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Jean‐Philippe Galanaud Marc Righini Lorris Le Collen Aymeric Douillard Helia Robert‐Ebadi Daniel Pontal David Morrison Marie‐Thrse Barrellier Antoine Diard Herv Gunnguez Dominique Brisot Pascale Faïsse Sandrine Accassat Myriam Martin Aurlien Delluc Susan Solymoss Jeannine Kassis Marc Carrier Isabelle Qur Susan R. Kahn 《Journal of thrombosis and haemostasis》2020,18(4):857-864
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Tobias Tritschler Nomie Kraaijpoel Philippe Girard Harry R. Büller Nicole Langlois Marc Righini Sam Schulman Annelise Segers Grgoire Le Gal 《Journal of thrombosis and haemostasis》2020,18(6):1495-1500
Pulmonary embolism (PE)‐related death is often a component of the primary outcome in venous thromboembolism (VTE) clinical studies. Definitions for PE‐related death vary widely, which may lead to biased risk estimates of clinical outcomes, thereby affecting both internal and external validity of study results. We here provide a standardized definition of PE‐related death and propose guidance for classification and reporting of the cause of death for clinical studies in VTE. The proposal was developed in a four‐step process, including a systematic review of definitions used for PE‐related death in previous studies, two subsequent surveys with VTE experts, and meetings held within the Scientific and Standardization Committee (SSC) working group until consensus on the proposal was reached. The proposed classification comprises three categories: Category A: PE‐related death, category B: undetermined cause of death, and category C: cause of death other than PE. Category A includes A1: autopsy‐confirmed PE in the absence of another more likely cause of death; A2: objectively confirmed PE before death in the absence of another more likely cause of death; and A3: PE is not objectively confirmed, but is most likely the main cause of death. Category B includes B1: cause of death is undetermined, despite available information; and B2: insufficient clinical information available to determine the cause of death. The use of the proposed definition will hopefully improve the accuracy of study outcomes, between‐study comparisons, meta‐analyses, and validity of future clinical VTE studies. 相似文献
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Long‐term outcomes of elderly patients with CYP2C9 and VKORC1 variants treated with vitamin K antagonists 下载免费PDF全文
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Siavash Piran Grégoire Le Gal Philip S. Wells Esteban Gandara Marc Righini Marc A. Rodger Marc Carrier 《Thrombosis research》2013
Background
Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE.Materials and Methods
A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated.Results
A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I2: 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I2: 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I2: 0%) and 0.29% (95% CI: 0.06 to 0.68%; I2: 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I2: 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management.Conclusions
Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate. 相似文献17.
Advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use, and well standardized. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D‐dimer measurement, and imaging tests—predominantly computed tomography pulmonary angiography. These diagnostic algorithms allow safe and cost‐effective diagnosis for most patients with suspected PE. In this review, we summarize signs and symptoms of PE, current existing evidence for PE diagnosis, and focus on the challenge of diagnosing PE in special patient populations, such as pregnant women, or patients with a prior VTE. We also discuss novel imaging tests for PE diagnosis and highlight some of the additional challenges that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of PE among suspected patients as well as the overdiagnosis of subsegmental PE. 相似文献
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Clinical characteristics and prognostic factors of sinonasal undifferentiated carcinoma: a multicenter study 下载免费PDF全文
Guillaume de Bonnecaze MD MSc Benjamin Verillaud MD PhD Leonor Chaltiel PhD Sylvestre Fierens MD Mark Chapelier MD Cécile Rumeau MD MSc Olivier Malard MD PhD Marie Gavid MD MSC Xavier Dufour MD PhD Christian Righini MD PhD Emmanuelle Uro‐coste MD PhD Michel Rives MD Christine Bach MD Bertrand Baujat MD PhD François Janot MD PhD Ludovic de Gabory MD PhD Sebastien Vergez MD PhD 《International forum of allergy & rhinology》2018,8(9):1065-1072
Background
Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management.Methods
A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors.Results
Definitive analyses focused on 54 patients with a majority of advanced stage; the 3‐year overall survival (OS) and 3‐year recurrence‐free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow‐up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph‐node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity‐modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS.Conclusion
Multimodal therapies including induction chemotherapy and intensity‐modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required.19.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis owing to the lack of sensitivity and specificity of clinical signs and symptoms. Phlebography and pulmonary angiography are invasive and resource-demanding imaging modalities. Because the prevalence of DVT and PE is relatively low (typically 20% or less) among clinically suspected individuals, submitting all of them to imaging would not be cost-effective. Therefore, non-invasive diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement. These initial steps allow the selection of patients who require non-invasive imaging: compression ultrasonography in cases of suspected DVT and multidetector computed tomography (CT) angiography in cases of suspected PE. This review gives a critical appraisal of the sequential steps of the diagnostic work-up in suspected DVT or PE. 相似文献
20.