Management of Patients with Acute Venous Thromboembolism: Findings from the RIETE Registry

Monréal, Manuel; Suárez, Carmen; Fajardo, J. A. González; Barba, Raquel; Uresandi, Fernando; Valle, Reina; Rondón, P.; Investigators, Riete

doi:10.1159/000083823

Cited by 58 publications

(40 citation statements)

References 16 publications

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“…22,[31][32][33][34] In TUSCAN-PE recent infectious diseases, especially affecting the respiratory system, were found as the main risk factors of PE. Despite this percentage is much greater compared to the most recently published studies on topic, 10,11,14,17 this finding is not completely surprising, since than in the recent years many literature reports have focused on link between infectious diseases, inflammation and thrombosis. 35,36 Further investigations are warranted to better define the role of infectious diseases as risk factors for PE.…”

Section: Discussionmentioning

confidence: 81%

“…Compared with other studies, the population of TUSCAN-PE is older, even when considered other Italian populations enrolled in registries, such as those of IPER, an Italian registry performed in 49 Centers of which 37 Cardiology Units, 6 Emergency Medicine Units and 6 Internal Medicine Units, and RIETE, an international multicenter registry. [6][7][8][9][10][11][12][13][14]27 One of the most important findings emerged in TUSCAN-PE study was that around one third of patients received diagnosis of PE from Internists in the first hours from admission in their wards. Diagnosis of acute PE remains a challenge due to non-specific presentation in terms of signs, instrumental and laboratory findings, especially in the older patients such as those of our study.…”

Section: Discussionmentioning

confidence: 99%

“…Immobility remains one of the most frequent risk factors for VTE, especially in elderly patients and our study confirms it in agreement with literature. [9][10][11][12][13][14]17,28 In TUSCAN-PE around one third of patients discharged with PE from Internal Medicine wards has active cancer. This finding is higher compared to the most [ Management of acute pulmonary embolism recent studies, such as IPER, EMPEROR, MASTER, SWIVTER and ZATPOL, but similar to that observed in the Italian population of RIETE registry.…”

Section: Discussionmentioning

confidence: 99%

“…18,19,50 On the other side our study highlights the high percentage of patients treated with LMWHs or fondaparinux in acute phase, even if in high risk patients, performed in more than 80% of overall patients, in agreement with literature evidence. 10,11,14,16 Surprisingly, around one half of our patients were discharged without switching to oral anticoagulation. However, it is not possible to know if this kind of therapy has been started after hospital discharge due to the lack of follow-up.…”

mentioning

confidence: 85%

“…[6][7][8][9][10][11][12] Furthermore other studies or registries such as MASTER, RIETE and the ongoing SCOPE, despite enclosing Italian Internal Medicine Units, were conducted in Centers of recognized experience in the field of venous thromboembolism, whereas other studies such as ZATPOL and SWIVTER were conducted in European countries out of Italy. [13][14][15][16][17] Practical recommendations on prevention, diagnosis, prognostic stratification and acute treatment have had wide diffusion in the last years [18][19][20][21] but evidence about their application in real life lack. Therefore the aim of our study was to provide information about characteristics and clinical management of acute PE patients admitted in the setting of Italian Internal Medicine wards.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Masotti

Pieralli

Panigada³

et al. 2014

Ital J Med

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Acute pulmonary embolism (PE) remains one of the leading causes of mortality and morbidity in cardiovascular setting. Despite much information about clinical aspects and recommendations or clinical guidelines is available from literature, few data exist about the management of PE in real world of internal medicine scenario. Therefore the aim of the present study was to report on characteristics and management of PE patients admitted in this setting. TUSCAN-PE study was a multicenter, observational, retrospective, cohort study aimed to analyze data of PE patients admitted in Internal Medicine wards of Tuscany. Each center was invited to submit anonymously data of at least ten patients consecutively discharged for acute PE in 2012. Data were referred to demographic, clinical, instrumental, prognostic and therapeutic characteristics. A total of 452 patients from 28 Tuscan centers (60.2% F), with mean age 76.01±12.34 years, were enrolled. A total of 87% of patients was admitted from Emergency Department, but only 65.2% of patients with diagnosis of PE. Around one third of diagnoses of PE was performed by internists. In 14.8% of diagnoses was incidental. In 86% of patients, diagnosis was performed by computer tomography pulmonary angiography. Overall mortality was 9.5%, 5.75% being PE-related. Main risk factors enclosed recent respiratory tract infections (55.3%), immobility (42.25%), recent hospital admissions (33.6%) and cancer (30.3%). In 65.8% of patients, PE was associated with deep vein thrombosis. 16.6% of patients had a shock index ≥1 and 84.75% simplified pulmonary embolism severity index (PESI) score ≥1. A number of 51.5% of patients presented echocardiographic right heart dysfunction, 50.6% and 55.9% of patients presented increased values of troponins and natriuretic peptides, respectively. The following percentage, 6.5%, 71.1% and 22.4%, were defined as high, intermediate and low risk according to the European Society of Cardiology (ESC) criteria, respectively. Antithrombotic treatment was started in Internal Medicine wards in 60.6% of patients. 4.9% of patients were treated with systemic thrombolysis, 15.1% with intravenous unfractionated heparin, whereas low molecular weight heparins and fondaparinux were performed in 39.2% and 39.8% of patients, respectively. Vitamin K antagonists were prescribed in 52.1% of patients at hospital discharge. Fatal and non-fatal major bleedings occurred in 1.7% of patients. TUSCAN-PE study contributes to the knowledge of real life management of acute PE in the Internal Medicine setting.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Masotti

Pieralli

Panigada³

et al. 2014

Ital J Med

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Treatment of Acute Venous Thromboembolism in Hospitalized Patients

Minichiello

Doctoroff

Farrell

2011

Inpatient Anticoagulation

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Real‐life Use of Anticoagulants in Venous Thromboembolism With a Focus on Patients With Exclusion Criteria for Direct Oral Anticoagulants

Moustafa

Pesavento

Micco

et al. 2017

Clin Pharma and Therapeutics

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and the RIETE InvestigatorsWe assessed the real-life use of direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and exclusion criteria for randomized trials. From 2013 to 2016, 3,578 of 18,853 patients (19%) had exclusion criteria. Irrespective of which anticoagulant was chosen, they had more VTE recurrences (hazard ratio (HR): 3.10; 95% confidence interval (CI): 2.47-3.88), major bleeds (HR: 4.10; 95% CI: 3.38-4.96), and deaths (HR: 9.47; 95% CI: 8.46-10.6) than those without exclusion criteria. During initial therapy, no patient with exclusion criteria on DOACs (n 5 115) recurred, but those on rivaroxaban bled less often (adjusted HR: 0.18; 95% CI: 0.04-0.79) than those on unfractionated heparin (n 5 224) and similar to those (n 5 3,172) on low-molecular-weight (LMWH) heparin. For long-term therapy, patients on rivaroxaban (n 5 151) had nonsignificantly fewer VTE recurrences (adjusted HR: 0.74; 95% CI: 0.08-1.32) and major bleeds (adjusted HR: 0.41; 95% CI: 0.15-1.15) than those on LMWH (n 5 2,071). The efficacy and safety of DOACs were similar to standard therapy.

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Management of Patients with Acute Venous Thromboembolism: Findings from the RIETE Registry

Cited by 58 publications

References 16 publications

Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE Study

Treatment of Acute Venous Thromboembolism in Hospitalized Patients

Real‐life Use of Anticoagulants in Venous Thromboembolism With a Focus on Patients With Exclusion Criteria for Direct Oral Anticoagulants

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