Background .Venous thromboembolic disease (VTE) is a leading cause of Cardiovascular mortali-ty.Treatment strategies for this condition are described in Guidelines, but single Centers may dif-ferently apply them. Recently for mostly inherited thrombophilias the advice has been given for “no testing anymore” in most situations of VTE. Objectives: to investigate: 1) VTE-type distribution (Unprovoked, Provoked, K-associated); 2) fre-quency of Triggers and of comorbidities, levels of Cardiac Biomarkers in relation to the three sub-sets of VTE; 3) features associated to use of Lytic therapy (LT), 4) search for thrombophilia and 5) prevalence of RF associated to potential CETPH development. Methods. Single Center Retrospective study in 145 VTE Pts admitted in the Cardiology Ward of our Policlinic Hospital (2016-2021). In addition to VTE-type, our Pts were also subdivided in Low Risk (LR), Int. Low/High (Int LR/IntHR) and High Risk Groups (HR) of early death (30 days) according to 2019 ESC Guidelines. True candidates for advanced diagnostic work-up for CETPH are selected with the use of the CTEPH prediction score of Klok. Results. Median Age (IQ) of our Pts was 73 (58.8-81.3), 54.5% were males. 12 (8.3%) belongs to HR, 84 (57.9%) to Int. HR, 40 (27.6%) to Int.LR and 9 (6.2%) to LR. Seventy-three (50.3%), 56 (38.6%) and 16 (11.1%) VTE pts belonged to Unprovoked, Provoked, K-associated Groups. VTE triggers frequently reported: Age>70 (58%), High TnI, pro-BNP, D-dimer levels and low EF were associated to the HR Groups (intHR and HR). LT was performed in 16.6% of Pts: 58.3% coming from the HR, 16,7% coming from the HR, 7.5% coming from the LR Group. The search of FV Leiden (31.9%), Prothrombin G20210A (29.8%) and APL Ab (32.6 %) is similarly distributed between Unprovoked and Provoked VTE. Comparing two temporal windows (2016-2018 vd 2019-2021): search for FV Leiden (36.3% vs 26.2%) and for Prothrombin G20210A (32.5% vs 26.1%) decreased and search for APL Ab (17.5% vs 50.7%) increased. Regarding potential CETPH de-velopment, Klok score > 6 was present only in the unprovoked subgroup (63.4% of pts within this subgroup). Conclusions. Unprovoked VTE represents the most frequent type of VTE in our Cardiology ward. Mostly of our VTE Pts are aged and belong to a HR/Int HR Group. LT is not restricted to HR Pts, suggesting that signs of RV dysfunction and clinical gestalt play a role for the choice to de-liver this drug. Search for FV Leiden and for Prothrombin G20210A is still frequent ( one out of four VTE pts) and is not restricted to Unprovoked VTE subset. CETPH screening in follow-up should be proposed for the subset with unprovoked TEP
Systemic Acute Venous Thromboembolic Disease: Focus on Patients seen by Cardiologists
Costa P;Sessarego E;Troccolo A;Barca L;Vecchiato V;Sarocchi M;Spallarossa P;Ameri P;Della Bona R;Porto I;Ghigliotti G
2023-01-01
Abstract
Background .Venous thromboembolic disease (VTE) is a leading cause of Cardiovascular mortali-ty.Treatment strategies for this condition are described in Guidelines, but single Centers may dif-ferently apply them. Recently for mostly inherited thrombophilias the advice has been given for “no testing anymore” in most situations of VTE. Objectives: to investigate: 1) VTE-type distribution (Unprovoked, Provoked, K-associated); 2) fre-quency of Triggers and of comorbidities, levels of Cardiac Biomarkers in relation to the three sub-sets of VTE; 3) features associated to use of Lytic therapy (LT), 4) search for thrombophilia and 5) prevalence of RF associated to potential CETPH development. Methods. Single Center Retrospective study in 145 VTE Pts admitted in the Cardiology Ward of our Policlinic Hospital (2016-2021). In addition to VTE-type, our Pts were also subdivided in Low Risk (LR), Int. Low/High (Int LR/IntHR) and High Risk Groups (HR) of early death (30 days) according to 2019 ESC Guidelines. True candidates for advanced diagnostic work-up for CETPH are selected with the use of the CTEPH prediction score of Klok. Results. Median Age (IQ) of our Pts was 73 (58.8-81.3), 54.5% were males. 12 (8.3%) belongs to HR, 84 (57.9%) to Int. HR, 40 (27.6%) to Int.LR and 9 (6.2%) to LR. Seventy-three (50.3%), 56 (38.6%) and 16 (11.1%) VTE pts belonged to Unprovoked, Provoked, K-associated Groups. VTE triggers frequently reported: Age>70 (58%), High TnI, pro-BNP, D-dimer levels and low EF were associated to the HR Groups (intHR and HR). LT was performed in 16.6% of Pts: 58.3% coming from the HR, 16,7% coming from the HR, 7.5% coming from the LR Group. The search of FV Leiden (31.9%), Prothrombin G20210A (29.8%) and APL Ab (32.6 %) is similarly distributed between Unprovoked and Provoked VTE. Comparing two temporal windows (2016-2018 vd 2019-2021): search for FV Leiden (36.3% vs 26.2%) and for Prothrombin G20210A (32.5% vs 26.1%) decreased and search for APL Ab (17.5% vs 50.7%) increased. Regarding potential CETPH de-velopment, Klok score > 6 was present only in the unprovoked subgroup (63.4% of pts within this subgroup). Conclusions. Unprovoked VTE represents the most frequent type of VTE in our Cardiology ward. Mostly of our VTE Pts are aged and belong to a HR/Int HR Group. LT is not restricted to HR Pts, suggesting that signs of RV dysfunction and clinical gestalt play a role for the choice to de-liver this drug. Search for FV Leiden and for Prothrombin G20210A is still frequent ( one out of four VTE pts) and is not restricted to Unprovoked VTE subset. CETPH screening in follow-up should be proposed for the subset with unprovoked TEP
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
