Profile of Patients Diagnosed With Acute Venous Thromboembolism in Routine Clinical Practice: The RE-COVERY DVT/PE™ Study

Goldhaber, Samuel Z.; Ageno, Walter; Casella, Ivan Benaduce; Chee, Kok Han; Schellong, Sebastian; Singer, Daniel E.; Desch, Marc; Reilly, Paul; Donado, Esther; Tang, Wenbo; Voccia, Isabelle; Schulman, Sam

doi:10.1016/j.amjmed.2020.03.036

Cited by 10 publications

(15 citation statements)

References 14 publications

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“…Overall, 77% of patients received oral anticoagulants (54% non–vitamin K antagonist oral anticoagulants [NOACs] and 23% vitamin K antagonists [VKAs]), with 20% receiving parenteral anticoagulation only; NOAC treatment was less frequent in patients with cancer, chronic renal disease, heart failure, or stroke. 12…”

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confidence: 99%

“…Overall, 77% of patients received oral anticoagulants (54% non-vitamin K antagonist oral anticoagulants [NOACs] and 23% vitamin K antagonists [VKAs]), with 20% receiving parenteral anticoagulation only; NOAC treatment was less frequent in patients with cancer, chronic renal disease, heart failure, or stroke. 12 Despite current guidelines, studies have shown that anticoagulants are used in almost all patients with IDDVT. [13][14][15][16] The aim of this ancillary study of RE-COVERY DVT/PE was to further investigate the characteristics, management, and anticoagulant use in patients with IDDVT in clinical practice.…”

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confidence: 99%

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Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

Schellong

Ageno

Casella

et al. 2021

Semin Thromb Hemost

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Isolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Of the 6,095 eligible patients, 323 with DVT located outside the lower limb and no PE were excluded. Of the remaining 5,772 patients, 17.6% had IDDVT, 39.9% had PDVT ± DDVT, and 42.5% had PE ± DVT. IDDVT patients were younger and had fewer risk factors for VTE than the other groups. Other comorbidities were less frequent in the IDDVT group, except for varicose veins, superficial thrombophlebitis, and venous insufficiency. IDDVT patients were less likely to be diagnosed in an emergency department (22.3 vs. 29.7% for PDVT ± DDVT and 45.4% for PE ± DVT) or hospitalized for VTE (29.2 vs. 48.5% for PDVT ± DDVT and 75.0% for PE ± DVT). At hospital discharge or 14 days after diagnosis (whichever was later), non–vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (55.6% for IDDVT, 54.7% for PDVT ± DDVT, and 52.8% for PE ± DVT). Although differences in patient characteristics, risk factors, and clinical management were identified, anticoagulant treatment of IDDVT was almost equal to that of PDVT or PE. Prospective studies should investigate whether, in a global perspective, this is an appropriate use of anticoagulants. Trial registration number ClinicalTrials.gov NCT02596230.

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confidence: 99%

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confidence: 99%

Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

Schellong

Ageno

Casella

et al. 2021

Semin Thromb Hemost

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“…Cancer-associated thrombosis (CAT), or Trousseau's syndrome, is attributed as the second leading cause of cancer patient death after organ failure upon metastatic disease (2,3). High D-dimer levels, a product of coagulation cascade activation, are associated with advance cancer stage and accordingly there is a high prevalence of venous thromboembolism (VTE) in stage IV cancer patients (4)(5)(6). Given the risk of VTE being 4-to 7-fold higher in the cancer patient, modulation of the coagulation system is currently an essential aspect of cancer treatment (7), with the potential to improve in the coming years.…”

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confidence: 99%

Deciphering the Role of the Coagulation Cascade and Autophagy in Cancer-Related Thrombosis and Metastasis

et al. 2020

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Thrombotic complications are the second leading cause of death among oncology patients worldwide. Enhanced thrombogenesis has multiple origins and may result from a deregulation of megakaryocyte platelet production in the bone marrow, the synthesis of coagulation factors in the liver, and coagulation factor signaling upon cancer and the tumor microenvironment (TME). While a hypercoagulable state has been attributed to factors such as thrombocytosis, enhanced platelet aggregation and Tissue Factor (TF) expression on cancer cells, further reports have suggested that coagulation factors can enhance metastasis through increased endothelial-cancer cell adhesion and enhanced endothelial cell activation. Autophagy is highly associated with cancer survival as a double-edged sword, as can both inhibit and promote cancer progression. In this review, we shall dissect the crosstalk between the coagulation cascade and autophagic pathway and its possible role in metastasis and cancer-associated thrombosis formation. The signaling of the coagulation cascade through the autophagic pathway within the hematopoietic stem cells, the endothelial cell and the cancer cell are discussed. Relevant to the coagulation cascade, we also examine the role of autophagy-related pathways in cancer treatment. In this review, we aim to bring to light possible new areas of cancer investigation and elucidate strategies for future therapeutic intervention.

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“…The RE-COVERY DVT/PE study has two objectives. In the first phase, it aims to characterize patients with VTE, the location of VTE events, and treatment patterns at initial presentation [11]. In the second phase, it evaluates outcomes in patients treated with dabigatran or VKA in routine clinical practice [12].…”

Section: Introductionmentioning

confidence: 99%

“…In the second phase, it evaluates outcomes in patients treated with dabigatran or VKA in routine clinical practice [12]. We previously described baseline characteristics of the overall cohort of patients in the first phase, regional variations in treatment choices, and the influence of baseline clinical features such as cancer on the choice of anticoagulants [11]. Overall, 77% of patients received oral anticoagulants (54% NOACs and 23% VKAs), and 20% received parenteral anticoagulation only.…”

Section: Introductionmentioning

confidence: 99%

Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study

Ageno

Casella

Chee

et al. 2020

J Thromb Thrombolysis

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In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), ~ 12–13% of patients were elderly and ~ 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (< or ≥ 75 years) and renal impairment (creatinine clearance [CrCl; estimated with Cockcroft–Gault formula] < 30 [severe], 30 to < 50 [moderate], 50 to < 80 [mild], ≥ 80 [normal] mL/min). Of 6095 eligible patients, 25.3% were aged ≥ 75 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged ≥ 75 vs. 58.1% < 75 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT02596230. Graphic abstract Decreasing renal function, particularly in the subgroup with CrCl < 30 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant.

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Profile of Patients Diagnosed With Acute Venous Thromboembolism in Routine Clinical Practice: The RE-COVERY DVT/PE™ Study

Cited by 10 publications

References 14 publications

Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

Deciphering the Role of the Coagulation Cascade and Autophagy in Cancer-Related Thrombosis and Metastasis

Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study

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