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Management of antithrombotic therapy in gray areas of venous thromboembolism: a Delphi consensus panel
We report a Delphi Consensus on DOAC use in VTE patients. The consensus dealt with seven main topics: (1) clinical superiority of DOACs compared to VKAs; (2) therapeutic opt ions for patients with intermediate risk PE; (3) therapeutic management of patients with deep vein thrombosis (DVT); (4) DOACs’ role in oncological patients with VTE; (5) role of the reversal agent; (6) safety of low doses of DOACs in VTE patients; (7) DOACs long-term therapy (more than 12 months ) in VTE patients; Forty-six physicians (cardiologists, internists, angiologists, oncologists, hematologists, and geriatricians) from Italy expressed their...
Source: Internal and Emergency Medicine - March 29, 2020 Category: Emergency Medicine Source Type: research

Design and rationale of a randomized, placebo-controlled trial on the efficacy and safety of sulodexide for extended treatment in elderly patients after a first venous thromboembolism
AbstractHow to prevent recurrences after a first venous thromboembolic (VTE) event in elderly patients is still an open issue, especially because of the high bleeding risk of anticoagulation in these patients. The placebo-controlled “Jason” study aims at assessing the efficacy and safety for secondary VTE prevention in elderly patients of oral Sulodexide (Vessel®) administration, a mixture of glycosaminoglycans (Alfasigma, Bologna, Italy) which proved effective against recurrences in a general population (SURVET study) without major bleeding (MB) complications. 1450 patients, aged  ≥ 75 years, after at least 3�...
Source: Internal and Emergency Medicine - May 24, 2020 Category: Emergency Medicine Source Type: research

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry
AbstractRefractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients ’ condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously impla...
Source: Internal and Emergency Medicine - August 8, 2020 Category: Emergency Medicine Source Type: research

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort
AbstractThe 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] was recently proposed to characterize AF patients. In this post hoc analysis we evaluated the agreement between the therapeutic strategy (rate or rhythm control, respectively), as suggested by the 4S-AF scheme, and the actual strategy followed in a patients cohort. Outcomes of interest were as follows: all-cause death, a composite of all-cause death/any thromboembolism/acute coronary syndrome, and a composite of all-cause death, any thrombotic/ischemic event, and major bleeding (net clinical outcome). W...
Source: Internal and Emergency Medicine - December 2, 2021 Category: Emergency Medicine Source Type: research

Sex differences at the platelet –vascular interface
AbstractPlatelets are multifunctional cells that ensure the integrity of the vascular wall and modulate the immune response at the blood/vascular interface. Their pathological activation results in both thrombosis and inflammation and implicates them in the pathogenesis of vascular disease. Vascular diseases are sexually dimorphic in terms of incidence, clinical presentation, outcome, and efficacy of anti-platelet therapy. We here provide an overview of what is known about the role of platelets in the initiation and progression of vascular diseases and summarize what is known about the sex differences in platelet reactivit...
Source: Internal and Emergency Medicine - May 16, 2022 Category: Emergency Medicine Source Type: research

Efficacy of mobile health-technology  integrated care based on the ‘Atrial fibrillation Better Care’ (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial
Abstract The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster-randomized trial showed that a mobile health (mHealth)-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway approach reduced the risk of adverse events in atrial fibrillation (AF) patients. Whether this benefit can be applied to both males and females is unclear, especially given the suboptimal management and poorer cardiovascular outcomes in females wit h AF. In this post-hoc analysis, we performed a sex-stratified analysis of the mAFA-II trial. Between June 2018 and August 2019, adult AF patient...
Source: Internal and Emergency Medicine - January 11, 2023 Category: Emergency Medicine Source Type: research

Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial
AbstractAF patients with history of thromboembolic events are at higher risk of thromboembolic recurrences, despite appropriate antithrombotic treatment. We aimed to evaluate the effect of mobile health (mHealth) technology-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway approach (mAFA intervention) in secondary prevention AF patients. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial enrolled adult AF patients across 40 centers in China. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and reho...
Source: Internal and Emergency Medicine - March 16, 2023 Category: Emergency Medicine Source Type: research

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