used which ultimately resulted in a high risk of bias. Comorbidities reported across the studies were diverse, with some studies reporting individual comorbidities while others reported comorbidity burden using tools like the Charlson Comorbidity Index. Generally, prearrest comorbidity was associated with both reduced survival and poorer neurological outcomes following OHCA with 79% (74/94) of all reported adjusted results across 23 studies showing effect estimates suggesting lower survival with 42% (40/94) of these being statistically significant. OHCA survival was particularly reduced in patients with a prior history of diabetes (four out of six studies). However, a prearrest history of myocardial infarction appeared to be associated with increased survival in one of four studies.ConclusionsPrearrest comorbidity is generally associated with unfavourable OHCA outcomes, however differences between individual studies makes comparisons difficult. Due to the clinical and statistical heterogeneity across the studies, no meta-analysis was conducted. Future studies should follow a more standardised approach to investigating the impact of comorbidity on OHCA outcomes.PROSPERO registration numberCRD42018087578

scholarly journals Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Jian Zhu ◽  
Yu-Ping Zhou ◽  
Yun-Peng Wei ◽  
Xi-Qi Xu ◽  
Xin-Xin Yan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Prior History ◽  
Anticoagulation Treatment ◽  
Increased Risk ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Recurrent Vte ◽  
Potential Factors

Background: The association between anticoagulation outcomes and prior history of venous thromboembolism (VTE) in chronic thromboembolic pulmonary hypertension (CTEPH) has not been established. This study aimed to compare the efficacy and safety of anticoagulation treatment in CTEPH patients with and without prior history of VTE.Methods: A total of 333 CTEPH patients prescribed anticoagulants were retrospectively included from May 2013 to April 2019. The clinical characteristics were collected at their first admission. Incidental recurrent VTE and clinically relevant bleeding were recorded during follow-up. The Cox proportional regression models were used to identify potential factors associated with recurrent VTE and clinically relevant bleeding.Results: Seventy patients (21%) without a prior history of VTE did not experience recurrent VTE during anticoagulation. Compared to CTEPH patients without a prior history of VTE, those with a prior history of VTE had an increased risk of recurrent VTE [2.27/100 person-year vs. 0/100 person-year; hazard ratio (HR), 8.92; 95% confidence interval (CI), 1.18–1142.00; P = 0.029] but a similar risk of clinically relevant bleeding (3.90/100 person-year vs. 4.59/100 person-year; HR, 0.83; 95% CI, 0.38–1.78; P = 0.623). Multivariate Cox analyses suggested that a prior history of VTE and interruption of anticoagulation treatments were significantly associated with an increased risk of recurrent VTE, while anemia and glucocorticoid use were significantly associated with a higher risk of clinically relevant bleeding.Conclusions: This study is the first to reveal that a prior history of VTE significantly increases the risk of recurrent VTE in CTEPH patients during anticoagulation treatment. This finding should be further evaluated in prospective studies.

Oral anticoagulant use in patients with morbid obesity: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Tzu-Fei Wang ◽  
Marc Carrier ◽  
Karine Fournier ◽  
Deborah M. Siegal ◽  
Grégoire Le Gal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Morbid Obesity ◽  
Major Bleeding ◽  
Observational Studies ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Systemic Embolism ◽  
Recurrent Vte

Objectives: Obesity is associated with increased risks of atrial fibrillation (AF) and venous thromboembolism (VTE) for which anticoagulation is commonly used. However, data on the efficacy and safety of oral anticoagulants in patients with morbid obesity are limited. Methods: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for AF or VTE in patients with morbid obesity. Results: We included 3 randomized controlled trials (5 studies) and 18 observational studies in adult patients with a body weight ≥ 120 kg, body mass index (BMI) ≥ 40 kg/m2 or classified as morbid obesity who received DOACs or VKAs for AF or VTE (N=77,687). The primary efficacy outcome was stroke/systemic embolism or recurrent VTE, and the primary safety outcome was major bleeding. DOACs were associated with a pooled incidence rate of stroke/systemic embolism of 1.16 per 100 person-years, compared to 1.18 with VKAs. The incidence of recurrent VTE on DOACs was 3.83 per 100 person-years, compared to 6.81 on VKAs. In both VTE and AF populations, DOACs were associated with lower risks of major bleeding compared to VKAs. However, all observational studies had moderate to serious risks of bias. Conclusions: Patients with morbid obesity on DOACs had similar risks of stroke/systemic embolism, lower rates of recurrent VTE and major bleeding events compared to those on VKAs. However, the certainty of evidence was low given that studies were mostly observational with high risk of confounding.

Marburg I polymorphism of factor VII-activating protease and risk of recurrent venous thromboembolism

2006 ◽  
Vol 95 (01) ◽  
pp. 65-67 ◽  
Author(s):  
Talin Gulesserian ◽  
Gregor Hron ◽  
Georg Endler ◽  
Sabine Eichinger ◽  
Oswald Wagner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Recurrence Risk ◽  
Factor Vii ◽  
Study Endpoint ◽  
Protease Gene ◽  
Confounding Factors ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

SummaryWhether a single nucleotide polymorphism (1601 G>A) in the factor VII-activating protease gene (FSAP Marburg I) is a risk factor for venous thromboembolism (VTE) is unclear. We investigated the relevance of the variant with respect to recurrent VTE. 854 patients with a first unprovoked VTE were followed for an average of 41 months after discontinuation of anticoagulation. Study endpoint was symptomatic recurrent VTE. VTE recurred in 7 of 41 patients (17%) with and in 106 of 813 patients (13%) without the variant. After3 years, the probability of recurrence was 20.0% (95% CI, 5.3% to 34.6%) among patients with and 12.2% (95% CI, 9.6% to 14.8%) among those without FSAP MarburgI (p = 0. 5). The relative recurrence risk among carriers of the variant was 1.3 (95% CI, 0.6 to 2.8; p = 0.5) before and 1.5 (95% CI, 0.7 to 3.3; p = 0. 3) after adjustment for potentially confounding factors. We conclude that FSAP Marburg I is, if at all, only a mild factor for recurrent VTE. Patients with FSAP Marburg I most probably will not benefit from extended anticoagulation.

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