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Papers by Luca Masotti

Research paper thumbnail of Prognostic determinants in patients with non traumatic intracerebral hemorrhage: a real life report

Acta Clinica Belgica

Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for... more Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for high in-hospital and long-term mortality and residual neurological disability. The aim of our study was to analyze the prognostic factors in patients managed for ICH in the reallife clinical practice. Materials and Methods: We retrospectively analyzed clinical and neuro-radiological data of consecutive patients admitted to our Hospital for ICH along 1 year. In-hospital mortality and 90-day modified Rankin scale (mRS) ≥4 were the study outcomes. Moreover, we compared patients admitted in Intensive Care Unit (ICU) with patients admitted in Stroke Unit (SU). Results: Ninety-eight patients with mean age ± SD 78 ± 12 years were enrolled. In-hospital and 90-day mortality were 36.7% and 41.8%, respectively. Patients who died had a significantly higher percentage of ICH volume >30 mL, irregular shape, lobar location, intraventricular hemorrhage (IVH), midline shift, hydrocephalus, hematoma enlargement, Glasgow Coma Scale (GCS) ≤9 at hospital admission, early neurological worsening (ENW), higher Hemphill ICH score, and underwent oro-tracheal intubation more frequently compared with patients who survived. Patients admitted to ICU were younger and significantly more critical compared with those who were admitted to SU. In-hospital mortality in patients admitted to ICU was 52.6% compared with 25% in patients admitted to SU (p < 0.01). Median mRS score at hospital discharge was 4 (IQR 3-5) and at 90 days was 4 (IQR 3-4). ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were found independent risk factors for inhospital mortality, while age was found as independent risk factor for 90-day mRS ≥4). Conclusion: In real life, prognosis of ICH is associated with clinical and radiological determinants. In our study ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were associated with short-term mortality risk, while age with 90-day mRS ≥4.

Research paper thumbnail of New-onset type 1 diabetes mellitus triggered by SARS-CoV-2 infection in a patient with Hashimoto thyroiditis: a case report

Italian Journal of Medicine, 2021

New onset type 1 diabetes mellitus is an uncommon but possible complication triggered by SARSCoV-... more New onset type 1 diabetes mellitus is an uncommon but possible complication triggered by SARSCoV- 2 infection. Metabolic inflammation supported by cytokine storm leading to pancreatic beta cells destruction is the most probable link between COVID-19 and diabetes. Here, we describe the case of a 51-year-old female suffering from Hashimoto thyroiditis, who came to our attenction for new onset polyuria-polydipsia syndrome associated to hyperglycemia after a mild form of COVID- 19 recognized two months before and already recovered. Type 1 diabetes was diagnosed.

Research paper thumbnail of Trasformazione emorragica dello stroke ischemico e trattamento della trasformazione emorragica durante terapia trombolitica

Hemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication o... more Hemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: hemorrhagic infarct (HI) and pa renchymal haematoma (PH). PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the manage ment of acute stroke.

Research paper thumbnail of VHRM-4861-Prognostic stratification of acute pulmonary embol

Luca Masotti1 Marc Righini2 Nicolas Vuilleumier3 Fabio Antonelli4 Giancarlo Landini5 Roberto Capp... more Luca Masotti1 Marc Righini2 Nicolas Vuilleumier3 Fabio Antonelli4 Giancarlo Landini5 Roberto Cappelli6 Patrick Ray7 1internal Medicine, 4Clinical Chemistry, Cecina Hospital, Cecina, italy; 2Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva University Hospital, Switzerland; 3Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Switzerland; 5internal Medicine, Santa Maria Nuova Hospital, Florence, italy; 6Thrombosis Center, University of Siena, Siena, Italy; 7Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, UPMC Paris 6, Paris, France

Research paper thumbnail of End of life management in Internal Medicine Wards: a single centre real life report

Italian Journal of Medicine, 2020

The burden of end of life in Internal Medicine wards is not negligible. However, literature evide... more The burden of end of life in Internal Medicine wards is not negligible. However, literature evidence about the end-of-life care in Internal Medicine wards lacks. Therefore, this study aimed to report on end-of-life management in an Internal Medicine ward. We performed a retrospective study focusing on the characteristics and management of patients who consecutively died in an Italian Internal Medicine ward between July 1, 2018 and June 30, 2019. Demographic, co-morbidity, pharmacological treatment at hospital admission, and in the last 48-hours of life and procedures during hospital stay were collected. The study population was composed of 354 patients (190 females), corresponding to about ten percent of patients admitted to the ward, with a mean age ± standard deviation 83.5±10.6 years. Eighty-four percent of deaths was expected in the last 48 h before exitus. The main co-morbidities were blood hypertension (66.3%), solid or hematological malignancies (40.3%), arrhythmias (34.7%), ...

Research paper thumbnail of Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral Hemorrhage

Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral ... more Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral Hemorrhage Introduction: Early neurological worsening (ENW) is a major determinant of death in spontaneous intracerebral hemorrhage. In recent years, several clinical grading scales have been developed to identify patients at risk of 30-day or 90-day poor outcome following spontaneous (ICH), but whether these are able to predict ENW remains unclear. The aim of our study was to validate and compare two ICH grading scales for predicting ENW. Methods: Original (o) ICH and FUNC scores were calculated for 128 consecutive, prospectively-collected ICH patients using components and cutoff values identical to those described in the original derivation cohorts. Receiver operating characteristic (ROC) analysis, including area under the curve (AUC), was used to assess the ability of each score to predict ENW. Results: Overall, thirty-day mortality rate was 33.6% (n=43), while only 19 (15.3%) patient...

Research paper thumbnail of Sex Differences in Characteristics and Management of Patients with Acute Heart Failure

Burden of heart failure (HF) among females is growing. However, whether characteristics and manag... more Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay ...

Research paper thumbnail of Burden of an educational program on end of life management in a Internal Medicine ward: a real life report

La Clinica terapeutica, 2021

Background and aim Appropriate end of life (EOL) management in Internal Medicine wards is challan... more Background and aim Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses. Results Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and ...

Research paper thumbnail of The Triage ICH Model for Predicting Prognosis of Patients with Non Traumatic Supratentorial Intracerebral Hemorrhage Admitted in Non ICU Setting: A Real World Brief Report

Appropriate setting of care based on mortality risk is of utmost importance for reducing adverse ... more Appropriate setting of care based on mortality risk is of utmost importance for reducing adverse outcome in patients with non traumatic intracerebral hemorrhage (ICH). The Triage ICH model, which includes as variables Glasgow Coma Scale score < 13, ICH volume ≥ 30 mL and intraventricular bleeding, has been proposed as effective and safe tool for identifying patients with supratentorial ICH requiring Intensive Care Unit (ICU) admission.

Research paper thumbnail of Intracerebral Hemorrhage : What Do We Know About Risks and Benefits ? Pharmacological Prophylaxis of Venous Thromboembolism During Acute Phase of Spontaneous

http://cat.sagepub.com/content/18/4/393 The online version of this article can be found at: DOI: ... more http://cat.sagepub.com/content/18/4/393 The online version of this article can be found at: DOI: 10.1177/1076029612441055 2012 18: 393 originally published online 19 May 2012 CLIN APPL THROMB HEMOST Luca Masotti, Daniel Agustin Godoy, Mario Di Napoli, Alejandro A. Rabinstein, Maurizio Paciaroni and Walter Ageno Intracerebral Hemorrhage: What Do We Know About Risks and Benefits? Pharmacological Prophylaxis of Venous Thromboembolism During Acute Phase of Spontaneous

Research paper thumbnail of Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Stroke, 2019

Background and Purpose— Despite treatment with oral anticoagulants, patients with nonvalvular atr... more Background and Purpose— Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non–vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods— Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results— Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified ...

Research paper thumbnail of Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: The real life evidence

Thrombosis Research, 2018

Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non v... more Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: The real life evidence. Tr (2018),

Research paper thumbnail of Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage

International Journal of Clinical and Experimental Medical Sciences, 2015

Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism ... more Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.

Research paper thumbnail of ICH score in patients with spontaneous intracerebral hemorrhage pre-treated and not treated with antithrombotics

Neurology and Clinical Neuroscience, 2016

Spontaneous intracerebral hemorrhage (ICH) represents the most feared stroke subtype. Real world ... more Spontaneous intracerebral hemorrhage (ICH) represents the most feared stroke subtype. Real world epidemiological data about trends in incident cases and in-hospital mortality lack. Therefore we performed this study aimed to answer this concern. International Classification of Diseases, 9 th revision, Clinical Modification (ICD-9 th CM) database referred to patients discharged from six Hospitals of Florence district, Tuscany, Italy in a period fifteen years long (2001-2015)was analyzed. We searched for code 431 as primary or secondary diagnosis at hospital discharge. Overall, 7452 patients were discharged with ICH as primary or secondary diagnosis. Of them, 3695 (49.5%) were females and 4363 (59.1%) were 75years old and over. Cases of ICH increased from 461 in 2001 to 568 in 2015. The greatest increase was observed in patients 75 years old and over (216 cases in 2001, 339 cases in 2015). Overall, 2273 patients died during hospital stay, in-hospital mortality being 30.5%. In-hospital mortality increased according to age, being 18% in under 65 years and 35.9% in 75-years old and over. In-hospital mortality decreased from 30.8% in 2001 to 25.1% in 2015. The decrease in in-hospital mortality was observed irrespective of age. In Florence district, cases of ICH increased over the years, especially in very old people, whereas in-hospital mortality decreased irrespective of age.

Research paper thumbnail of Prognostic Ability of Simplified Pulmonary Embolism Severity Index (PESI) Score in Real World: A Brief Report

International Journal of Clinical and Experimental Medical Sciences, 2015

Background and aim: Prognostic stratification of acute pulmonary embolism (PE) represents the cor... more Background and aim: Prognostic stratification of acute pulmonary embolism (PE) represents the cornerstone of modern management of this potentially life-threatening disease. In the latest years, a lot of clinical prognostic models have been validated. However, these are yet underused in clinical practice, especially in real world populations. The aim of our study was to test the prognostic ability of the Simplified Pulmonary Embolism Severity Index (sPESI) score in a real world population. Methods: Data records of 452 patients that were discharged for acute PE from 28 Internal Medicine wards of Tuscany (Italy) were retrospectively analysed. sPESI was calculated in the identical manner as the original study. Prognostic ability of sPESI score for predicting in-hospital all-cause and PE-related mortality was tested by using Areas under Receiver Operating Characteristics (ROC) curve (AUC). Results: 15.2% of patients were classified as sPESI score 0, whereas 84.8% were classified as sPESI ≥ 1. All causes of in-hospital mortality were 10.95% (5.75% PE-related) in patients with sPESI score ≥ 1 and 0% (0% PE-related) in sPESI score 0. AUC for all causes of mortality was 0.694 (95% CI: 0.650-0.736), whereas it was 0.702 (95% CI: 0.657-0.743) for PE-related mortality. Conclusion: In a real world population, sPESI is a good prognosticator for all causes of in-hospital and PE-related mortality and its use should be encouraged.

Research paper thumbnail of Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

International Journal of Research in Medical Sciences, 2015

Background: Prognostic stratification is of utmost importance for management of acute Pulmonary E... more Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE) in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC) in 2008 and simplified PESI score (sPESI). Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC) Curves (AUCs) and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpoints Results: All cause in-hospital mortality was 25% (16.6% PE related) in high risk, 8.7% (4.7%) in intermediate risk and 3.8% (1.2%) in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related) in patients with sPESI score ≥1 and 0% (0%) in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084) and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11). Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI: 0.606-0.707 versus ESC 0.512, 95% CI: 0.459-0.565, difference between AUCs 0.145, p=0.34). In hemodynamically stable patients, the combined endpoint in-hospital PE-related mortality and/or fatal or major bleeding (adverse events) occurred in 0% of patients with low risk ESC model and sPESI score 0, whilst it occurred in 5.5% of patients with low-risk ESC model but sPESI ≥1. In intermediate risk patients according to ESC model, adverse events occurred in 3.6% of patients with sPESI score 0 and 6.65% of patients with sPESI score ≥1. Conclusions: In real world, predictive performance of sPESI and the hemodynamic/biomarkers-based ESC model as prognosticator of in-hospital mortality and bleedings is similar. Combination of sPESI 0 with low risk ESC model may identify patients with very low risk of adverse events and candidate for early hospital discharge or home treatment.

Research paper thumbnail of Simplified PESI score and sex difference in prognosis of acute pulmonary embolism: a brief report from a real life study

Journal of Thrombosis and Thrombolysis, 2015

Prognostic stratification of acute pulmonary embolism (PE) remains a challenge in clinical practi... more Prognostic stratification of acute pulmonary embolism (PE) remains a challenge in clinical practice. Simplified PESI (sPESI) score is a practical validated score aimed to stratify 30-day mortality risk in acute PE. Whether prognostic value of sPESI score differs according to sex has not been previously investigated. Therefore the aim of our study was to provide information about it. Data records of 452 patients, 180 males (39.8 %) and 272 females (60.2 %) discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. sPESI was retrospectively calculated. Variables enclosed in sPESI score, all cause in-hospital mortality and overall bleedings were compared between sexes. Moreover, predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was tested and compared between sexes. sPESI score 0 (low risk) was found in 17.7 % of males and 13.6 % of females (p = 0.2323). We didn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t find significant difference in sPESI scoring distribution. Age ≥80 years (51.4 vs. 33.8 %, p = 0.0003) and heart rate ≥110 bpm (23.5 vs. 14.4 %, p = 0.0219) were found significantly more prevalent in females, whereas active cancer (23.8 vs. 39.4 %, p = 0.0004) and cardio-respiratory diseases (19.8 vs. 27.7 %, p = 0.0416) were in males. All cause in-hospital mortality was 0 % in both genders for sPESI score 0, whereas it was 5.4 % in females and 13.6 % in males with sPESI score 1-2 (p = 0.0208) and 22 % in females and 19.3 % in males with sPESI score ≥3 (p = 0.7776). Overall bleedings were significantly more frequent in females compared with males (4.77 vs. 0.55 %, p = 0.0189). In females overall bleedings ranged from 2.7 % in sPESI score 0 to 6 % in sPESI score ≥3. Predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was higher in females compared to males (AUC 0.72 vs. 0.67, respectively). In real life different co-morbidity burdens in females compared to males. Females seems to be at lower risk of all cause in-hospital mortality for sPESI score ≤2 but at higher risk of bleeding, irrespective from sPESI scoring. Predictive ability of sPESI score seems better in females.

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K ... more There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%,

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

Italian Journal of Medicine, 2014

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

Research paper thumbnail of Pharmacology of new oral anticoagulants: mechanism of action, pharmacokinetics, pharmacodynamics

Italian Journal of Medicine, 2013

Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulant... more Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulants (DOACs). Dabigatran is a selective, competitive, direct inhibitor of thrombin (Factor IIa) while rivaroxaban, apixaban and edoxaban act by directly inhibiting the activated Factor X (FXa) in a selective and competitive manner. DOACs have a relatively short half-life and almost immediate anticoagulant activity, and rapidly reach the plasma peak concentration. Therefore, they do not need a phase of overlapping with parenteral anticoagulants. After their withdrawal, their removal is sufficiently rapid, although influenced by renal function. Dabigatran is the only DOACs to be administered as a pro-drug and becomes active after drug metabolization. The route of elimination of dabigatran is primarily renal, whereas FXa inhibitors are mainly eliminated by the biliary-fecal route. The drug interactions of DOACs are mainly limited to drugs that act on P-glycoprotein for dabigatran and on P-glycoprotein and/or cytochrome P3A4 for anti-Xa. DOACs have no interactions with food. Given their linear pharmacodynamics, with a predictable dose/response relationship and anticoagulant effect, DOACs are administered at a fixed dose and do not require routine laboratory monitoring.

Research paper thumbnail of Prognostic determinants in patients with non traumatic intracerebral hemorrhage: a real life report

Acta Clinica Belgica

Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for... more Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for high in-hospital and long-term mortality and residual neurological disability. The aim of our study was to analyze the prognostic factors in patients managed for ICH in the reallife clinical practice. Materials and Methods: We retrospectively analyzed clinical and neuro-radiological data of consecutive patients admitted to our Hospital for ICH along 1 year. In-hospital mortality and 90-day modified Rankin scale (mRS) ≥4 were the study outcomes. Moreover, we compared patients admitted in Intensive Care Unit (ICU) with patients admitted in Stroke Unit (SU). Results: Ninety-eight patients with mean age ± SD 78 ± 12 years were enrolled. In-hospital and 90-day mortality were 36.7% and 41.8%, respectively. Patients who died had a significantly higher percentage of ICH volume >30 mL, irregular shape, lobar location, intraventricular hemorrhage (IVH), midline shift, hydrocephalus, hematoma enlargement, Glasgow Coma Scale (GCS) ≤9 at hospital admission, early neurological worsening (ENW), higher Hemphill ICH score, and underwent oro-tracheal intubation more frequently compared with patients who survived. Patients admitted to ICU were younger and significantly more critical compared with those who were admitted to SU. In-hospital mortality in patients admitted to ICU was 52.6% compared with 25% in patients admitted to SU (p < 0.01). Median mRS score at hospital discharge was 4 (IQR 3-5) and at 90 days was 4 (IQR 3-4). ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were found independent risk factors for inhospital mortality, while age was found as independent risk factor for 90-day mRS ≥4). Conclusion: In real life, prognosis of ICH is associated with clinical and radiological determinants. In our study ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were associated with short-term mortality risk, while age with 90-day mRS ≥4.

Research paper thumbnail of New-onset type 1 diabetes mellitus triggered by SARS-CoV-2 infection in a patient with Hashimoto thyroiditis: a case report

Italian Journal of Medicine, 2021

New onset type 1 diabetes mellitus is an uncommon but possible complication triggered by SARSCoV-... more New onset type 1 diabetes mellitus is an uncommon but possible complication triggered by SARSCoV- 2 infection. Metabolic inflammation supported by cytokine storm leading to pancreatic beta cells destruction is the most probable link between COVID-19 and diabetes. Here, we describe the case of a 51-year-old female suffering from Hashimoto thyroiditis, who came to our attenction for new onset polyuria-polydipsia syndrome associated to hyperglycemia after a mild form of COVID- 19 recognized two months before and already recovered. Type 1 diabetes was diagnosed.

Research paper thumbnail of Trasformazione emorragica dello stroke ischemico e trattamento della trasformazione emorragica durante terapia trombolitica

Hemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication o... more Hemorrhagic transformation (HT) of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: hemorrhagic infarct (HI) and pa renchymal haematoma (PH). PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the manage ment of acute stroke.

Research paper thumbnail of VHRM-4861-Prognostic stratification of acute pulmonary embol

Luca Masotti1 Marc Righini2 Nicolas Vuilleumier3 Fabio Antonelli4 Giancarlo Landini5 Roberto Capp... more Luca Masotti1 Marc Righini2 Nicolas Vuilleumier3 Fabio Antonelli4 Giancarlo Landini5 Roberto Cappelli6 Patrick Ray7 1internal Medicine, 4Clinical Chemistry, Cecina Hospital, Cecina, italy; 2Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva University Hospital, Switzerland; 3Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Switzerland; 5internal Medicine, Santa Maria Nuova Hospital, Florence, italy; 6Thrombosis Center, University of Siena, Siena, Italy; 7Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, UPMC Paris 6, Paris, France

Research paper thumbnail of End of life management in Internal Medicine Wards: a single centre real life report

Italian Journal of Medicine, 2020

The burden of end of life in Internal Medicine wards is not negligible. However, literature evide... more The burden of end of life in Internal Medicine wards is not negligible. However, literature evidence about the end-of-life care in Internal Medicine wards lacks. Therefore, this study aimed to report on end-of-life management in an Internal Medicine ward. We performed a retrospective study focusing on the characteristics and management of patients who consecutively died in an Italian Internal Medicine ward between July 1, 2018 and June 30, 2019. Demographic, co-morbidity, pharmacological treatment at hospital admission, and in the last 48-hours of life and procedures during hospital stay were collected. The study population was composed of 354 patients (190 females), corresponding to about ten percent of patients admitted to the ward, with a mean age ± standard deviation 83.5±10.6 years. Eighty-four percent of deaths was expected in the last 48 h before exitus. The main co-morbidities were blood hypertension (66.3%), solid or hematological malignancies (40.3%), arrhythmias (34.7%), ...

Research paper thumbnail of Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral Hemorrhage

Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral ... more Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral Hemorrhage Introduction: Early neurological worsening (ENW) is a major determinant of death in spontaneous intracerebral hemorrhage. In recent years, several clinical grading scales have been developed to identify patients at risk of 30-day or 90-day poor outcome following spontaneous (ICH), but whether these are able to predict ENW remains unclear. The aim of our study was to validate and compare two ICH grading scales for predicting ENW. Methods: Original (o) ICH and FUNC scores were calculated for 128 consecutive, prospectively-collected ICH patients using components and cutoff values identical to those described in the original derivation cohorts. Receiver operating characteristic (ROC) analysis, including area under the curve (AUC), was used to assess the ability of each score to predict ENW. Results: Overall, thirty-day mortality rate was 33.6% (n=43), while only 19 (15.3%) patient...

Research paper thumbnail of Sex Differences in Characteristics and Management of Patients with Acute Heart Failure

Burden of heart failure (HF) among females is growing. However, whether characteristics and manag... more Burden of heart failure (HF) among females is growing. However, whether characteristics and management of acute HF differ according to sex is unknown. Therefore, the aim of the present study was to provide information about this concern from a real life perspective. Data from the Scompenso Cardiaco in Medicina Interna in Toscana (SMIT) Study, an observational, retrospective, multicenter 30-day cross-sectional study performed in thirty-two Internal Medicine wards of Tuscany, Italy, were analyzed. The present sub-analysis focused on the difference between female and male patients. Overall, seven hundred and seventy patients were enrolled in the SMIT Study. Of these, four hundred and twenty-nine (55.7%) were females. Females were significantly older than males. Seventy-two women (16.7%) and forty-eight men (14%) presented a new onset HF, whereas the majority of patients presented at least one previous hospital admission for HF in their history. No difference in length of hospital stay ...

Research paper thumbnail of Burden of an educational program on end of life management in a Internal Medicine ward: a real life report

La Clinica terapeutica, 2021

Background and aim Appropriate end of life (EOL) management in Internal Medicine wards is challan... more Background and aim Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses. Results Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and ...

Research paper thumbnail of The Triage ICH Model for Predicting Prognosis of Patients with Non Traumatic Supratentorial Intracerebral Hemorrhage Admitted in Non ICU Setting: A Real World Brief Report

Appropriate setting of care based on mortality risk is of utmost importance for reducing adverse ... more Appropriate setting of care based on mortality risk is of utmost importance for reducing adverse outcome in patients with non traumatic intracerebral hemorrhage (ICH). The Triage ICH model, which includes as variables Glasgow Coma Scale score < 13, ICH volume ≥ 30 mL and intraventricular bleeding, has been proposed as effective and safe tool for identifying patients with supratentorial ICH requiring Intensive Care Unit (ICU) admission.

Research paper thumbnail of Intracerebral Hemorrhage : What Do We Know About Risks and Benefits ? Pharmacological Prophylaxis of Venous Thromboembolism During Acute Phase of Spontaneous

http://cat.sagepub.com/content/18/4/393 The online version of this article can be found at: DOI: ... more http://cat.sagepub.com/content/18/4/393 The online version of this article can be found at: DOI: 10.1177/1076029612441055 2012 18: 393 originally published online 19 May 2012 CLIN APPL THROMB HEMOST Luca Masotti, Daniel Agustin Godoy, Mario Di Napoli, Alejandro A. Rabinstein, Maurizio Paciaroni and Walter Ageno Intracerebral Hemorrhage: What Do We Know About Risks and Benefits? Pharmacological Prophylaxis of Venous Thromboembolism During Acute Phase of Spontaneous

Research paper thumbnail of Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Stroke, 2019

Background and Purpose— Despite treatment with oral anticoagulants, patients with nonvalvular atr... more Background and Purpose— Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non–vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods— Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results— Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified ...

Research paper thumbnail of Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: The real life evidence

Thrombosis Research, 2018

Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non v... more Ninety-day prognosis of patients receiving direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: The real life evidence. Tr (2018),

Research paper thumbnail of Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage

International Journal of Clinical and Experimental Medical Sciences, 2015

Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism ... more Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.

Research paper thumbnail of ICH score in patients with spontaneous intracerebral hemorrhage pre-treated and not treated with antithrombotics

Neurology and Clinical Neuroscience, 2016

Spontaneous intracerebral hemorrhage (ICH) represents the most feared stroke subtype. Real world ... more Spontaneous intracerebral hemorrhage (ICH) represents the most feared stroke subtype. Real world epidemiological data about trends in incident cases and in-hospital mortality lack. Therefore we performed this study aimed to answer this concern. International Classification of Diseases, 9 th revision, Clinical Modification (ICD-9 th CM) database referred to patients discharged from six Hospitals of Florence district, Tuscany, Italy in a period fifteen years long (2001-2015)was analyzed. We searched for code 431 as primary or secondary diagnosis at hospital discharge. Overall, 7452 patients were discharged with ICH as primary or secondary diagnosis. Of them, 3695 (49.5%) were females and 4363 (59.1%) were 75years old and over. Cases of ICH increased from 461 in 2001 to 568 in 2015. The greatest increase was observed in patients 75 years old and over (216 cases in 2001, 339 cases in 2015). Overall, 2273 patients died during hospital stay, in-hospital mortality being 30.5%. In-hospital mortality increased according to age, being 18% in under 65 years and 35.9% in 75-years old and over. In-hospital mortality decreased from 30.8% in 2001 to 25.1% in 2015. The decrease in in-hospital mortality was observed irrespective of age. In Florence district, cases of ICH increased over the years, especially in very old people, whereas in-hospital mortality decreased irrespective of age.

Research paper thumbnail of Prognostic Ability of Simplified Pulmonary Embolism Severity Index (PESI) Score in Real World: A Brief Report

International Journal of Clinical and Experimental Medical Sciences, 2015

Background and aim: Prognostic stratification of acute pulmonary embolism (PE) represents the cor... more Background and aim: Prognostic stratification of acute pulmonary embolism (PE) represents the cornerstone of modern management of this potentially life-threatening disease. In the latest years, a lot of clinical prognostic models have been validated. However, these are yet underused in clinical practice, especially in real world populations. The aim of our study was to test the prognostic ability of the Simplified Pulmonary Embolism Severity Index (sPESI) score in a real world population. Methods: Data records of 452 patients that were discharged for acute PE from 28 Internal Medicine wards of Tuscany (Italy) were retrospectively analysed. sPESI was calculated in the identical manner as the original study. Prognostic ability of sPESI score for predicting in-hospital all-cause and PE-related mortality was tested by using Areas under Receiver Operating Characteristics (ROC) curve (AUC). Results: 15.2% of patients were classified as sPESI score 0, whereas 84.8% were classified as sPESI ≥ 1. All causes of in-hospital mortality were 10.95% (5.75% PE-related) in patients with sPESI score ≥ 1 and 0% (0% PE-related) in sPESI score 0. AUC for all causes of mortality was 0.694 (95% CI: 0.650-0.736), whereas it was 0.702 (95% CI: 0.657-0.743) for PE-related mortality. Conclusion: In a real world population, sPESI is a good prognosticator for all causes of in-hospital and PE-related mortality and its use should be encouraged.

Research paper thumbnail of Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

International Journal of Research in Medical Sciences, 2015

Background: Prognostic stratification is of utmost importance for management of acute Pulmonary E... more Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE) in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC) in 2008 and simplified PESI score (sPESI). Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC) Curves (AUCs) and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpoints Results: All cause in-hospital mortality was 25% (16.6% PE related) in high risk, 8.7% (4.7%) in intermediate risk and 3.8% (1.2%) in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related) in patients with sPESI score ≥1 and 0% (0%) in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084) and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11). Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI: 0.606-0.707 versus ESC 0.512, 95% CI: 0.459-0.565, difference between AUCs 0.145, p=0.34). In hemodynamically stable patients, the combined endpoint in-hospital PE-related mortality and/or fatal or major bleeding (adverse events) occurred in 0% of patients with low risk ESC model and sPESI score 0, whilst it occurred in 5.5% of patients with low-risk ESC model but sPESI ≥1. In intermediate risk patients according to ESC model, adverse events occurred in 3.6% of patients with sPESI score 0 and 6.65% of patients with sPESI score ≥1. Conclusions: In real world, predictive performance of sPESI and the hemodynamic/biomarkers-based ESC model as prognosticator of in-hospital mortality and bleedings is similar. Combination of sPESI 0 with low risk ESC model may identify patients with very low risk of adverse events and candidate for early hospital discharge or home treatment.

Research paper thumbnail of Simplified PESI score and sex difference in prognosis of acute pulmonary embolism: a brief report from a real life study

Journal of Thrombosis and Thrombolysis, 2015

Prognostic stratification of acute pulmonary embolism (PE) remains a challenge in clinical practi... more Prognostic stratification of acute pulmonary embolism (PE) remains a challenge in clinical practice. Simplified PESI (sPESI) score is a practical validated score aimed to stratify 30-day mortality risk in acute PE. Whether prognostic value of sPESI score differs according to sex has not been previously investigated. Therefore the aim of our study was to provide information about it. Data records of 452 patients, 180 males (39.8 %) and 272 females (60.2 %) discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. sPESI was retrospectively calculated. Variables enclosed in sPESI score, all cause in-hospital mortality and overall bleedings were compared between sexes. Moreover, predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was tested and compared between sexes. sPESI score 0 (low risk) was found in 17.7 % of males and 13.6 % of females (p = 0.2323). We didn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t find significant difference in sPESI scoring distribution. Age ≥80 years (51.4 vs. 33.8 %, p = 0.0003) and heart rate ≥110 bpm (23.5 vs. 14.4 %, p = 0.0219) were found significantly more prevalent in females, whereas active cancer (23.8 vs. 39.4 %, p = 0.0004) and cardio-respiratory diseases (19.8 vs. 27.7 %, p = 0.0416) were in males. All cause in-hospital mortality was 0 % in both genders for sPESI score 0, whereas it was 5.4 % in females and 13.6 % in males with sPESI score 1-2 (p = 0.0208) and 22 % in females and 19.3 % in males with sPESI score ≥3 (p = 0.7776). Overall bleedings were significantly more frequent in females compared with males (4.77 vs. 0.55 %, p = 0.0189). In females overall bleedings ranged from 2.7 % in sPESI score 0 to 6 % in sPESI score ≥3. Predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was higher in females compared to males (AUC 0.72 vs. 0.67, respectively). In real life different co-morbidity burdens in females compared to males. Females seems to be at lower risk of all cause in-hospital mortality for sPESI score ≤2 but at higher risk of bleeding, irrespective from sPESI scoring. Predictive ability of sPESI score seems better in females.

Research paper thumbnail of Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

Annals of Neurology, 2015

There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K ... more There is little evidence to guide treatment strategies for intracerebral hemorrhage on vitamin K antagonists (VKA-ICH). Treatments utilized in clinical practice include fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC). Our aim was to compare case fatality with different reversal strategies. Methods: We pooled individual ICH patient data from 16 stroke registries in 9 countries (n 5 10 282), of whom 1,797 (17%) were on VKA. After excluding 250 patients with international normalized ratio < 1.3 and/or missing data required for analysis, we compared all-cause 30-day case fatality using Cox regression. Results: We included 1,547 patients treated with FFP (n 5 377, 24%), PCC (n 5 585, 38%), both (n 5 131, 9%), or neither (n 5 454, 29%). The crude case fatality and adjusted hazard ratio (HR) were highest with no reversal (61.7%,

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

Italian Journal of Medicine, 2014

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

Research paper thumbnail of Pharmacology of new oral anticoagulants: mechanism of action, pharmacokinetics, pharmacodynamics

Italian Journal of Medicine, 2013

Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulant... more Due to their mechanism of action, the new oral anticoagulants are named direct oral anticoagulants (DOACs). Dabigatran is a selective, competitive, direct inhibitor of thrombin (Factor IIa) while rivaroxaban, apixaban and edoxaban act by directly inhibiting the activated Factor X (FXa) in a selective and competitive manner. DOACs have a relatively short half-life and almost immediate anticoagulant activity, and rapidly reach the plasma peak concentration. Therefore, they do not need a phase of overlapping with parenteral anticoagulants. After their withdrawal, their removal is sufficiently rapid, although influenced by renal function. Dabigatran is the only DOACs to be administered as a pro-drug and becomes active after drug metabolization. The route of elimination of dabigatran is primarily renal, whereas FXa inhibitors are mainly eliminated by the biliary-fecal route. The drug interactions of DOACs are mainly limited to drugs that act on P-glycoprotein for dabigatran and on P-glycoprotein and/or cytochrome P3A4 for anti-Xa. DOACs have no interactions with food. Given their linear pharmacodynamics, with a predictable dose/response relationship and anticoagulant effect, DOACs are administered at a fixed dose and do not require routine laboratory monitoring.