Article
Hematology
Luise Adam, Martin Feller, Lamprini Syrogiannouli, Cinzia Del-Giovane, Jacques Donze, Christine Baumgartner, Daniel Segna, Carmen Floriani, Laurent Roten, Urs Fischer, Stefanie Aeschbacher, Giorgio Moschovitis, Jurg Schlapfer, Dipen Shah, Peter Amman, Richard Kobza, Matthias Schwenkglenks, Michael Kuehne, Leo H. Bonati, Jurg Beer, Stefan Osswald, David Conen, Drahomir Aujesky, Nicolas Rodondi
Summary: This study successfully developed a bleeding risk prediction model for AF patients on oral anticoagulants, with factors such as age over 75 years, history of cancer, prior major hemorrhage, and arterial hypertension included in the final prediction model. The model showed good calibration and discrimination with a Brier score of 0.23 and a c-statistic of 0.71 at 12 months follow-up.
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
(2021)
Article
Medicine, General & Internal
Jacopo Francesco Imberti, Davide Antonio Mei, Marco Vitolo, Niccolo Bonini, Marco Proietti, Tatjana Potpara, Gregory Y. H. Lip, Giuseppe Boriani
Summary: Clinical practice in atrial fibrillation patient management is constantly evolving. Various new guidelines have been published in the past few years, and they differ in key elements such as thromboembolic risk assessment, oral anticoagulants prescription, bleeding risk evaluation, and integrated patient management. The importance of an integrated and multidisciplinary approach to patient care is emerging.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2022)
Article
Pharmacology & Pharmacy
Giulia Montrasio, Martin F. Reiner, Andrea Wiencierz, Stefanie Aeschbacher, Christine Baumgartner, Nicolas Rodondi, Michael Kuhne, Giorgio Moschovitis, Helga Preiss, Michael Coslovsky, Maria L. De Perna, Leo H. Bonati, David Conen, Stefan Osswald, Juerg H. Beer, Pascal Koepfli
Summary: The study found that inappropriate dosing of DOACs was more common in patients with multiple comorbidities, but after adjusting for confounders, patients who were not prescribed according to label did not have a higher risk of adverse events.
VASCULAR PHARMACOLOGY
(2022)
Article
Medicine, General & Internal
Gyeong-Won Jang, Jung Myung Lee, Seung Woo Choi, Joan Kim, Young Shin Lee, Hyung Oh Kim, Hyemoon Chung, Jong Shin Woo, Jin Bae Kim, Woo-Shik Kim, Weon Kim
Summary: The study found no significant differences in the prevention of endothelial dysfunction and atherosclerosis progression between the NOAC and warfarin groups in patients with atrial fibrillation.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Hematology
Lavinia Dirienzo, Antonia Vitulli, Federica Mancazzo, Concetta T. Ammollo, Claudia Dellanoce, Oriana Paoletti, Sophie Testa, Mario Colucci
Summary: This study compared the effects of different direct oral anticoagulants (DOAC) on thrombin generation parameters and tissue plasminogen activator (t-PA)-induced clot lysis. The results showed that dabigatran inhibits thrombin generation in a different way than anti-Xa DOAC and exhibits profibrinolytic activity.
Article
Cardiac & Cardiovascular Systems
Ju Hee Choi, Woojin Kim, Yun Tae Kim, Jaelim Cho, Seung Yong Shin, Changsoo Kim, Jin-Bae Kim
Summary: This study investigated the cost-effectiveness of DOACs versus warfarin in non-valvular AF patients with intermediate stroke risk. The findings showed that DOACs were more cost-effective than warfarin in this patient population.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Yunwen Xu, Alex R. Chang, Lesley A. Inker, Mara McAdams-DeMarco, Morgan E. Grams, Jung-Im Shin
Summary: This study evaluated the risk of bleeding in patients with atrial fibrillation who used diltiazem concurrently with direct oral anticoagulants (DOACs). The study found that concomitant use of diltiazem increased the risk of bleeding compared to DOACs alone. This risk was observed in both patients with and without chronic kidney disease.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Pharmacology & Pharmacy
M. Sabate, X. Vidal, E. Ballarin, M. Rottenkolber, S. Schmiedl, B. Grave, C. Huerta, E. Martin-Merino, D. Montero, L. M. Leon-Munoz, C. Gasse, N. Moore, C. Droz, R. Lassalle, M. Aakjaer, M. Andersen, M. L. De Bruin, P. Souverein, O. H. Klungel, H. Gardarsdottir, L. Ibanez
Summary: This study described and compared the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Despite differences in database characteristics and population demographics, a similar pattern was observed with apixaban having the highest persistence and dabigatran having the highest rates of discontinuation and switching at 12 months in most databases.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Multidisciplinary Sciences
Ji Yun Lee, Il-Young Oh, Ju-Hyeon Lee, Seok Kim, Jihoon Cho, Charg Hyun Park, Sooyoung Yoo, Soo-Mee Bang
Summary: This study examined the impact of potential drug-drug interactions on the risk of ischemic stroke and major bleeding in atrial fibrillation patients treated with DOACs. It was found that an increased number of DDIs significantly raised the risk of both ischemic stroke and hospitalization for major bleeding in these patients.
SCIENTIFIC REPORTS
(2021)
Review
Cardiac & Cardiovascular Systems
Xinxing Gao, Donghua Huang, Yuting Hu, Yuanyuan Chen, Haidong Zhang, Fuwei Liu, Jun Luo
Summary: This meta-analysis compared the effectiveness and safety of DOACs and warfarin in patients with atrial fibrillation at risk of falling, and found that DOACs were significantly associated with reduced risks of hemorrhagic stroke, major or clinically relevant non-major bleeding, and intracranial bleeding compared to warfarin.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Review
Medicine, General & Internal
Matej Samos, Tomas Bolek, Lucia Stanciakova, Martin Jozef Pec, Kristina Brisudova, Ingrid Skornova, Jan Stasko, Marian Mokan, Peter Kubisz
Summary: DOAC is currently the drug of choice for preventing stroke or systemic embolism in AF patients, but there is still a challenge in optimizing its clinical efficacy.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Geriatrics & Gerontology
Kuo-Hsuan Chang, Chiung-Mei Chen, Chun-Li Wang, Hui-Tzu Tu, Yu-Tung Huang, Hsiu-Chuan Wu, Chien-Hung Chang, Shang-Hung Chang
Summary: This retrospective cohort study examined the association between direct oral anticoagulants (DOACs) and concurrent antidepressant use in patients with atrial fibrillation (AF). The study found that concurrent use of bupropion with DOACs increased the risk of major bleeding and gastrointestinal hemorrhage. The combinations of DOACs with selective serotonin reuptake inhibitors (SSRIs) and tetracyclic antidepressants (TeCAs) were associated with an increased risk of intracerebral hemorrhage. The study suggests that careful consideration should be given to drug-drug interactions when prescribing DOACs to adult patients with AF.
FRONTIERS IN AGING NEUROSCIENCE
(2022)
Article
Pharmacology & Pharmacy
Ya-Ling Huang, Ching-Yao Chen, Ching-Chi Chu
Summary: This study aimed to compare the safety and effectiveness of direct oral anticoagulants and warfarin in Asian patients with nonvalvular atrial fibrillation. It found that direct oral anticoagulant use was not associated with major bleeding and thromboembolism occurrence, but was associated with increased risk of gastrointestinal bleeding compared to warfarin use, especially within 0-6 months of treatment.
INTERNATIONAL JOURNAL OF CLINICAL PHARMACY
(2022)
Article
Pharmacology & Pharmacy
Ply Chichareon, Arjbordin Winijkul, Gregory Y. H. Lip, Rungroj Krittayaphong
Summary: This study compared the performance of 3 scoring models in anticoagulated Asian patients with atrial fibrillation (AF). The results showed that the clinical utility for bleeding prediction of GARFIELD-AF, HAS-BLED, modified HAS-BLED, and ORBIT scores were similar in this population.
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
(2023)
Article
Hematology
Jacopo Sabbatinelli, Olga Protic, Anna Rita Bonfigli, Andrea Stronati, Marianna Pavani, Antonio Domenico Procopio, Fabrizia Lattanzio, Fabiola Olivieri, Roberto Antonicelli, Roberto Testa
Summary: A retrospective study evaluated the efficacy, safety, and dose appropriateness of DOACs in older patients. Results showed that subtherapeutic dose of DOACs in patients over 80 years old increased the incidence of cardiovascular mortality, stroke, or systemic embolism. However, reduced renal function did not increase the adverse safety and efficacy outcomes. Therefore, the use of DOACs in older patients should be cautious to avoid inappropriate prescriptions.
THROMBOSIS RESEARCH
(2023)
Article
Rheumatology
Ecem Sevim, Diane Zisa, Danieli Andrade, Savino Sciascia, Vittorio Pengo, Maria G. Tektonidou, Amaia Ugarte, Maria Gerosa, H. Michael Belmont, Maria Angeles Aguirre Zamorano, Paul R. Fortin, Lanlan Ji, Maria Efthymiou, Hannah Cohen, D. Ware Branch, Guilherme Ramires Jesus, Laura Andreoli, Michelle Petri, Esther Rodriguez, Ricard Cervera, Jason S. Knight, Tatsuya Atsumi, Rohan Willis, Robert Roubey, Maria Laura Bertolaccini, Doruk Erkan, Medha Barbhaiya
Summary: This study describes the baseline characteristics of patients with antiphospholipid antibodies (aPLs) and demonstrates the heterogeneity of clinical manifestations and laboratory profiles in this group. Different degrees of aPL positivity were associated with varying frequencies of clinical events.
ARTHRITIS CARE & RESEARCH
(2022)
Article
Hematology
Vittorio Pengo, Gentian Denas
Summary: Unprovoked or provoked by mild risk factors, VTE in young patients, VTE in uncommon sites, or cases of unexplained VTE recurrence may be positive for antiphospholipid antibodies (aPL) and thus may be diagnosed with antiphospholipid syndrome (APS). The evaluation of aPL is standardized using immunological tests for anticardiolipin and anti-beta 2-glycoprotein I. The determination of functional antibodies (lupus anticoagulant) is less standardized, especially in patients on anticoagulant treatment. Patients positive for all three tests are at high risk of recurrence, which may lead to chronic thromboembolic pulmonary hypertension. Randomized clinical trials have shown that triple-positive patients should be treated with vitamin K antagonists maintaining an international normalized ratio between 2 and 3. Whether patients with VTE and incomplete aPL profile can be treated with direct oral anticoagulants should be further investigated.
SEMINARS IN THROMBOSIS AND HEMOSTASIS
(2023)
Article
Rheumatology
Zeynep Belce Erton, Ecem Sevim, Guilherme Ramires de Jesus, Ricard Cervera, Lanlan Ji, Vittorio Pengo, Amaia Ugarte, Danieli Andrade, Laura Andreoli, Tatsuya Atsumi, Paul R. Fortin, Maria Gerosa, Yu Zuo, Michelle Petri, Savino Sciascia, Maria G. Tektonidou, Maria Angeles Aguirre-Zamorano, D. Ware Branch, Doruk Erkan
Summary: This study aimed to describe the outcomes of pregnancies in aPL-positive patients, revealing that 27% of pregnancies resulted in early pregnancy loss before 10 weeks, while 23% of the remaining 40 pregnancies had composite outcomes related to aPL.
LUPUS SCIENCE & MEDICINE
(2022)
Review
Medicine, General & Internal
Irene Cecchi, Massimo Radin, Silvia Grazietta Foddai, Marta Arbrile, Alice Barinotti, Elena Rubini, Alessandro Morotti, Vittorio Pengo, Dario Roccatello, Savino Sciascia
Summary: Antiphospholipid syndrome (APS) is an autoimmune condition characterized by thrombosis and/or pregnancy morbidity in patients with persistent positive antiphospholipid antibodies (aPL). Patients who do not completely fulfill the classification criteria for overt APS may pose challenges in terms of treatment and management. This article aims to discuss therapeutic strategies based on available literature for challenging scenarios of aPL positive patients.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Candrika D. Khairani, Antoine Bejjani, Gregory Piazza, David Jimenez, Manuel Monreal, Saurav Chatterjee, Vittorio Pengo, Scott C. Woller, Josefina Cortes-Hernandez, Jean M. Connors, Yogendra Kanthi, Harlan M. Krumholz, Saskia Middeldorp, Anna Falanga, Mary Cushman, Samuel Z. Goldhaber, David A. Garcia, Behnood Bikdeli
Summary: A systematic review and meta-analysis of randomized controlled trials comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) for thrombotic antiphospholipid syndrome patients found that DOACs were associated with an increased risk of subsequent arterial thrombotic events compared to VKAs. However, there were no significant differences in the risk of subsequent venous thromboembolic events or major bleeding between the two groups.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Article
Rheumatology
Zeynep B. Erton, Rebecca K. Leaf, Danieli de Andrade, Ann E. Clarke, Maria G. Tektonidou, Vittorio Pengo, Savino Sciascia, Amaia Ugarte, H. Michael Belmont, Maria Gerosa, Paul R. Fortin, Chary Lopez-Pedrera, Tatsuya Atsumi, Zhouli Zhang, Hannah Cohen, Guilherme Ramires de Jesus, David W. Branch, Denis Wahl, Laura Andreoli, Esther Rodriguez-Almaraz, Michelle Petri, Giuseppe Barilaro, Yu Zuo, Bahar Artim-Esen, Rohan Willis, Rosana Quintana, Margarete B. G. Vendramini, Megan W. Barber, Maria L. Bertolaccini, Robert Roubey, Doruk Erkan
Summary: The study aimed to investigate the outcomes of patients with persistently positive antiphospholipid antibodies and the use of immunosuppression. The results showed that 14% of patients received immunosuppression, with half of them receiving it for selected microvascular and/or non-thrombotic aPL-related manifestations.
Article
Hematology
Elena Pontara, Maria Grazia Cattini, Elisa Bison, Chunyan Cheng, Gentian Denas, Vittorio Pengo
Summary: This study evaluated the role of phospholipids in reversing aPS/PT-mediated APC-R. The findings indicate that phospholipids can reverse the resistance, possibly due to changes in phospholipid availability.
THROMBOSIS RESEARCH
(2022)
Review
Medicine, General & Internal
Rui Zhu, Gang-Yi Cheng, Gentian Denas, Vittorio Pengo
Summary: Acquired thrombophilia, specifically antiphospholipid antibodies (aPL), may contribute to the development of chronic thromboembolic pulmonary hypertension (CTEPH). Young patients who experience an unprovoked pulmonary embolism (PE) or PE triggered by mild risk factors should be tested for aPL. If positive, close monitoring and lifelong anticoagulant therapy should be considered because aPL-induced thrombophilia increases the risk of recurrent PE leading to CTEPH. The presence of lupus anticoagulant (LAC), anti-cardiolipin (aCL), and anti-& beta;2-glycoprotein I (a & beta;2GPI) antibodies indicates the highest risk of recurrence and necessitates treatment with warfarin for maximum protection.
EUROPEAN JOURNAL OF INTERNAL MEDICINE
(2023)
Article
Rheumatology
Cecilia B. Chighizola, Francesca Pregnolato, Danieli Andrade, Maria Tektonidou, Vittorio Pengo, Guillermo Ruiz-Irastorza, H. Michael Belmont, Maria Gerosa, Paul Fortin, D. Ware Branch, Laura A. Andreoli, Michelle A. Petri, Ricard S. Cervera, Jason S. Knight, Rohan Willis, Maria Efthymiou, Hannah Cohen, Doruk Erkan, Maria Laura Bertolaccini
Summary: The study aims to evaluate the antibodies titers against beta(2)-glycoprotein I (anti-beta(2)GPI) and domain 1 (anti-D1) in a longitudinally manner. The results show that treatment with hydroxychloroquine (HCQ) is associated with a decrease in antibody titers, while incident vascular events are associated with an increase in antibody titers. The titers of antibodies are lower at the time of thrombosis. This study is of great importance in understanding the fluctuations in antibody titers and their relationship with thrombosis.
ARTHRITIS & RHEUMATOLOGY
(2023)
Review
Pharmacology & Pharmacy
Giovanni Santostasi, Gentian Denas, Vittorio Pengo
Summary: This article summarizes the progress made in using anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation, with a particular focus on new drugs that can minimize bleeding risk in elderly patients.
EXPERT OPINION ON PHARMACOTHERAPY
(2023)
Article
Medicine, Research & Experimental
Elena Gkrouzman, Rohan Willis, Danieli Andrade, Maria G. Tektonidou, Vittorio Pengo, Guillermo Ruiz-Irastorza, H. Michael Belmont, Paul R. Fortin, Maria Gerosa, Flavio Signorelli, Tatsuya Atsumi, D. Ware Branch, Cecilia Nalli, Esther Rodriguez-Almaraz, Michelle A. Petri, Ricard Cervera, Jason S. Knight, Maria Efthymiou, Hannah Cohen, Maria Laura Bertolaccini, Doruk Erkan, Robert Roubey
Summary: A study found that different profiles of antiphospholipid antibody (aPL) are associated with the clinical manifestations of antiphospholipid syndrome (APS), particularly higher levels of anticardiolipin antibody (aCL) and anti -b2 glycoprotein-I antibody (ab2GPI). The study also identified overlapping antibody detection methods and proposed a calculation method to assess the overall burden of aPL.
LABORATORY INVESTIGATION
(2023)
Article
Rheumatology
Gustavo G. M. Balbi, Yasaman Ahmadzadeh, Maria G. Tektonidou, Vittorio Pengo, Savino Sciascia, Amaia Ugarte, H. Michael Belmont, Chary Lopez-Pedrera, Paul R. Fortin, Denis Wahl, Maria Gerosa, Guilherme R. de Jesus, Lanlan Ji, Tatsuya Atsumi, Maria Efthymiou, D. Ware Branch, Cecilia Nalli, Esther Rodriguez Almaraz, Michelle Petri, Ricard Cervera, Jason S. Knight, Bahar Artim-Esen, Rohan Willis, Maria Laura Bertolaccini, Hannah Cohen, Robert Roubey, Doruk Erkan, Danieli Castro Oliveira de Andrade
Summary: The objective of this study was to quantify the damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPL-positive patients with or without a history of thrombosis, and to identify clinical and laboratory characteristics associated with damage in these patients. The study found that DIAPS is of great significance in identifying patients with a higher damage burden and selected traditional cardiovascular risk factors, steroid use, and specific aPL profiles may help in identifying these patients.
Letter
Hematology
Marta Monti, Tiziano Martini, Vittorio Pengo, Giovanni Poletti, Paola Pedrazzi, Chiara Biasoli, Maddalena Giovacchini, Tommaso Fasano
SEMINARS IN THROMBOSIS AND HEMOSTASIS
(2023)
Article
Rheumatology
Yu Zuo, Sherwin Navaz, Alex Tsodikov, Katarina Kmetova, Lyndsay Kluge, Amala Ambati, Claire K. Hoy, Srilakshmi Yalavarthi, Danieli de Andrade, Maria G. Tektonidou, Savino Sciascia, Vittorio Pengo, Guillermo Ruiz-Irastorza, H. Michael Belmont, Maria Gerosa, Paul R. Fortin, Guilherme Ramires de Jesus, D. Ware Branch, Laura Andreoli, Esther Rodriguez-Almaraz, Michelle Petri, Ricard Cervera, Rohan Willis, David R. Karp, Quan-Zhen Li, Hannah Cohen, Maria Laura Bertolaccini, Doruk Erkan, Jason S. Knight
Summary: This study aimed to investigate the presence, antigen specificities, and potential clinical associations of anti-neutrophil extracellular trap (anti-NET) antibodies in antiphospholipid (aPL) antibody-positive patients without lupus. The results showed that high levels of anti-NET antibodies were found in 45% of aPL-positive patients, and they were associated with clinical manifestations and the production of specific autoantibodies.
ARTHRITIS & RHEUMATOLOGY
(2023)
Meeting Abstract
Rheumatology
Zeynep Belce Erton, Rebecca K. Leaf, Danieli Castro Oliveira de Andrade, Megan Barber, Maria G. Tektonidou, Vittorio Pengo, Savino Sciascia, Amaia Ugarte, H. Michael Belmont, Chary Lopez-Pedrera, Paul R. Fortin, Maria Gerosa, Guilherme de Jesus, Tatsuya Atsumi, Zhuoli Zhang, Hannah Cohen, D. Ware Branch, Denis Wahl, Laura Andreoli, Esther Rodriguez Almaraz, Michelle Petri, Ricard Cervera, Yu Ray Zuo, Bahar Artim-Esen, Rohan Willis, Maria Laura Bertolaccini, Robert Roubey, Doruk Erkan
ARTHRITIS & RHEUMATOLOGY
(2022)