A. Braester - Academia.edu (original) (raw)
Papers by A. Braester
Acta radiologica, 2002
Sir, Is a ventilation-perfusion mismatch in a lung scan always a sign of pulmonary embolism? Á pr... more Sir, Is a ventilation-perfusion mismatch in a lung scan always a sign of pulmonary embolism? Á propós a case of Takayasu’s arteritis. A 27-year-old woman of Sepharadic origin was admitted because of an incidental finding of high blood pressure. Her physical examination disclosed a blood pressure of 200/110 mm Hg, a regular pulse rate of 100/min, and a normal respiratory rate. The peripheral pulses were intact. A systolic murmur was heard over the carotid arteries, bilaterally, and over the heart apex and pulmonary area. The cell blood count was within normal limits, the erythrocyte sedimentation rate was 100 mm after the first hour and there was diffuse hypergammaglobulinemia. Chest radiography disclosed mild enlargement of the heart and prominence of the right pulmonary conus. Echocardiography revealed pulmonary hypertension with a 43 mm Hg gradient. Following these findings a radionuclide ventriculography was done which disclosed enlargement of the right atrium and both ventricles...
Thrombosis Research, 2019
Results: In the majority of cases, the underlying disease was DIC-type postpartum hemorrhage (n=4... more Results: In the majority of cases, the underlying disease was DIC-type postpartum hemorrhage (n=43) or placental abruption (n=37). Mean (± standard deviation) obstetrical DIC score was 10.6±4.9. Mean duration of TM-α administration was 2.2±1.7 days. The most commonly used concomitant anticoagulants were antithrombin (n=60) and gabexate mesilate (n=37). Concomitantly used blood components products included red blood cell concentrate (n=72), fresh frozen plasma (n=70), and platelet concentrate (n=31). Hemostatic test result profiles revealed significant improvement of fibrinogen/fibrin degradation products, D dimer, fibrinogen, prothrombin time and activated partial thromboplastin time. Efficacies of TM-α as evaluated by "The efficacy evaluation criteria for DIC in obstetrics" at 24 h, 48 h and the day after last administration of TM-α were 72.3%, 82.4% and 90.2%, respectively. Total bleeding adverse drug reactions occurred in 6 patients (5.1%). Conclusions: This surveillance confirmed the safety and efficacy of TM-α in clinical practice. These findings thus indicated that the efficacy of TM-α is comparable to that of previously investigated obstetrical DIC pharmacotherapies.
Journal of vascular surgery. Venous and lymphatic disorders, 2017
We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembol... more We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients. The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hem...
Biology of Blood and Marrow Transplantation, 2016
The American Journal of Medicine, 2015
BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lowe... more BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P ¼ .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
Journal of Thrombosis and Haemostasis, 2008
ABSTRACT Although extensive screening in patients with venous thromboembolism (VTE) may result in... more ABSTRACT Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted. Of 17,475 patients with acute VTE, 2852 (16%) had cancer diagnosed before VTE or during admission. Hidden cancer was detected in 178 (1.2%) of the remaining 14,623 patients. The most common sites were lung, prostate, colorectum, or hematologic, and 51% had metastases. As compared with patients in whom no symptoms of cancer were noted, those with hidden cancer had an increased incidence of recurrent VTE (11.4% vs. 2.1%; P < 0.001), major bleeding (5.1% vs. 2.1%; P = 0.007), and mortality (20% vs. 5.4%; P < 0.001). In the multivariate analysis, patients aged 60-75 years [odds ratio 1.8; 95% CI 1.2-2.7], with idiopathic VTE (odds ratio 3.0; 95% CI 2.2-4.2), with bilateral thrombosis (odds ratio 2.3; 95% CI 1.3-4.1) or with anemia (odds ratio 1.9; 95% CI 1.4-2.6) were at an increased risk for hidden cancer. VTE patients with hidden cancer have an increased incidence of recurrences, major bleeding or death during the first 3 months of therapy. With four simple, easily obtainable variables, it is possible to identify a subgroup of VTE patients with a higher risk for hidden cancer.
Editor-in-Chief, 2009
... 88 Eythymiou A. 35 Fabris S. 11, 12 Faderl S. 93 Fais F. 14, 86 Falcão R. 3 Farren T. 8, 40 F... more ... 88 Eythymiou A. 35 Fabris S. 11, 12 Faderl S. 93 Fais F. 14, 86 Falcão R. 3 Farren T. 8, 40 Fazi C. 27 Fecteau JF 39 Federico M. 12 ... Friedman DR 89 Fullford L. 29 Furman RR 81, 88, 92 Gabriel R. 1 Gaidano G. 31, 35, 43, 47, 59, 87 Gaiger A. 48, 91 Galletti JG 63 Gamberale R ...
Drug Intelligence & Clinical Pharmacy, 1988
A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while t... more A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while taking methyldopa is described. The hyponatremia was found to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Bone marrow biopsy revealed granulomas. A MEDLINE search of the English literature was done, yielding only one previous report of methyldopa-induced bone marrow granulomatosis and no previous reports of methyldopa-induced SIADH.
Acta Haematologica, 2000
We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile... more We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile 3 weeks after the treatment was started. After drug withdrawal, the fever resolved but after rechallenge there was recurrence of the fever. Although hydroxyurea-induced fever is rare, this drug must be added to the list of drugs that produce fever and the physicians should be aware of this possibility.
Acta Haematologica, 2000
We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile... more We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile 3 weeks after the treatment was started. After drug withdrawal, the fever resolved but after rechallenge there was recurrence of the fever. Although hydroxyurea-induced fever is rare, this drug must be added to the list of drugs that produce fever and the physicians should be aware of this possibility.
Estimation of blood loss during caesarean sectionsdiscrepancy between visual and laboratory estim... more Estimation of blood loss during caesarean sectionsdiscrepancy between visual and laboratory estimation A
Chest, 2021
BACKGROUND The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not b... more BACKGROUND The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low- and intermediate-high risk patients are not well known. RESEARCH QUESTION Is there an association between baseline HR and PE outcome across the continuum of HR values? STUDY DESIGN AND METHODS The current study included 44,331 consecutive non-hypotensive patients with symptomatic PE from the RIETE registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. RESULTS There was a positive relationship between admission HR and 30-day all-cause and PE-related mortality. Considering HR 80-99 beats per minute [bpm] as reference, patients in the higher HR strata had higher rates of all-cause death ((adjusted odds ratio [OR] 1.5 for HR 100-109 beats per minute [bpm]; OR 1.7 for HR 110-119 bpm; OR 1.9 for HR 120-139 bpm; and 2.4 for HR >140 bpm). Patients in the lower strata of HR had significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR 0.6 for HR 60-79 bpm; and OR 0.5 for HR <60 bpm). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cut-off value of 80 bpm (vs. 110 bpm) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate-high risk patients, a cut-off value of 140 bpm (vs. 110 bpm) increased the specificity of the Bova score from 93.2% to 98.0%. INTERPRETATION In non-hypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of PE patients. CLINICAL TRIAL REGISTRATION Not applicable.
Archives of Internal Medicine, 1989
Malabsorption and Systemic Lupus Erythematosus To the Editor. \p=m-\Inreference to Rustgi and Pep... more Malabsorption and Systemic Lupus Erythematosus To the Editor. \p=m-\Inreference to Rustgi and Peppercorn's article appearing in the July 1988 issue of the ARCHIVES dealing with gluten-sensitive enteropathy (GSE) and systemic lupus erythematosus (SLE),1 we wish to point out some inaccuracies. A MEDLINE search of the literature yields eight cases of concomitant occurrence of
Internal and Emergency Medicine, 2021
The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patient... more The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding or death in apparent liver disease-free patients with acute VTE under anticoagulation therapy. A total of 6206 patients with acute VTE and without liver disease were included. Of them, 92 patients had major bleeding and 168 died under anticoagulation therapy. On multivariable analysis, patients with elevated liver enzymes were at increased mortality risk (HR: 1.58; 95% CI: 1.10-2.28), while those with FIB-4 levels > 2.67 points were at increased risk for major bleeding (HR: 1.69; 95% CI: 1.04-2.74). Evaluation of liver enzymes and FIB-4 index at baseline in liver disease-free patients with VTE may provide additional information on the risk for major bleeding or death during anticoagulation. Keywords Non-invasive liver assessment • Clinical VTE • Healthy individuals • Anticoagulation adverse events • VTE risk assessment Abbreviations FIB-4 Fibrosis index 4 VTE Venous thromboembolism RIETE Registro informatizado enfermedad tromboembólica CT scan Computer tomography scan PE Pulmonary embolism DVT Deep vein thrombosis HR Hazard ratio BMI Body mass index
Journal of Thrombosis and Haemostasis, 2020
The long-term prognosis after a massive pulmonary embolism (PE) is poorly understood. We comp... more The long-term prognosis after a massive pulmonary embolism (PE) is poorly understood. We compared short/long-term risks of clinical events after massive vs. non-massive PE. Recurrent venous thromboembolism was similar in both groups, perhaps with different severity.
Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021
BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperative... more BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacological prophylaxis is effective in reducing the incidence of this complication but is often discontinued at the time of hospital discharge, especially for those with benign diseases. The implications of this practice are not known. AIM To assess data from a large, ongoing registry regarding the time course of VTE and outcomes after non-cancer surgery. METHODS We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes consecutive patients with symptomatic confirmed VTE. This study focuses on general surgical patients who developed symptomatic postoperative VTE in the first 8 weeks after non-cancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavourable outcomes. RESULTS A total of 3,296 patients were analysed. Median time from surgery to detection of VTE was 16 days (IQR: 8-30). Seventy-seven percent of the events were detected after the first postoperative week, and another 27% after 4 weeks. Overall, 43.9% of the patients with VTE received pharmacological prophylaxis after surgery, for a median of eight days (IQR: 5-14), and three quarters of the VTE events were detected despite pharmacological prophylaxis was discontinued. Overall, 54% of patients with VTE presented with pulmonary embolism. In 15% of patients the clinical outcome was unfavourable, including 4% who died within 90 days. CONCLUSIONS The risk of VTE after non-cancer general surgery remains high for up to 2 months. More than half of the patients presented VTE as symptomatic PE, and 15% had unfavourable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around one week.
Scientific Reports, 2019
In young patients with acute pulmonary embolism (PE), the predictive value of currently available... more In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6–97.5), RIETE score (90.4%; 95%CI: 84.0–96.7) and sPESI (88%; 95% CI: 81–95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also...
Internal and Emergency Medicine, 2019
European Heart Journal, 2017
Background: Current guidelines recommend a trans-thoracic echocardiogram (TTE) to assist the diag... more Background: Current guidelines recommend a trans-thoracic echocardiogram (TTE) to assist the diagnosis, stratify the risk and guide the treatment of patients with acute pulmonary embolism (PE). However, its use in real life has not been consistently studied. Purpose: We used a database to assess the real life use of TTE in patients with acute PE and to find which variable had a better prognostic value. Methods: Patients were stratified in 3 groups: those presenting with systolic blood pressure (SBP) levels ≤90 mm Hg, those scoring ≥1 points according to sPESI, and those scoring zero points. The primary outcome was 15-day mortality. Results: From March 2001 to December 2016, 34098 PE patients were recruited. Of these, 14470 (42%) underwent a TTE: 1038 (7.2%) presented with SBP levels ≤90 mm Hg, 8422 (58%) had a sPESI ≥1 points and 5013 (35%) a sPESI of 0 points. In 1038 patients with SBP levels ≤90 mm Hg, pulmonary artery pressure levels (PAP) >45 mm Hg had the highest prognostic value (c-statistics 0.64; 95% CI 0.53-0.74). In 8422 patients scoring ≥1 points, right atrial diameter scored better (c-statistics: 0.80; 95% CI: 0.66-0.94). In 5013 patients scoring zero points, TAPSE ≤16 mm scored better (c-statistics: 0.76; 95% CI 0-59-0.94). Conclusions: The predictive value of most TTE variables was poor, and may differ according to clinical status. Identifying echocardiography variables that will reliably predict mortality in patients with acute PE should be more thoroughly explored. Acknowledgement/Funding: The sponsors of the study (Sanofi and Bayer) had no role in study design, data collection, data analysis, data interpretation or writing of the report
Acta radiologica, 2002
Sir, Is a ventilation-perfusion mismatch in a lung scan always a sign of pulmonary embolism? Á pr... more Sir, Is a ventilation-perfusion mismatch in a lung scan always a sign of pulmonary embolism? Á propós a case of Takayasu’s arteritis. A 27-year-old woman of Sepharadic origin was admitted because of an incidental finding of high blood pressure. Her physical examination disclosed a blood pressure of 200/110 mm Hg, a regular pulse rate of 100/min, and a normal respiratory rate. The peripheral pulses were intact. A systolic murmur was heard over the carotid arteries, bilaterally, and over the heart apex and pulmonary area. The cell blood count was within normal limits, the erythrocyte sedimentation rate was 100 mm after the first hour and there was diffuse hypergammaglobulinemia. Chest radiography disclosed mild enlargement of the heart and prominence of the right pulmonary conus. Echocardiography revealed pulmonary hypertension with a 43 mm Hg gradient. Following these findings a radionuclide ventriculography was done which disclosed enlargement of the right atrium and both ventricles...
Thrombosis Research, 2019
Results: In the majority of cases, the underlying disease was DIC-type postpartum hemorrhage (n=4... more Results: In the majority of cases, the underlying disease was DIC-type postpartum hemorrhage (n=43) or placental abruption (n=37). Mean (± standard deviation) obstetrical DIC score was 10.6±4.9. Mean duration of TM-α administration was 2.2±1.7 days. The most commonly used concomitant anticoagulants were antithrombin (n=60) and gabexate mesilate (n=37). Concomitantly used blood components products included red blood cell concentrate (n=72), fresh frozen plasma (n=70), and platelet concentrate (n=31). Hemostatic test result profiles revealed significant improvement of fibrinogen/fibrin degradation products, D dimer, fibrinogen, prothrombin time and activated partial thromboplastin time. Efficacies of TM-α as evaluated by "The efficacy evaluation criteria for DIC in obstetrics" at 24 h, 48 h and the day after last administration of TM-α were 72.3%, 82.4% and 90.2%, respectively. Total bleeding adverse drug reactions occurred in 6 patients (5.1%). Conclusions: This surveillance confirmed the safety and efficacy of TM-α in clinical practice. These findings thus indicated that the efficacy of TM-α is comparable to that of previously investigated obstetrical DIC pharmacotherapies.
Journal of vascular surgery. Venous and lymphatic disorders, 2017
We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembol... more We sought to determine the risk factors for subsequent bleeding and recurrent venous thromboembolism (VTE) events following isolated noncatheter-associated upper extremity deep venous thrombosis (non-CA-UEDVT) to better inform future treatment decisions for this group of patients. The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of patients with objectively confirmed symptomatic VTE. Patients with a symptomatic, isolated, proximal UEDVT from March 2001 through March 2015 were analyzed. Any patient with an indwelling catheter or pacemaker lead at the DVT site and at the time of thrombosis was considered to have a CA-UEDVT and was excluded. Patient and treatment characteristics such as age, gender, comorbidities, VTE risk factors, treatment drug, and duration were collected. Outcomes examined included recurrent DVT, subsequent pulmonary embolism (PE), and hem...
Biology of Blood and Marrow Transplantation, 2016
The American Journal of Medicine, 2015
BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lowe... more BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P ¼ .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
Journal of Thrombosis and Haemostasis, 2008
ABSTRACT Although extensive screening in patients with venous thromboembolism (VTE) may result in... more ABSTRACT Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted. Of 17,475 patients with acute VTE, 2852 (16%) had cancer diagnosed before VTE or during admission. Hidden cancer was detected in 178 (1.2%) of the remaining 14,623 patients. The most common sites were lung, prostate, colorectum, or hematologic, and 51% had metastases. As compared with patients in whom no symptoms of cancer were noted, those with hidden cancer had an increased incidence of recurrent VTE (11.4% vs. 2.1%; P < 0.001), major bleeding (5.1% vs. 2.1%; P = 0.007), and mortality (20% vs. 5.4%; P < 0.001). In the multivariate analysis, patients aged 60-75 years [odds ratio 1.8; 95% CI 1.2-2.7], with idiopathic VTE (odds ratio 3.0; 95% CI 2.2-4.2), with bilateral thrombosis (odds ratio 2.3; 95% CI 1.3-4.1) or with anemia (odds ratio 1.9; 95% CI 1.4-2.6) were at an increased risk for hidden cancer. VTE patients with hidden cancer have an increased incidence of recurrences, major bleeding or death during the first 3 months of therapy. With four simple, easily obtainable variables, it is possible to identify a subgroup of VTE patients with a higher risk for hidden cancer.
Editor-in-Chief, 2009
... 88 Eythymiou A. 35 Fabris S. 11, 12 Faderl S. 93 Fais F. 14, 86 Falcão R. 3 Farren T. 8, 40 F... more ... 88 Eythymiou A. 35 Fabris S. 11, 12 Faderl S. 93 Fais F. 14, 86 Falcão R. 3 Farren T. 8, 40 Fazi C. 27 Fecteau JF 39 Federico M. 12 ... Friedman DR 89 Fullford L. 29 Furman RR 81, 88, 92 Gabriel R. 1 Gaidano G. 31, 35, 43, 47, 59, 87 Gaiger A. 48, 91 Galletti JG 63 Gamberale R ...
Drug Intelligence & Clinical Pharmacy, 1988
A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while t... more A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while taking methyldopa is described. The hyponatremia was found to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Bone marrow biopsy revealed granulomas. A MEDLINE search of the English literature was done, yielding only one previous report of methyldopa-induced bone marrow granulomatosis and no previous reports of methyldopa-induced SIADH.
Acta Haematologica, 2000
We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile... more We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile 3 weeks after the treatment was started. After drug withdrawal, the fever resolved but after rechallenge there was recurrence of the fever. Although hydroxyurea-induced fever is rare, this drug must be added to the list of drugs that produce fever and the physicians should be aware of this possibility.
Acta Haematologica, 2000
We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile... more We report on a patient with essential thrombocythemia treated with hydroxyurea who became febrile 3 weeks after the treatment was started. After drug withdrawal, the fever resolved but after rechallenge there was recurrence of the fever. Although hydroxyurea-induced fever is rare, this drug must be added to the list of drugs that produce fever and the physicians should be aware of this possibility.
Estimation of blood loss during caesarean sectionsdiscrepancy between visual and laboratory estim... more Estimation of blood loss during caesarean sectionsdiscrepancy between visual and laboratory estimation A
Chest, 2021
BACKGROUND The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not b... more BACKGROUND The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low- and intermediate-high risk patients are not well known. RESEARCH QUESTION Is there an association between baseline HR and PE outcome across the continuum of HR values? STUDY DESIGN AND METHODS The current study included 44,331 consecutive non-hypotensive patients with symptomatic PE from the RIETE registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. RESULTS There was a positive relationship between admission HR and 30-day all-cause and PE-related mortality. Considering HR 80-99 beats per minute [bpm] as reference, patients in the higher HR strata had higher rates of all-cause death ((adjusted odds ratio [OR] 1.5 for HR 100-109 beats per minute [bpm]; OR 1.7 for HR 110-119 bpm; OR 1.9 for HR 120-139 bpm; and 2.4 for HR >140 bpm). Patients in the lower strata of HR had significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR 0.6 for HR 60-79 bpm; and OR 0.5 for HR <60 bpm). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cut-off value of 80 bpm (vs. 110 bpm) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate-high risk patients, a cut-off value of 140 bpm (vs. 110 bpm) increased the specificity of the Bova score from 93.2% to 98.0%. INTERPRETATION In non-hypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of PE patients. CLINICAL TRIAL REGISTRATION Not applicable.
Archives of Internal Medicine, 1989
Malabsorption and Systemic Lupus Erythematosus To the Editor. \p=m-\Inreference to Rustgi and Pep... more Malabsorption and Systemic Lupus Erythematosus To the Editor. \p=m-\Inreference to Rustgi and Peppercorn's article appearing in the July 1988 issue of the ARCHIVES dealing with gluten-sensitive enteropathy (GSE) and systemic lupus erythematosus (SLE),1 we wish to point out some inaccuracies. A MEDLINE search of the literature yields eight cases of concomitant occurrence of
Internal and Emergency Medicine, 2021
The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patient... more The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding or death in apparent liver disease-free patients with acute VTE under anticoagulation therapy. A total of 6206 patients with acute VTE and without liver disease were included. Of them, 92 patients had major bleeding and 168 died under anticoagulation therapy. On multivariable analysis, patients with elevated liver enzymes were at increased mortality risk (HR: 1.58; 95% CI: 1.10-2.28), while those with FIB-4 levels > 2.67 points were at increased risk for major bleeding (HR: 1.69; 95% CI: 1.04-2.74). Evaluation of liver enzymes and FIB-4 index at baseline in liver disease-free patients with VTE may provide additional information on the risk for major bleeding or death during anticoagulation. Keywords Non-invasive liver assessment • Clinical VTE • Healthy individuals • Anticoagulation adverse events • VTE risk assessment Abbreviations FIB-4 Fibrosis index 4 VTE Venous thromboembolism RIETE Registro informatizado enfermedad tromboembólica CT scan Computer tomography scan PE Pulmonary embolism DVT Deep vein thrombosis HR Hazard ratio BMI Body mass index
Journal of Thrombosis and Haemostasis, 2020
The long-term prognosis after a massive pulmonary embolism (PE) is poorly understood. We comp... more The long-term prognosis after a massive pulmonary embolism (PE) is poorly understood. We compared short/long-term risks of clinical events after massive vs. non-massive PE. Recurrent venous thromboembolism was similar in both groups, perhaps with different severity.
Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021
BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperative... more BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacological prophylaxis is effective in reducing the incidence of this complication but is often discontinued at the time of hospital discharge, especially for those with benign diseases. The implications of this practice are not known. AIM To assess data from a large, ongoing registry regarding the time course of VTE and outcomes after non-cancer surgery. METHODS We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes consecutive patients with symptomatic confirmed VTE. This study focuses on general surgical patients who developed symptomatic postoperative VTE in the first 8 weeks after non-cancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavourable outcomes. RESULTS A total of 3,296 patients were analysed. Median time from surgery to detection of VTE was 16 days (IQR: 8-30). Seventy-seven percent of the events were detected after the first postoperative week, and another 27% after 4 weeks. Overall, 43.9% of the patients with VTE received pharmacological prophylaxis after surgery, for a median of eight days (IQR: 5-14), and three quarters of the VTE events were detected despite pharmacological prophylaxis was discontinued. Overall, 54% of patients with VTE presented with pulmonary embolism. In 15% of patients the clinical outcome was unfavourable, including 4% who died within 90 days. CONCLUSIONS The risk of VTE after non-cancer general surgery remains high for up to 2 months. More than half of the patients presented VTE as symptomatic PE, and 15% had unfavourable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around one week.
Scientific Reports, 2019
In young patients with acute pulmonary embolism (PE), the predictive value of currently available... more In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6–97.5), RIETE score (90.4%; 95%CI: 84.0–96.7) and sPESI (88%; 95% CI: 81–95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also...
Internal and Emergency Medicine, 2019
European Heart Journal, 2017
Background: Current guidelines recommend a trans-thoracic echocardiogram (TTE) to assist the diag... more Background: Current guidelines recommend a trans-thoracic echocardiogram (TTE) to assist the diagnosis, stratify the risk and guide the treatment of patients with acute pulmonary embolism (PE). However, its use in real life has not been consistently studied. Purpose: We used a database to assess the real life use of TTE in patients with acute PE and to find which variable had a better prognostic value. Methods: Patients were stratified in 3 groups: those presenting with systolic blood pressure (SBP) levels ≤90 mm Hg, those scoring ≥1 points according to sPESI, and those scoring zero points. The primary outcome was 15-day mortality. Results: From March 2001 to December 2016, 34098 PE patients were recruited. Of these, 14470 (42%) underwent a TTE: 1038 (7.2%) presented with SBP levels ≤90 mm Hg, 8422 (58%) had a sPESI ≥1 points and 5013 (35%) a sPESI of 0 points. In 1038 patients with SBP levels ≤90 mm Hg, pulmonary artery pressure levels (PAP) >45 mm Hg had the highest prognostic value (c-statistics 0.64; 95% CI 0.53-0.74). In 8422 patients scoring ≥1 points, right atrial diameter scored better (c-statistics: 0.80; 95% CI: 0.66-0.94). In 5013 patients scoring zero points, TAPSE ≤16 mm scored better (c-statistics: 0.76; 95% CI 0-59-0.94). Conclusions: The predictive value of most TTE variables was poor, and may differ according to clinical status. Identifying echocardiography variables that will reliably predict mortality in patients with acute PE should be more thoroughly explored. Acknowledgement/Funding: The sponsors of the study (Sanofi and Bayer) had no role in study design, data collection, data analysis, data interpretation or writing of the report