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Melina Verso - One of the best experts on this subject based on the ideXlab platform.
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prevalence of risk factors for venous thromboembolism in the italian population results of a cross sectional study from the Master Registry
Internal and Emergency Medicine, 2013Co-Authors: Walter Ageno, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, R Pistelli, Melina VersoAbstract:The prevalence of major risk factors for VTE may differ according to age, gender and clinical presentation. We tested this hypothesis in a large Italian VTE population. Master is a multicenter Registry aimed to prospectively collect information on a large cohort of patients with acute VTE. The presence of major risk factors was captured by an electronic data network in consecutive patients with objectively confirmed acute VTE. We enrolled 2,119 patients (49.8% men) of whom 424 (20%) 80 years. The prevalence of known risk factors in the four age groups is 63.9, 52.6, 54.6, and 58.3%, respectively (p = 0.002). Immobilization and severe medical disorders are more commonly associated with VTE in patients >80 years, trauma is significantly more common in patients <40 years than in older patient groups. The prevalence of unprovoked events is the highest in patients 41–60 years, and lowest in patients less than 40 years. After logistic regression analysis, patients with pulmonary embolism are more likely to have known risk factors for VTE than patients with deep vein thrombosis at presentation (p = 0.0021), and women are less likely than men to have an unprovoked VTE (p < 0.0001). In conclusion, a substantial proportion of VTE events remain classified as unprovoked. Unprovoked events are more common in middle aged patients, in men, and in patients presenting with deep vein thrombosis.
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long term death and recurrence in patients with acute venous thromboembolism the Master Registry
Thrombosis Research, 2012Co-Authors: Melina Verso, Giancarlo Agnelli, Davide Imberti, Walter Ageno, Gualtiero Palareti, Marco Moia, R Pistelli, Valeria CantoneAbstract:Abstract Background The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter Registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Meth o ds Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results 2119 patients with acute VTE were included in the Registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence.
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seasonal variation in the occurrence of venous thromboembolism data from the Master Registry
Clinical and Applied Thrombosis-Hemostasis, 2009Co-Authors: Roberto Manfredini, Riccardo Pistelli, Davide Imberti, Massimo Gallerani, Melina Verso, Walter Ageno, Giancarlo AgnelliAbstract:Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal variation. As for venous thromboembolism (VTE), not univocal results are available, and studies are mainly retrospective. We aimed to confirm the existence of a seasonal pattern in the occurrence of VTE on a large prospective population. The analysis considered consecutive cases of VTE enrolled into the Master Registry in 25 Italian hospitals, between January 2002 and November 2004. The total population consisted of 2119 subjects (1056 men, mean age 59 ± 18 years). The total sample was divided into subgroups by gender, age (<40, 41—60, 61—80, ≥80 years), type of event (first episode; proximal or distal; upper or lower limb; idiopathic or secondary deep vein thrombosis or pulmonary embolism, or both), and underlying risk factors, eg, cancer, previous VTE, estroprogestinic therapy, lack of prophylaxis, immobilization, surgery, pregnancy or puerperium, and medical diseases. Cases were grouped according to...
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do italian vascular centers look for isolated calf deep vein thrombosis analysis of isolated calf deep vein thromboses included in the Master Registry
International Angiology, 2008Co-Authors: Gualtiero Palareti, Riccardo Pistelli, Marco Moia, Romina Rossi, G Agnelli, D Imberti, W Ageno, Melina VersoAbstract:Aim. Two diagnostic imaging strategies for suspected deep venous thrombosis (DVT) in symptomatic patients are currently used: a serial compression ultrasound examination of proximal veins, or a single complete ultrasound investigation of proximal and distal veins. These strategies lead to different results since only the latter allows diagnosis of isolated calf DVT (ICDVT). Methods. We analyzed the approach of Italian centers in looking for ICDVT using the observational Master Registry which prospectively collected information on patients with acute symptomatic venous thromboembolism. Results. ICDVT was diagnosed in 170 of the 1772 patients with leg DVT (9.6%). The rate of diagnosed ICDVT vs total DVT differed between centers from 0% to 24%. Patients with ICDVT were younger (P<0.0001); diagnosis was more frequently delayed (P<0.0001), temporary risk factors were more frequent, cancer was less frequent (P<0.001), and pulmonary embolism (PE) was more frequent at presentation (P<0.05). More ICDVT patients received LMWH only, not followed by oral anticoagulation (P<0.001). Conclusion. The diagnostic strategy for suspected leg DVT differs greatly among Italian centers. A relatively high rate of PE was recorded in patients with ICDVT for reasons which are open to debate. Prospective, well designed studies on the clinical risks and the need for diagnosing ICDVT, and the advantages/disadvantages of the two diagnostic procedures are urgently needed.
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risk factors for venous thromboembolism in the elderly results of the Master Registry
Blood Coagulation & Fibrinolysis, 2008Co-Authors: Walter Ageno, Riccardo Pistelli, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Approximately 50–75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence an
Giancarlo Agnelli - One of the best experts on this subject based on the ideXlab platform.
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prevalence of risk factors for venous thromboembolism in the italian population results of a cross sectional study from the Master Registry
Internal and Emergency Medicine, 2013Co-Authors: Walter Ageno, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, R Pistelli, Melina VersoAbstract:The prevalence of major risk factors for VTE may differ according to age, gender and clinical presentation. We tested this hypothesis in a large Italian VTE population. Master is a multicenter Registry aimed to prospectively collect information on a large cohort of patients with acute VTE. The presence of major risk factors was captured by an electronic data network in consecutive patients with objectively confirmed acute VTE. We enrolled 2,119 patients (49.8% men) of whom 424 (20%) 80 years. The prevalence of known risk factors in the four age groups is 63.9, 52.6, 54.6, and 58.3%, respectively (p = 0.002). Immobilization and severe medical disorders are more commonly associated with VTE in patients >80 years, trauma is significantly more common in patients <40 years than in older patient groups. The prevalence of unprovoked events is the highest in patients 41–60 years, and lowest in patients less than 40 years. After logistic regression analysis, patients with pulmonary embolism are more likely to have known risk factors for VTE than patients with deep vein thrombosis at presentation (p = 0.0021), and women are less likely than men to have an unprovoked VTE (p < 0.0001). In conclusion, a substantial proportion of VTE events remain classified as unprovoked. Unprovoked events are more common in middle aged patients, in men, and in patients presenting with deep vein thrombosis.
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long term death and recurrence in patients with acute venous thromboembolism the Master Registry
Thrombosis Research, 2012Co-Authors: Melina Verso, Giancarlo Agnelli, Davide Imberti, Walter Ageno, Gualtiero Palareti, Marco Moia, R Pistelli, Valeria CantoneAbstract:Abstract Background The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter Registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Meth o ds Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results 2119 patients with acute VTE were included in the Registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence.
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seasonal variation in the occurrence of venous thromboembolism data from the Master Registry
Clinical and Applied Thrombosis-Hemostasis, 2009Co-Authors: Roberto Manfredini, Riccardo Pistelli, Davide Imberti, Massimo Gallerani, Melina Verso, Walter Ageno, Giancarlo AgnelliAbstract:Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal variation. As for venous thromboembolism (VTE), not univocal results are available, and studies are mainly retrospective. We aimed to confirm the existence of a seasonal pattern in the occurrence of VTE on a large prospective population. The analysis considered consecutive cases of VTE enrolled into the Master Registry in 25 Italian hospitals, between January 2002 and November 2004. The total population consisted of 2119 subjects (1056 men, mean age 59 ± 18 years). The total sample was divided into subgroups by gender, age (<40, 41—60, 61—80, ≥80 years), type of event (first episode; proximal or distal; upper or lower limb; idiopathic or secondary deep vein thrombosis or pulmonary embolism, or both), and underlying risk factors, eg, cancer, previous VTE, estroprogestinic therapy, lack of prophylaxis, immobilization, surgery, pregnancy or puerperium, and medical diseases. Cases were grouped according to...
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Attitudes to prescribing compression stockings for patients with acute dvt: the Master Registry
Journal of Thrombosis and Thrombolysis, 2009Co-Authors: Guido Arpaia, Monica Carpenedo, Riccardo Pistelli, Ornella Mastrogiacomo, Claudio Cimminiello, Giancarlo AgnelliAbstract:Compression therapy is still not widely used for patients with deep vein thrombosis (DVT). This report provides information on Italian doctors’ use of elastic stockings (ES) after acute DVT and identifies some predictors of prescription. Material and methods The Master multicenter Registry collected information about clinical characteristics and management of patients with venous thromboembolism (VTE). In patients with objectively confirmed acute VTE, information about clinical presentation, diagnostic methods, temporary and permanent risk factors, pre-event prophylaxis and treatment, including ES prescription, were captured by an electronic data network at the time of the index event. Results Of 2119 patients enrolled, 1913 had DVT, 1772 in the legs; 1277 were prescribed ES at hospital discharge. The following conditions were associated with more frequent prescription: edema, in-hospital management, known thrombophilia; younger age. In multivariate analysis these factors all remained significantly associated with more frequent use of ES. Conclusions Italian clinicians’ attitudes to prescribing ES still appear suboptimal. Special attention is needed for patients treated at home, where organizational problems can interfere with the use of ES.
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risk factors for venous thromboembolism in the elderly results of the Master Registry
Blood Coagulation & Fibrinolysis, 2008Co-Authors: Walter Ageno, Riccardo Pistelli, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Approximately 50–75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence an
Gualtiero Palareti - One of the best experts on this subject based on the ideXlab platform.
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prevalence of risk factors for venous thromboembolism in the italian population results of a cross sectional study from the Master Registry
Internal and Emergency Medicine, 2013Co-Authors: Walter Ageno, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, R Pistelli, Melina VersoAbstract:The prevalence of major risk factors for VTE may differ according to age, gender and clinical presentation. We tested this hypothesis in a large Italian VTE population. Master is a multicenter Registry aimed to prospectively collect information on a large cohort of patients with acute VTE. The presence of major risk factors was captured by an electronic data network in consecutive patients with objectively confirmed acute VTE. We enrolled 2,119 patients (49.8% men) of whom 424 (20%) 80 years. The prevalence of known risk factors in the four age groups is 63.9, 52.6, 54.6, and 58.3%, respectively (p = 0.002). Immobilization and severe medical disorders are more commonly associated with VTE in patients >80 years, trauma is significantly more common in patients <40 years than in older patient groups. The prevalence of unprovoked events is the highest in patients 41–60 years, and lowest in patients less than 40 years. After logistic regression analysis, patients with pulmonary embolism are more likely to have known risk factors for VTE than patients with deep vein thrombosis at presentation (p = 0.0021), and women are less likely than men to have an unprovoked VTE (p < 0.0001). In conclusion, a substantial proportion of VTE events remain classified as unprovoked. Unprovoked events are more common in middle aged patients, in men, and in patients presenting with deep vein thrombosis.
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long term death and recurrence in patients with acute venous thromboembolism the Master Registry
Thrombosis Research, 2012Co-Authors: Melina Verso, Giancarlo Agnelli, Davide Imberti, Walter Ageno, Gualtiero Palareti, Marco Moia, R Pistelli, Valeria CantoneAbstract:Abstract Background The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter Registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Meth o ds Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results 2119 patients with acute VTE were included in the Registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence.
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do italian vascular centers look for isolated calf deep vein thrombosis analysis of isolated calf deep vein thromboses included in the Master Registry
International Angiology, 2008Co-Authors: Gualtiero Palareti, Riccardo Pistelli, Marco Moia, Romina Rossi, G Agnelli, D Imberti, W Ageno, Melina VersoAbstract:Aim. Two diagnostic imaging strategies for suspected deep venous thrombosis (DVT) in symptomatic patients are currently used: a serial compression ultrasound examination of proximal veins, or a single complete ultrasound investigation of proximal and distal veins. These strategies lead to different results since only the latter allows diagnosis of isolated calf DVT (ICDVT). Methods. We analyzed the approach of Italian centers in looking for ICDVT using the observational Master Registry which prospectively collected information on patients with acute symptomatic venous thromboembolism. Results. ICDVT was diagnosed in 170 of the 1772 patients with leg DVT (9.6%). The rate of diagnosed ICDVT vs total DVT differed between centers from 0% to 24%. Patients with ICDVT were younger (P<0.0001); diagnosis was more frequently delayed (P<0.0001), temporary risk factors were more frequent, cancer was less frequent (P<0.001), and pulmonary embolism (PE) was more frequent at presentation (P<0.05). More ICDVT patients received LMWH only, not followed by oral anticoagulation (P<0.001). Conclusion. The diagnostic strategy for suspected leg DVT differs greatly among Italian centers. A relatively high rate of PE was recorded in patients with ICDVT for reasons which are open to debate. Prospective, well designed studies on the clinical risks and the need for diagnosing ICDVT, and the advantages/disadvantages of the two diagnostic procedures are urgently needed.
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risk factors for venous thromboembolism in the elderly results of the Master Registry
Blood Coagulation & Fibrinolysis, 2008Co-Authors: Walter Ageno, Riccardo Pistelli, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Approximately 50–75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence an
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clinical characteristics and management of cancer associated acute venous thromboembolism findings from the Master Registry
Haematologica, 2008Co-Authors: Davide Imberti, Riccardo Pistelli, Giancarlo Agnelli, Walter Ageno, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Background Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective Registry. Design and Methods Master is a multicenter Registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. Results A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p <0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p <0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p <0.001). Major bleeding (3.3% versus 1.1%; p =0.001), in-hospital treatment (73.3% versus 66.6%; p =0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p =0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p <0.0001). Conclusions The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters.
Marco Moia - One of the best experts on this subject based on the ideXlab platform.
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prevalence of risk factors for venous thromboembolism in the italian population results of a cross sectional study from the Master Registry
Internal and Emergency Medicine, 2013Co-Authors: Walter Ageno, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, R Pistelli, Melina VersoAbstract:The prevalence of major risk factors for VTE may differ according to age, gender and clinical presentation. We tested this hypothesis in a large Italian VTE population. Master is a multicenter Registry aimed to prospectively collect information on a large cohort of patients with acute VTE. The presence of major risk factors was captured by an electronic data network in consecutive patients with objectively confirmed acute VTE. We enrolled 2,119 patients (49.8% men) of whom 424 (20%) 80 years. The prevalence of known risk factors in the four age groups is 63.9, 52.6, 54.6, and 58.3%, respectively (p = 0.002). Immobilization and severe medical disorders are more commonly associated with VTE in patients >80 years, trauma is significantly more common in patients <40 years than in older patient groups. The prevalence of unprovoked events is the highest in patients 41–60 years, and lowest in patients less than 40 years. After logistic regression analysis, patients with pulmonary embolism are more likely to have known risk factors for VTE than patients with deep vein thrombosis at presentation (p = 0.0021), and women are less likely than men to have an unprovoked VTE (p < 0.0001). In conclusion, a substantial proportion of VTE events remain classified as unprovoked. Unprovoked events are more common in middle aged patients, in men, and in patients presenting with deep vein thrombosis.
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long term death and recurrence in patients with acute venous thromboembolism the Master Registry
Thrombosis Research, 2012Co-Authors: Melina Verso, Giancarlo Agnelli, Davide Imberti, Walter Ageno, Gualtiero Palareti, Marco Moia, R Pistelli, Valeria CantoneAbstract:Abstract Background The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter Registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Meth o ds Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results 2119 patients with acute VTE were included in the Registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence.
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do italian vascular centers look for isolated calf deep vein thrombosis analysis of isolated calf deep vein thromboses included in the Master Registry
International Angiology, 2008Co-Authors: Gualtiero Palareti, Riccardo Pistelli, Marco Moia, Romina Rossi, G Agnelli, D Imberti, W Ageno, Melina VersoAbstract:Aim. Two diagnostic imaging strategies for suspected deep venous thrombosis (DVT) in symptomatic patients are currently used: a serial compression ultrasound examination of proximal veins, or a single complete ultrasound investigation of proximal and distal veins. These strategies lead to different results since only the latter allows diagnosis of isolated calf DVT (ICDVT). Methods. We analyzed the approach of Italian centers in looking for ICDVT using the observational Master Registry which prospectively collected information on patients with acute symptomatic venous thromboembolism. Results. ICDVT was diagnosed in 170 of the 1772 patients with leg DVT (9.6%). The rate of diagnosed ICDVT vs total DVT differed between centers from 0% to 24%. Patients with ICDVT were younger (P<0.0001); diagnosis was more frequently delayed (P<0.0001), temporary risk factors were more frequent, cancer was less frequent (P<0.001), and pulmonary embolism (PE) was more frequent at presentation (P<0.05). More ICDVT patients received LMWH only, not followed by oral anticoagulation (P<0.001). Conclusion. The diagnostic strategy for suspected leg DVT differs greatly among Italian centers. A relatively high rate of PE was recorded in patients with ICDVT for reasons which are open to debate. Prospective, well designed studies on the clinical risks and the need for diagnosing ICDVT, and the advantages/disadvantages of the two diagnostic procedures are urgently needed.
-
risk factors for venous thromboembolism in the elderly results of the Master Registry
Blood Coagulation & Fibrinolysis, 2008Co-Authors: Walter Ageno, Riccardo Pistelli, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Approximately 50–75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence an
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clinical characteristics and management of cancer associated acute venous thromboembolism findings from the Master Registry
Haematologica, 2008Co-Authors: Davide Imberti, Riccardo Pistelli, Giancarlo Agnelli, Walter Ageno, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Background Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective Registry. Design and Methods Master is a multicenter Registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. Results A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p <0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p <0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p <0.001). Major bleeding (3.3% versus 1.1%; p =0.001), in-hospital treatment (73.3% versus 66.6%; p =0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p =0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p <0.0001). Conclusions The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters.
Davide Imberti - One of the best experts on this subject based on the ideXlab platform.
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prevalence of risk factors for venous thromboembolism in the italian population results of a cross sectional study from the Master Registry
Internal and Emergency Medicine, 2013Co-Authors: Walter Ageno, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, R Pistelli, Melina VersoAbstract:The prevalence of major risk factors for VTE may differ according to age, gender and clinical presentation. We tested this hypothesis in a large Italian VTE population. Master is a multicenter Registry aimed to prospectively collect information on a large cohort of patients with acute VTE. The presence of major risk factors was captured by an electronic data network in consecutive patients with objectively confirmed acute VTE. We enrolled 2,119 patients (49.8% men) of whom 424 (20%) 80 years. The prevalence of known risk factors in the four age groups is 63.9, 52.6, 54.6, and 58.3%, respectively (p = 0.002). Immobilization and severe medical disorders are more commonly associated with VTE in patients >80 years, trauma is significantly more common in patients <40 years than in older patient groups. The prevalence of unprovoked events is the highest in patients 41–60 years, and lowest in patients less than 40 years. After logistic regression analysis, patients with pulmonary embolism are more likely to have known risk factors for VTE than patients with deep vein thrombosis at presentation (p = 0.0021), and women are less likely than men to have an unprovoked VTE (p < 0.0001). In conclusion, a substantial proportion of VTE events remain classified as unprovoked. Unprovoked events are more common in middle aged patients, in men, and in patients presenting with deep vein thrombosis.
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long term death and recurrence in patients with acute venous thromboembolism the Master Registry
Thrombosis Research, 2012Co-Authors: Melina Verso, Giancarlo Agnelli, Davide Imberti, Walter Ageno, Gualtiero Palareti, Marco Moia, R Pistelli, Valeria CantoneAbstract:Abstract Background The long-term clinical outcome of VTE has been essentially assessed in cohorts of selected patients. The aim of this multicenter Registry was to prospectively assess the long-term clinical outcome in a cohort of unselected patients with objectively confirmed acute VTE. Materials and Meth o ds Death and VTE recurrence at 24 months were the main study outcomes. Univariate and multivariate survival analyses were performed according to the Kaplan-Meyer and Cox proportional hazard model, respectively. Results 2119 patients with acute VTE were included in the Registry: 1541 (72.7%) with deep vein thrombosis, 206 (9.7%) with pulmonary embolism and 372 (17.6%) with both. Information about death was available in 2021 patients (95.4%) and about recurrence in 1988 patients (93.8%). 167 patients (4.55% patient-year) died during follow-up. After adjusting for age, cancer (Hazard ratio [HR]: 7.2; 95%CI 4.8-10.8), long-term heparin treatment (HR: 2.5; 95%CI 1.8-3.5), in-hospital management of VTE (HR: 2.0; 95%CI 1.3-3.0), and ileo-caval thrombosis (HR: 1.7; 95%CI 1.2-2.4) were found to be independent predictors of death. 124 (3.63% patient-year) patients had a VTE recurrence during follow-up. In-hospital management of VTE (HR: 1.8; 95%CI 1.2-2.9), male gender (HR: 1.7; 95%CI 1.2-2.4) were independent risk factors for recurrent VTE. Cancer (HR: 1.6; 95%CI 1.0-2.8) showed a trend for increased risk of VTE recurrence (p = 0.056). The reported rate of major bleeding was 2.5%. Conclusions In a large cohort of unselected VTE patients, cancer, ileo-caval thrombosis, long-term heparin treatment and in-hospital management were associated with increased mortality during long-term follow-up. In-hospital management, male gender were associated with an increased risk of VTE recurrence.
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seasonal variation in the occurrence of venous thromboembolism data from the Master Registry
Clinical and Applied Thrombosis-Hemostasis, 2009Co-Authors: Roberto Manfredini, Riccardo Pistelli, Davide Imberti, Massimo Gallerani, Melina Verso, Walter Ageno, Giancarlo AgnelliAbstract:Many studies showed that the occurrence of cardiovascular and cerebrovascular events exhibits a seasonal variation. As for venous thromboembolism (VTE), not univocal results are available, and studies are mainly retrospective. We aimed to confirm the existence of a seasonal pattern in the occurrence of VTE on a large prospective population. The analysis considered consecutive cases of VTE enrolled into the Master Registry in 25 Italian hospitals, between January 2002 and November 2004. The total population consisted of 2119 subjects (1056 men, mean age 59 ± 18 years). The total sample was divided into subgroups by gender, age (<40, 41—60, 61—80, ≥80 years), type of event (first episode; proximal or distal; upper or lower limb; idiopathic or secondary deep vein thrombosis or pulmonary embolism, or both), and underlying risk factors, eg, cancer, previous VTE, estroprogestinic therapy, lack of prophylaxis, immobilization, surgery, pregnancy or puerperium, and medical diseases. Cases were grouped according to...
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risk factors for venous thromboembolism in the elderly results of the Master Registry
Blood Coagulation & Fibrinolysis, 2008Co-Authors: Walter Ageno, Riccardo Pistelli, Giancarlo Agnelli, Davide Imberti, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Approximately 50–75% of patients with venous thromboembolism have a readily identifiable risk factor, either transient or permanent, whereas the remaining episodes are classified as unprovoked. The incidence of first-time venous thromboembolism rises exponentially with age. Whether the prevalence an
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clinical characteristics and management of cancer associated acute venous thromboembolism findings from the Master Registry
Haematologica, 2008Co-Authors: Davide Imberti, Riccardo Pistelli, Giancarlo Agnelli, Walter Ageno, Gualtiero Palareti, Marco Moia, Romina Rossi, Melina VersoAbstract:Background Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective Registry. Design and Methods Master is a multicenter Registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. Results A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p <0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p <0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p <0.001). Major bleeding (3.3% versus 1.1%; p =0.001), in-hospital treatment (73.3% versus 66.6%; p =0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p =0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p <0.0001). Conclusions The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters.