Marc Rodger

Does the Pulmonary Embolism Severity Index accurately identify low risk patients eligible for outpatient treatment

INTRODUCTION The pulmonary embolism severity index (PESI) and the recently derived simplified PESI prognostic model have been developed to estimate the risk of 30-day mortality in patients with acute PE. We sought to assess if the PESI and simplified PESI prognostic models can accurately identify adverse events and to determine the rates of events in patients treated as outpatients. METHODS A retrospective cohort study of patients with acute pulmonary embolism (PE) presenting at the Ottawa Hospital (Canada) was conducted between 1 January 2007 and 31 December 2008. RESULTS Two hundred and forty three patients were included. A total of 118 (48.6%) and 81 (33.3%) were classified as low risk patients using the original and simplified PESI prognostic models respectively. None of the low risk patients died within the 3months of follow-up. One hundred and fifteen (47.3%) patients were safely treated as outpatients with no deaths or bleeding episodes and only 1 recurrent event within the first 14days or after 30days of follow-up. Thirty four (29.6%) of these outpatients were classified as high risk patients according to the original PESI and 54 (47.0%) to the simplified PESI prognostic model. CONCLUSION Both PESI strategies accurately identify patients with acute PE who are at low risk and high risk for short-term adverse events. However, 30 to 47% of patients with acute PE and a high risk PESI score were safely managed as outpatients. Future research should be directed at developing tools that predict which patients would benefit from inpatient management.

Low-molecular-weight heparin for prevention of placenta-mediated pregnancy complications: protocol for a systematic review and individual patient data meta-analysis (AFFIRM).

BackgroundPlacenta-mediated pregnancy complications include pre-eclampsia, late pregnancy loss, placental abruption, and the small-for-gestational age newborn. They are leading causes of maternal, fetal, and neonatal morbidity and mortality in developed nations. Women who have experienced these complications are at an elevated risk of recurrence in subsequent pregnancies. However, despite decades of research no effective strategies to prevent recurrence have been identified, until recently. We completed a pooled summary-based meta-analysis that strongly suggests that low-molecular-weight heparin reduces the risk of recurrent placenta-mediated complications. The proposed individual patient data meta-analysis builds on this successful collaboration. The project is called AFFIRM, A n individual patient data meta-analysis oF low-molecular-weight heparin F or prevention of placenta-medI ated pR egnancy coMplications.Methods/DesignWe conducted a systematic review to identify randomized controlled trials with a low-molecular-weight heparin intervention for the prevention of recurrent placenta-mediated pregnancy complications. Investigators and statisticians representing eight trials met to discuss the outcomes and analysis plan for an individual patient data meta-analysis. An additional trial has since been added for a total of nine eligible trials. The primary analyses from the original trials will be replicated for quality assurance prior to recoding the data from each trial and combining it into a common dataset for analysis. Using the anonymized combined data we will conduct logistic regression and subgroup analyses aimed at identifying which women with previous pregnancy complications benefit most from treatment with low-molecular-weight heparin during pregnancy.DiscussionThe goal of the proposed individual patient data meta-analysis is a thorough estimation of treatment effects in patients with prior individual placenta-mediated pregnancy complications and exploration of which complications are specifically prevented by low-molecular-weight heparin.Systematic review registrationPROSPERO (International Prospective Registry of Systematic Reviews) 23 December 2013, CRD42013006249

Shifting from inpatient to outpatient treatment of deep vein thrombosis in a tertiary care center: a cost-minimization analysis.

Study Objective. To compare the cost of contemporary outpatient and historical inpatient management of proximal lower limb deep vein thrombosis (DVT) in adults.

Of matters great and small

If you really want to be smarter, reading can be one of the lots ways to evoke and realize. Many people who like reading will have more knowledge and experiences. Reading can be a way to gain information from economics, politics, science, fiction, literature, religion, and many others. As one of the part of book categories, of matters great and small always becomes the most wanted book. Many people are absolutely searching for this book. It means that many love to read this kind of book.

World Thrombosis Day

On October 13, World Thrombosis Day will be organized for the 3 time and hundreds of organizations around the globe will participate. This day is badly needed as thrombosis is still a neglected condition, and research on thrombosis is still relatively underfunded, especially when compared to other cardiovascular diseases. Nevertheless, based on the submissions we receive to be considered for publication in Thrombosis Research, we can safely say that the scientific field is alive and kicking.

On societal and hemostatic changes

Life is all about changes. Some changes benefit us all, but some are potentially devastating. One of the biggest changeswe have seen lastmonth is the election of Donald J. Trump as the 45th US president. You may agree or not agree with his plans for the future, but as scientists his election may be bad news for science in the US and potentially worldwide. Trump has been critical of many aspects of science; climate change, vaccination, NIH, NASA, etc. His proclivity for misinformation is disturbing to scientists as science is based, at its core, in truth-seeking.We are not optimistic that the Trump teamwill value nor fund science. The vice presidentelect, Mike Pence, the man currently in charge of the Trump transition team, is a man who denies evolution and believes homosexuality may be cured with electroshock therapy. Science has always found its way, even in times when scientists were put to death because of ideas that went against political and religious dogmas. It will continue to do so in Trump’s term. We are also perturbed by undercurrents of sexism, ageism and ableism that were on display in the campaign. As thrombosis scientists, we were disturbed that Hillary Clinton’s previous experiences with thrombosis provided ammunition to Trump, stating that Clinton would not have the stamina to be the next president. Enough politics! Let’s now turn to the hemostatic system. Also here, certain ‘changes’ do not appear to lead to much effect. In this issue, Cimenti et al report that children and adolescents suffering from diabetes type 1 do not show major alterations of the hemostatic system [1]. This is surprising as type 2 diabetes predisposes to hypercoagulability. Importantly, the authors draw the conclusion that diabetes may not influence hemostasis per se, but that the differences in underlying pathomechanisms between type 1 and type 2 diabetes explain the differential effects on hypercoagulation. In contrast,more fundamental changes, in the form ofmutations, seriously impact coagulation. Mezei et al describe that age, fibrinogen levels and BMI are multifactorial regulators of FXIII plasma levels [2]. However, the strongest effect was exerted by a FXIII-B polymorphism in intron K of the FXIII-B gene (intron K CNG). These results may be of importance in understanding the role of FXIII in thrombotic disease and arterial thrombosis. One hemostatic protein that has been associatedwith gene variation is fibrinogen. In fact, hundreds of mutations have been found in the

Tribute to Editor in Chief Per Morten Sandset

It is with some sadness and immense gratitude that we pay tribute to our outgoing Editor in Chief for Thrombosis Research, Dr. Per Morten Sandset. Thrombosis Research was first published in February of 1972. We will be celebrating its 45 anniversary next year in 2017. The initial Editor in Chief Al Copley and Co-Editor in Chief Birger Blomback served as co-Editors in Chief until 1992 when Al Copley passed away. Colvin Redmond and Birger Blomback continued to serve as Editors in Chief until 2001. In 2002 Jeff Ginsberg and PerMorten Sandset took over as Editors in Chief of Thrombosis Research. Per Morten has been Editor in Chief or Co-Editor in Chief since 2002. A fourteen year tenure as Editor in Chief is quite an unusual “marathon” stint as Editor in Chief. In reality it is an ultra-marathon run at the helm of a journal. We are deeply grateful to Per Morten for his persistence, diligence and hard work as Editor in Chief for almost a third of the journal’s time in existence. Per Morten was a pioneer very early on by advocating for and transitioning the journal from a print based submission journal to an electronic submission journal. It was one of the first journals to move to electronic submission in the Elsevier family. This enhanced Thrombosis Research’s reputation as an “author friendly” journal for rapid and thorough peer review. This “author friendly” reputation is one of the hallmarks of the journal and we are grateful to Per Morten for having established this mark of our journal. Per Morten’s diligence, kindness and pursuit of excellence for the journal are also well recognized. He has assisted many authors in improving their manuscripts and helping them to establish a foundation for their careers.Many in the Thrombosis Research community are indebted to Per Morten.

Thrombophilia and Obstetrical Outcomes

Abstract Thrombophilias are a diverse group of coagulation disorders that predispose to venous and arterial thrombosis. These hypercoagulable states have been shown to have important implications in perinatal medicine as they are associated with adverse pregnancy outcomes, including preeclampsia, intrauterine growth restriction, placental abruption and recurrent miscarriage. This article reviews the thrombophilias reported and their associations with adverse pregnancy outcomes.