Lipid lowering drugs and the risk of recurrent venous thromboembolism.

Introduction: Several studies have suggested that statins may lower the risk of venous thromboembolism (VTE), whereas fibrates may increase this risk. However, no studies have evaluated whether lipid-lowering drugs (LLD) use was associated with the risk of VTE recurrence.

Materials And Methods: In a prospective cohort study, we followed-up all patients who had been treated for a first unprovoked VTE event in our centre.

New anticoagulants in the treatment of VTE.

Low molecular weight heparins (LMWHs) and vitamin K antagonists make up the cornerstone of therapy for patients with venous thromboembolism (VTE) but have drawbacks making their use difficult in daily practice. Current research focuses on the development of new anticoagulant drugs that could be administered orally at a fixed dose, with fewer food and drug interactions and no need for monitoring or dose adjustment. Several new drugs are tested in noninferiority trials, either as a single-drug approach treatment (e.

Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study.

Objective: To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis.

Design: Prospective outcome study.

Setting: Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland.

Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded.

Background: D-dimer testing to rule out deep vein thrombosis is less useful in older patients because of a lower specificity. An age-adjusted D-dimer cut-off value increased the proportion of older patients (>50 years) in whom pulmonary embolism could be excluded. We retrospectively validated the efficacy of this cut-off combined with clinical probability for the exclusion of deep vein thrombosis.

Diagnosis of pulmonary embolism: planar images generated from V/Q SPECT are not a reliable substitute for traditional planar V/Q scan.

Objectives: The use of summed planar images generated from single-photon emission computed tomography (SPECT) ventilation/perfusion (V/Q) scintigraphy has been proposed as a substitute for planar V/Q scans in order to use the revised PIOPED interpretation criteria when only SPECT acquisition is performed in patients with suspected pulmonary embolism. The aim was to evaluate the accuracy of angular summed planar scans in comparison with true planar images.

Methods: Patients included in the 'SPECT study' assessing the diagnostic performance of V/Q SPECT were analysed.

Usefulness of preemptive anticoagulation in patients with suspected pulmonary embolism: a decision analysis.

Background: The diagnostic workup of pulmonary embolism (PE) may take several hours. The usefulness of anticoagulant treatment while awaiting the results of diagnostic tests has not been assessed. The objective of this study was to compare the risks and benefits of bid low-molecular-weight heparin vs no treatment in patients with suspected PE.

Medium-term survival of diffuse coronary artery disease patients following coronary artery reconstruction with the internal thoracic artery.

Objective: Diffuse coronary artery disease makes cardiac surgeons hesitant regarding whether coronary artery bypass grafting (CABG) surgery is feasible or not. Coronary artery reconstruction using the internal thoracic artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary artery reconstruction.

Biological determinants of bleeding in patients with heterozygous factor XI deficiency.

Bleeding risk is not predictable in patients with factor XI (FXI; F11) deficiency. In this prospective study, our objectives were to determine the biological determinants for bleeding risk in patients with heterozygous FXI deficiency. Patients were classified as either bleeding patients or non-bleeding patients by calculating the bleeding score (BS) described for von Willebrand disease.

Lipid parameters, lipid lowering drugs and the risk of venous thromboembolism.

Background: Besides their effects on atherogenesis, lipids and lipoproteins could contribute to the development of venous thromboembolism (VTE). This association has been investigated in a few studies with conflicting results.

Methods: Plasma levels of total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein A-I and apolipoprotein B were measured in 467 patients with a first unprovoked VTE event diagnosed between May 2000 and December 2004 and in 467 age and sex matched controls.

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.

Impact of genetic factors (VKORC1, CYP2C9, CYP4F2 and EPHX1) on the anticoagulation response to fluindione.

Aim: Genetic variants of the enzyme that metabolizes warfarin, cytochrome P-450 2C9 (CYP2C9) and of a key pharmacologic target of vitamin K antagonists, vitamin K epoxide reductase (VKORC1), contribute to differences in patients' responses to coumarin derivatives. The role of these variants in fluindione response is unknown. Our aim was to assess whether genetic factors contribute to the variability in the response to fluindione.

Diagnostic accuracy of single-photon emission tomography ventilation/perfusion lung scan in the diagnosis of pulmonary embolism.

Background: Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy.

Site of venous thromboembolism and prothrombotic mutations according to body mass index. Results from the EDITH study.

This study evaluated the impact of body mass index (BMI) on venous thromboembolism (VTE) site and assessed a possible interaction between BMI and prothrombotic risk factors in patients included in the EDITH (Etude des Déterminants et Interactions de le THrombose veineuse) study. A cross-sectional study was used to compare the site of unprovoked VTE according to BMI categories in 1077 patients and a matched case-control study (732 pairs) assessed the joint effect of BMI and prothrombotic mutations on VTE risk. The cross sectional analysis showed that the proportion of patients with pulmonary embolism was higher in overweight (63%) and obese (63·5%) patients than among patients with a BMI<25kg/m(2) (55%), P=0·02 and P=0·05 respectively.

The use of epicardial electrogram as a simple guide to select the optimal site of left ventricular pacing in cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) has been demonstrated to improve symptoms and survival in patients with left ventricular (LV) systolic dysfunction and dyssynchrony. To achieve this goal, the LV lead should be positioned in a region of delayed contraction. We hypothesized that pacing at the site of late electrical activation was also associated with long-term response to CRT.

Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?

Background: Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant.

Aim: To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease.

Venous thromboembolism in patients with pancreatic cancer: implications of circulating tissue factor.

Among cancers, pancreatic cancer is known to be associated with a higher incidence of venous thromboembolism (VTE). The aim of the study was to determine the implication of circulating tissue factor (TF) in VTE related to active pancreatic cancer. One hundred and sixty-four consecutive patients who participated to the Etude des Determinants et Interactions de la Thrombose veineuse (EDITH) study between January 2005 and August 2007 for symptomatic VTE related to active pancreatic cancer (n = 8), active cancer of other location (n = 42) or classified as unprovoked (n = 114) were included.

Atrial flutter after non-congenital cardiac surgery: incidence, predictors and outcome.

Background: Atrial arrhythmias (AAs) occur frequently after cardiac surgery. However, most authors do not differentiate postoperative atrial fibrillation (AF) from atrial flutter (AFL). Our study sought to investigate the incidence and predictors of AFL following non-congenital cardiac surgery, and the long-term outcome of this arrhythmia.

Noninvasive diagnosis of pulmonary embolism.

Background: We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging.

Methods: We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability.