Giancarlo Agnelli's research while affiliated with Università degli Studi di Perugia and other places
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Publications (838)
Intravenous thrombolysis (IVT) and/or endovascular therapy (EVT) are currently considered best practices in acute stroke patients. Data regarding the efficacy and safety of reperfusion therapies in patients with atrial fibrillation (AF) are conflicting as regards haemorrhagic transformation, mortality, and functional outcome. This study sought to i...
Background: The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducte...
Background In patients with acute venous thromboembolism (VTE), the rates of recurrence and major bleeding are highest during the first weeks of anticoagulation. The CARAVAGGIO trial demonstrated noninferiority of apixaban to dalteparin for treatment of cancer-associated VTE without an increased risk of major bleeding. We compared the early time co...
Background-The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within90 days)andtheirtiminginpatientswithacuteischemicstrokeandatrialfibrillati...
Background
Patients with acute venous thromboembolism associated with cancer have an increased risk of recurrences and bleeding in the long term.
Research question
To describe the clinical features and short-term course of patients with acute pulmonary embolism (PE) and active cancer, previous cancer or no cancer.
Study design and methods
Patient...
Background
Risk stratification for adverse outcome in hemodynamically stable patients with acute pulmonary embolism (PE) remains an issue. We aimed at validating and comparing currently available tools for risk stratification in this setting.
Methods
Hemodynamically stable patients (n= 5,036) from a prospective, multicentre study of adult patients...
Although substantial progress has been made in the pathophysiology and management of the post-thrombotic syndrome (PTS), several aspects still need clarification. Among them, the incidence and severity of PTS in the real world, the risk factors for its development, the value of patient’s self-evaluation, and the ability to identify patients at risk...
Background:
Atrial fibrillation (AFIB), the most frequent cardiac arrhythmia, is a major risk factor for stroke, heart failure, and death. Because of the recent advances in AFIB management and the availability of new oral anticoagulants (OACs), there is a need for a systematic and predefined collection of contemporary data regarding its management...
Direct oral anticoagulants (DOACs) are currently the first-choice therapy for the prevention of cardioembolic events in patients with atrial fibrillation and for the treatment of venous thromboembolism (VTE) due to their more favorable efficacy to safety profile in comparison to vitamin K antagonists (VKA). DOACs did not show a clinical benefit whe...
Introduction
Ischaemic stroke patients with atrial fibrillation (AF) are at high risk of stroke recurrence despite oral anticoagulation therapy. Patients with cardiovascular comorbidities may take both antiplatelet and oral anticoagulation therapy (OAC/AP). Our study aims to evaluate the safety and efficacy of OAC/AP therapy as secondary prevention...
In the last 10 years the introduction of the direct oral anticoagulants (DOACs) has revolutionized the anticoagulant treatment, one of the cornerstones of the therapy for cardiovascular diseases. Thanks to their efficacy at least not inferior compared to vitamin K antagonists and their better safety profile, particularly with regard to intracranial...
Background
Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (r...
Cancer-associated thrombosis, with the incidence rising over the years, is associated with significant morbidity and mortality in patients with cancer. Recent advances in the treatment of cancer-associated venous thromboembolism (VTE) include the introduction of direct oral anticoagulants (DOACs), which provide a more convenient and effective optio...
Anti-cancer treatment is considered an independent risk factor for emergent bleeding during anticoagulant treatment in patients with cancer-associated thrombosis. This increased bleeding risk is perceived as major concern particularly when tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial derived growth factor receptor (VEGFR-TKI...
Background:
New diagnosis, risk stratification and treatment strategies became recently available for patients with acute pulmonary embolism (PE) leading to changes in clinical practice and potentially influencing short-term patients' outcomes.
Research question:
The COntemporary management of PE (COPE) study is aimed at assessing the contempora...
Risks of recurrence and treatment-emergent bleeding are high in patients with cancer-associated venous thromboembolism (VTE) but factors associated with these risks remain substantially undefined. The aim of this analysis in patients with cancer-associated VTE included in the Caravaggio study was to identify risk factors for recurrent VTE and major...
Background
Right ventricle dysfunction (RVD) at echocardiography predicts mortality in patients with acute pulmonary embolism (PE), but heterogenous definitions of RVD have been used. We performed a meta-analysis to assess the role of different definitions of RVD and of individual parameters of RVD as predictors of death.
Methods
A systematic sear...
Venous thromboembolism (VTE) is common in patients with coronavirus disease-2019 (COVID-19). The optimal heparin regimen remains unknown and should balance thromboembolic and bleeding risks. The aim of this study was to evaluate the efficacy and safety of standard or higher heparin regimens for the prevention of VTE in patients hospitalized due to...
Introduction
The APULEIO study was designed to describe the psychological effects of apixaban in Italian elderly patients with non-valvular atrial fibrillation (NVAF), deep vein thrombosis (DVT) or pulmonary embolism (PE). The existence of implications of treatment on health-related quality of life (HRQL) and mood is among the most important knowle...
Background
As mortality from pulmonary embolism (PE) decreases, the personal and societal costs among survivors are receiving increasing attention. Detailing this burden would support an efficient public health resource allocation. We aimed to provide estimates for the economic and disease burden of PE also accounting for long‐term health care use...
Background
The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is a worldwide non-interventional study of stroke prevention in patients with non-valvular AF.Methods and results52,080 patients with newly diagnosed AF were prospectively enrolled from 2010 to 2016. 4121 (7.9%) of these patients were recruited in DACH [Germ...
Despite the recent advancements, oral anticoagulation is still challenging in some patients and this is the case for old and frail patients. The large majority of frail patients with atrial fibrillation should receive anticoagulation since the associated benefits outweigh the risk of bleeding. A multidisciplinary consensus document on the use and p...
Anticoagulant treatment in patients with primary and metastatic brain cancer is a concern due to risk of intracranial hemorrhage (ICH). We performed a systematic review and meta-analysis to evaluate the risk of ICH in patients with primary or metastatic brain cancer treated or not with anticoagulants. Articles on ICH in patients with primary or met...
Aim
Recent studies have compared the efficacy and safety of direct-acting oral anticoagulants (DOAC) and low-molecular-weight heparin (LMWH) for cancer-associated venous thromboembolism (VTE). However, there is no available cost-effectiveness analysis comparing DOAC and LMWH. The study aimed to conduct a cost-effectiveness analysis of DOAC (apixaba...
The clinical benefit of extended prophylaxis for venous thromboembolism after laparoscopic surgery for cancer is unclear. The efficacy and safety of direct oral anticoagulants for this indication are unexplored. PROLAPS-II was a randomized, double-blind, placebo-controlled, investigator-initiated, superiority study aimed at assessing the efficacy a...
Background
In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain.
Methods
This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding...
Background:
Venous thromboembolism (VTE) is a common complication in cancer patients. Much of its morbidity stems from the development of fatal pulmonary embolisms (PE). Little is known about the factors involved in clot stability, with angiogenesis possibly being implicated.
Methods:
The database is from the TESEO prospective registry that recr...
Background
Patients with cancer-associated venous thromboembolism (VTE) have a high risk of VTE recurrence and anticoagulant treatment–related bleeding, but the correlation of these risks with the cancer stage is unclear.
Methods
We evaluated the risks of VTE recurrence and treatment-related major bleeding according to the cancer stage in patients...
Background
Direct-acting oral anticoagulant use for stroke prevention in atrial fibrillation is limited by bleeding concerns. Asundexian, a novel, oral small molecule activated coagulation factor XIa (FXIa) inhibitor, might reduce thrombosis with minimal effect on haemostasis. We aimed to determine the optimal dose of asundexian and to compare the...
Herein we recount the legacy of Sir David Roxbee Cox (15 July 1924 - 18 January 2022) from the perspective of practicing clinicians. His-pioneering work in developing the logistic and Cox proportional hazard regression models revolutionized the analysis and interpretation of categorical and time-to-event survival outcomes in modern medicine. This l...
Background
The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severit...
Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a leading cause of morbidity and mortality in patients with cancer. Based on accumulating evidence, the prophylaxis and treatment of cancer-associated VTE have been changed over the years. Recently, the introduction in clinical practice of the direct oral a...
Cancer patients exhibit an increased risk of venous thromboembolism (VTE), with VTE being the second leading cause of morbidity and mortality in these patients. The implementation of lockdowns following the COVID-19 pandemic has resulted in decreased mobility and delayed access to care, thus further increasing the susceptibility to VTE. Cancer pati...
Background:
New management, risk stratification and treatment strategies have become available over the last years for patients with acute pulmonary embolism (PE), potentially leading to changes in clinical practice and improvement of patients' outcome.
Methods:
The COntemporary management of Pulmonary Embolism (COPE) is a prospective, non-inter...
Aims
OMERO is a prospective study, aimed to assess the long-term effectiveness, tolerability, and safety of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9-i), in the real life in Italy. The study is planned to include 800 patients, from 40 Italian sites, treated with alirocumab on top of standard lipid lowering therapy...
Background:
The long-term risk of major bleeding after discontinuing anticoagulant therapy for a first unprovoked venous thromboembolism (VTE) is uncertain.
Objectives:
To determine the incidence of major bleeding up to 5 years after discontinuing anticoagulation for a first unprovoked VTE.
Methods:
We searched MEDLINE, EMBASE, and Cochrane CE...
Background The clinical benefit of extending prophylaxis for venous thromboembolism (VTE) beyond hospital discharge after laparoscopic surgery for cancer is unclear. The efficacy and safety of thromboprophylaxis with direct oral anticoagulants in cancer surgery is unexplored.
Methods PROLAPS II is an investigator-initiated, prospective, randomized,...
Background. New management strategies, risk stratification procedures and treatments have become available over the last years for patients with acute pulmonary embolism (PE), leading to changes in clinical practice and potentially influencing patient's course and outcome.
Methods: The COntemporary management of Pulmonary Embolism (COPE) is an acad...
Systems tend toward inertia until an external pressure pushes them toward change; thus, a situation of crisis such as the COVID-19 pandemic represents an opportunity for technological innovation. The prevailing need for treatments and vaccines has impelled innovation in the world of randomized clinical trials (RCT), resorting to ideas that had been...
Background
In patients with venous thromboembolism (VTE), bleeding risk should be carefully assessed but none of the available risk scores is currently recommended. The aim of this study was to systematically evaluate the performance of bleeding scores in patients with VTE focusing on high-risk patients.
Methods
Longitudinal studies were searched...
Background
In the direct oral anticoagulants (DOACs) era, extended anticoagulation after 6–12 months of treatment is an attractive strategy in patients with venous thromboembolism (VTE). Real-life data on the clinical benefit of DOAC over time is lacking.
Purpose
The aim of this study is to assess the effectiveness and safety of DOACs in patients...
Purpose:
Patients with patent foramen ovale (PFO) and cryptogenic ischemic stroke (CS) are at risk for stroke recurrence. The optimal antithrombotic strategy in patients who undergo medical management is still debated.
Methods:
We systematically searched the literature for studies that reported on cerebrovascular event recurrences and/or death i...
Background and aim
Risk factors and mortality in patients with DOACs-associated gastrointestinal bleeding (GIB) are not completely defined. Aims of this study were to identify risk factors for bleeding and evaluate one-year mortality in patients with DOACs-associated GIB.
Methods
We conducted a case-control study. Cases were patients with DOACs-as...
Cancer-associated thrombosis (CAT) is associated with a high risk of recurrent venous thromboembolic events (VTE) that require extended anticoagulation in patients with active cancer, putting them at risk of bleeding.The aim of the API-CAT study (NCT03692065) is to assess whether a reduced-dose regimen of apixaban (2.5 mg twice daily [bid]) is non-...
Efficacy and safety of anticoagulant treatment for venous thromboembolism (VTE) may vary in patients with different cancer sites. We evaluated the rates of VTE recurrence and major bleeding and the relative efficacy and safety of 6-month treatment with oral apixaban or subcutaneous dalteparin in patients with different cancer sites randomized in th...
Background:
The long-term risk for major bleeding in patients receiving extended (beyond the initial 3 to 6 months) anticoagulant therapy for a first unprovoked venous thromboembolism (VTE) is uncertain.
Purpose:
To determine the incidence of major bleeding during extended anticoagulation of up to 5 years among patients with a first unprovoked V...
Patients with cancer are at a high risk of symptomatic venous thromboembolism (VTE), which is a common cause of morbidity and mortality in this patient population. Increased risk of recurrent VTE and bleeding complications are two major challenges associated with therapeutic anticoagulation in these patients. Long-term therapy with low-molecular-we...
The effect of renal impairment (RI) on risk of bleeding and recurrent thrombosis in cancer patients treated with direct oral anticoagulants for venous thromboembolism (VTE) is undefined. We run a prespecified analysis of the randomized Caravaggio study to evaluate the role of RI as risk factor for bleeding or recurrence in patients treated with dal...
The effect of renal impairment (RI) on risk of bleeding and recurrent thrombosis in cancer patients treated with direct oral anticoagulants for venous thromboembolism (VTE) is undefined. We ran a prespecified analysis of the randomized Caravaggio study to evaluate the role of RI as a risk factor for bleeding or recurrence in patients treated with d...
Background
The long-term risk for recurrent venous thromboembolism (VTE) during extended anticoagulation for a first unprovoked VTE is uncertain.
Objectives
To determine the incidence of recurrent VTE during extended anticoagulation up to 5 years in patients with a first unprovoked VTE.
Methods
MEDLINE, EMBASE, and the Cochrane CENTRAL were searc...
The incidence of venous and arterial thromboembolic events in advanced cancer patients treated with immune checkpoint inhibitors (ICIs) has been sporadically reported. We performed a systematic review and meta-analysis to assess the rate of vascular events in patients with melanoma and non-small cell lung cancer (NSCLC) treated with ICIs. A systema...
Background: Right ventricle (RV) dysfunction at echocardiography is a recognized predictor of death or clinical deterioration in patients with acute pulmonary embolism (PE). However, the best predictor of death among echo parameters of RV dysfunction is unknown.
Purpose: This meta-analysis is aimed at assessing the role of individual parameters of...
Importance
Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and effic...
Background
Limited data are available on the role of direct oral anticoagulants (DOACs) for the treatment of upper extremities deep vein thrombosis (UEDVT).
Objectives
The aim of this study was to assess the effectiveness and safety of DOACs in the treatment of UEDVT.
Methods
Patients with an objectively confirmed acute UEDVT treated with DOACs w...
Background:
Clinical guidelines advise similar anticoagulant treatment for symptomatic and incidental cancer-associated venous thromboembolism (VTE). We investigated clinical features and outcomes of cancer patients with incidental or symptomatic VTE randomized in the Caravaggio study.
Methods:
The Caravaggio study compared apixaban versus dalte...
Aims
Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short-hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone.
Methods and results
Individual...
Background
Whether concomitant administration of anticancer agents influences the efficacy and safety of oral anticoagulants in patients treated for cancer-associated venous thromboembolism (VTE) is undefined. The pharmacological interaction between anticancer agents and direct oral anticoagulants is perceived as a concern.
Methods
We evaluated th...
SARS-Cov-2 infection, a pandemic disease since March 2020, is associated with a high percentage of cardiovascular complications mainly of a thromboembolic (TE) nature. Although clinical patterns have been described for the assessment of patients with increased risk, many TE complications occur in patients with apparently moderate risk. Notably, a r...
PurposeIn patients with cancer, the safety of catheter ablation for non-valvular atrial fibrillation (AF) has not been evaluated, yet. The aim of this study was to assess the safety of AF ablation in cancer survivors.Methods
Consecutively recruited patients undergoing catheter ablation of non-valvular AF at our center between March 2015 and March 2...
Introduction
Sex and the presence of specific provoking risk factors, along with age, influence the presentation and prognosis of venous thromboembolism (VTE). We investigated the presentation, course and quality of life in women and men with acute VTE classified according to their VTE provoking factors.
Methods
PREFER in VTE is an international,...
Background and purpose:
Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patien...
Venous thromboembolism (VTE) is a common complication in patients with cancer. The risk of emergent VTE is four- to seven-fold higher in cancer patients compared to non-cancer patients. Although the therapeutic armamentarium for cancer-associated VTE has been recently implemented, anticoagulant treatment remains challenging because of the increased...
Jan Wouter was born in Amsterdam and studied medicine at the University of Amsterdam, specialized in internal medicine, and defended his PhD thesis in 1971 with the subject ‘Platelet functions in relation to haemostasis’. He became head of the department of thrombosis and hemostasis of the former Wilhelmina Gasthuis in Amsterdam, which later on, af...
Background
European guidelines do not recommend the use of carbamazepine, levetiracetam, phenobarbital, phenytoin, topiramate and valproic acid in patients taking direct oral anticoagulants (DOACs). Little is known regarding the clinical relevance of the interaction between DOACs and antiepileptic drugs.Objectives
To evaluate the incidence of throm...
Background Direct oral anticoagulants are recommended for the treatment of cancer-associated thrombosis (CAT) as an alternative to low-molecular-weight heparin (LMWH), but an increased bleeding risk in patients with gastrointestinal cancer was reported. The Caravaggio study compared apixaban and dalteparin for the treatment of patients with CAT. He...
Background:
In this randomized trial, currently utilized standard treatments were compared with enoxaparin for the prevention of venous thromboembolism (VTE) in patients with intracerebral hemorrhage (ICH).
Methods:
Enoxaparin (0.4 mg daily for 10 days) was started after 72 h from the onset of ICH. The primary outcome was symptomatic or asymptom...
Background
Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited.
Purpose
To assess the effectiveness and safety of DOACs in the treatment of UEDVT.
Methods
Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts...
Early diagnosis and treatment of deep vein thrombosis (DVT) is a main issue in the Emergency setting. With the aim of assisting clinicians in the diagnosis and the subsequent management of DVT in the Emergency Departments, a Nominal Group Technique (NGT) study was conducted. A panel of 5 Italian experts developed 21 consensus statements based on av...
Background:
Study-level meta-analyses provide high-certainty evidence that heparin reduces the risk of symptomatic venous thromboembolism for patients with cancer; however, whether the benefits and harms associated with heparin differ by cancer type is unclear. This individual participant data meta-analysis of randomised controlled trials examines...
Introduction:
Edoxaban had a positive risk-benefit ratio for the treatment of venous thromboembolism (VTE) compared to conventional therapy with warfarin. The objective of this analysis of the ongoing ETNA-VTE Europe study was to assess the real-world benefits and risks of edoxaban during the first 3 months of treatment, the highest risk period fo...
Background
In patients on anticoagulant treatment, the major bleeding (MB) definition released by the International Society of Thrombosis and Haemostasis (ISTH) is widely accepted. However, this definition identifies MBs with highly variable short‐term risk of death.
Objectives
The study aims were to derive and validate a classification of ISTH‐de...
Introduction
Edoxaban has proven its efficacy and safety in the ENGAGE AF-TIMI 48 and HOKUSAI-VTE clinical trials. Clinical practice patients, however, may differ from those enolled in clinical trials. We aimed to compare patients from the HOKUSAI-VTE clinical trial with those treated in clinical practice.
Materials and Methods
ETNA-VTE-Europe is...
Introduction
The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing.
Materials and Methods
Patients with PS were prospectively include...
Introduction
It is unknown whether the type of treatment (direct oral anticoagulant versus vitamin K antagonist) and the time of treatment introduction (early versus late) may affect the functional outcome in stroke patients with atrial fibrillation. We aimed to develop and validate a nomogram model including direct oral anticoagulant/vitamin K ant...
Background and Purpose
The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and...
Approximately one-fifth of all cases of venous thromboembolism (VTE) are related to cancer. VTE complications may have a substantial impact on prognosis, quality of life and care in patients with cancer. Patients with cancer-related VTE are at increased risk of developing recurrent VTE compared to patients without cancer, but also have a higher ris...
Introduction and objective:
Even though the introduction of less cumbersome anticoagulant agents has improved, the rates ofoverall anticoagulant treatment in eligible patients with atrial fibrillation (AF) remain to be defined. We aimed to assess the rates of and determinants for the use of anticoagulation treatment before stroke in patients with...
Background International guidelines have endorsed the use of edoxaban or rivaroxaban as an alternative to low-molecular-weight heparin (LMWH) for the treatment of acute venous thromboembolism (VTE) in cancer patients. Recently, a large randomized controlled trial of apixaban versus dalteparin in patients with cancer was completed. We performed an u...
Background
Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain.
Objective
To examine the performance of the Khorana score in assessing 6‐month VTE risk, and the efficacy and saf...
Intracerebral haemorrhage (ICH) is responsible for disproportionately high morbidity and mortality rates. The most used ICH classification system is based on the anatomical site. We used SMASH-U, an aetiological based classification system for ICH by predefined criteria: structural vascular lesions (S), medication (M), amyloid angiopathy (A), syste...
Background Most episodes of venous thromboembolism (VTE) occurred in primary care. To date, no score potentially able to identify those patients who may deserve an antithrombotic prophylaxis has been developed.
Aim The objective of this study is to develop and validate a prediction model for VTE in primary care.
Methods Using the Health Search Data...
Background
Recent guidelines recommend consideration of the use of oral edoxaban or rivaroxaban for the treatment of venous thromboembolism in patients with cancer. However, the benefit of these oral agents is limited by the increased risk of bleeding associated with their use.
Methods
This was a multinational, randomized, investigator-initiated,...
IntroductionHematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with short-term mortality, but its impact on long-term prognosis is still unclear. The aim of this study was to evaluate the impact of HE on long-term survival and functional status after spontaneous ICH.Methods
Consecutive patients admitted with spontaneous ICH...
Citations
... We performed a post-hoc analysis of pooled individual data from a previously published international collaboration of investigator-initiated prospective cohort studies; namely the RAF and RAF-NOACs studies. Details regarding the study designs and methods can be obtained from the published studies [18,19]. ...
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... One patient had to undergo fibrinolysis using a tissue plasminogen activator. These approaches are key for the treatment of thrombotic events leading to pulmonary embolism of different aetiologies [41,42]. Similar treatments using low-molecular-weight heparin have been used on SBE victims with considerable success, as demonstrated here [21]. ...
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... Previous studies have indicated a higher incidence of major bleeding subsequent to pulmonary embolism in patients with active cancer than in their counterparts (3). Could the authors elaborate on why the presence of active cancer does not exert a prognostic impact on the primary outcome, specifically major bleeding (1)? ...
... 4 Researches have demonstrated that effective anticoagulation and compression therapy during the phase of VTE can significantly decrease the incidence of PTS. 5 Patients with DVT who do not receive anticoagulant therapy or compression therapy for more than 3 months after discharge from the hospital, may have a significantly increased risk of PTS. 6 A comprehensive remote follow-up system for patients after discharge, which includes regular reminders to take medication and wear compression socks on time, can effectively prevent PTS. 7 Follow-up management is important since the prevention of PTS is a long-term treatment. ...
... Furthermore, there is an association between HF with unfavorable clinical outcome and mortality after stroke [2][3][4][5][6]. In addition, a reduced ejection fraction in patients with ischemic stroke and atrial fibrillation is associated with mortality [7]. In contrast, it is less clear whether HF is also associated with recurrent vascular events following an ischemic stroke. ...
... All these triggers, when present in a growing thrombus, can activate FXII which subsequently activates FXI. Emerging data show that FXI has a minor role in the physiological process of hemostasis but an important role in the development of thrombosis [11][12][13]. ...
... However, add-on treatment with aspirin does not reduce the recurrence risk but increases only the hemorrhagic risk. 23 A possible strategy in these patients would be an optimal control of vascular risk factors, which is part of the current holistic or integrated care approach to AF management recommended in guidelines. 24 Adherence to such an approach has been associated with improved clinical outcomes, including a lower relative risk of death, stroke, bleeding, and hospitalization. ...
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... For example, many clinical scenarios associated with a higher risk of bleeding lack high-quality evidence to guide management. 26,30 Up to 13% of cancer patients on anticoagulant therapy experience major bleeding, with a case-fatality rate of 8.9% in patients with cancer. 6,31 ...
... In-hospital mortality of patients admitted for acute intermediatehigh-risk PE is a considerable 1%-5%. [41][42][43] The optimal treatment of this patient subgroup is unclear, and we lack reliable methods for deciding which intermediate-high-risk patient will become hemodynamically unstable. Blood pressure, biomarkers, and echocardiographic findings alone are insufficient to risk stratify this subgroup, as some patients who are initially normotensive will experience hemodynamic instability requiring rescue reperfusion, vasopressors, intubation, or cardiopulmonary resuscitation. 4 Besides the ESC classification, prediction scores might also be helpful to identify acute PE patients who may benefit from reperfusion treatment. ...
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... The thromboembolic risk is markedly increased in patients with concurrent AF and CKD, compared to those with either condition alone [22]. Cancer patients, particularly those with metastatic disease or primary GI and genitourinary malignancies, are at an increased risk of VTE recurrence as well as bleeding, making the management of anticoagulant therapy especially challenging [23][24][25]. These complexities underline the need for safer anticoagulants, preferably with minimal renal clearance and enhanced efficacy, with FXI inhibitors emerging as potential solutions. ...
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