Anticoagulation Hub

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

[email protected]

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

Schizophrenia patients exhibited a twofold higher adjusted risk of deep vein thrombosis and pulmonary embolism development than those without schizophrenia, according to research by Dr. Wen-Yu Hsu of China Medical University in Taiwan published in Schizophrenia Research.

The schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT and a 1.99-fold higher adjusted HR for developing PE. The population-based cohort study included 60,264 schizophrenia patients in Taiwan, compared with 60,264 control patients, obtained from the National Health Insurance Research Database in Taiwan from 1996 to 2011.

The researchers identified several lifestyle factors that could contribute to the development of DVT and PE, including a decrease in activities of daily living because of either antipsychotics or negative symptoms of schizophrenia, higher rates of smoking and metabolic syndrome among schizophrenia patients, and prolonged antipsychotic exposure. In addition, patients who are immobile could be at greater risk of developing DVT and PE. “Based on the findings of this study, receiving first-generation antipsychotics or receiving second-generation antipsychotics should be considered a contributing factor of DVT and PE development,” the researchers said.

Read more here: (Schizophr. Res. 2015;162:248-52 [doi:10.1016/j.schres.2015.01.012]).

Schizophrenia patients exhibited a twofold higher adjusted risk of deep vein thrombosis and pulmonary embolism development than those without schizophrenia, according to research by Dr. Wen-Yu Hsu of China Medical University in Taiwan published in Schizophrenia Research.

The schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT and a 1.99-fold higher adjusted HR for developing PE. The population-based cohort study included 60,264 schizophrenia patients in Taiwan, compared with 60,264 control patients, obtained from the National Health Insurance Research Database in Taiwan from 1996 to 2011.

The researchers identified several lifestyle factors that could contribute to the development of DVT and PE, including a decrease in activities of daily living because of either antipsychotics or negative symptoms of schizophrenia, higher rates of smoking and metabolic syndrome among schizophrenia patients, and prolonged antipsychotic exposure. In addition, patients who are immobile could be at greater risk of developing DVT and PE. “Based on the findings of this study, receiving first-generation antipsychotics or receiving second-generation antipsychotics should be considered a contributing factor of DVT and PE development,” the researchers said.

Read more here: (Schizophr. Res. 2015;162:248-52 [doi:10.1016/j.schres.2015.01.012]).

Schizophrenia patients exhibited a twofold higher adjusted risk of deep vein thrombosis and pulmonary embolism development than those without schizophrenia, according to research by Dr. Wen-Yu Hsu of China Medical University in Taiwan published in Schizophrenia Research.

The schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT and a 1.99-fold higher adjusted HR for developing PE. The population-based cohort study included 60,264 schizophrenia patients in Taiwan, compared with 60,264 control patients, obtained from the National Health Insurance Research Database in Taiwan from 1996 to 2011.

The researchers identified several lifestyle factors that could contribute to the development of DVT and PE, including a decrease in activities of daily living because of either antipsychotics or negative symptoms of schizophrenia, higher rates of smoking and metabolic syndrome among schizophrenia patients, and prolonged antipsychotic exposure. In addition, patients who are immobile could be at greater risk of developing DVT and PE. “Based on the findings of this study, receiving first-generation antipsychotics or receiving second-generation antipsychotics should be considered a contributing factor of DVT and PE development,” the researchers said.

Read more here: (Schizophr. Res. 2015;162:248-52 [doi:10.1016/j.schres.2015.01.012]).

SNOWMASS, COLO. – Recent data seem to refute the 2013 American Heart Association/American College of Cardiology class III recommendation to avoid multivessel percutaneous coronary intervention at the time of primary PCI for ST-elevation MI, Dr. David R. Holmes Jr. observed at the Annual Cardiovascular Conference at Snowmass.

“The current AHA/ACC guidelines for STEMI should be and are being reevaluated regarding clarifications for the indications and timing of non–infarct artery revascularization,” according to Dr. Holmes, a cardiologist at the Mayo Clinic in Rochester, Minn., and an ACC past president.

Indeed, the ACC has already withdrawn from its ‘Choosing Wisely’ campaign its former recommendation discouraging multivessel revascularization at the time of primary PCI for STEMI. The college cited “new science showing that complete revascularization of all significant blocked arteries leads to better outcomes in some heart attack patients.”

Dr. Holmes was coauthor of a meta-analysis of 4 prospective and 14 retrospective studies involving more than 40,000 patients that concluded multivessel PCI for STEMI should be discouraged, and that significant nonculprit lesions should only be treated during staged procedures (J. Am. Coll. Cardiol. 2011;58:692-703). This meta-analysis was influential in the creation of the class III ‘don’t do it’ recommendation in the AHA/ACC guidelines. But Dr. Holmes said that in hindsight, the data included in the meta-analysis were something of a mishmash and “wound up being very hard to interpret.”

Greater clarity has been brought by two more recent randomized trials: PRAMI and CvLPRIT. Both were relatively small by cardiology standards, but they ended up showing similarly striking advantages in favor of using the STEMI hospitalization to perform preventive PCI of both the infarct-related artery and non–infarct arteries with major stenoses.

PRAMI included 465 acute STEMI patients who underwent infarct artery PCI and were then randomized to preventive PCI or infarct artery–only PCI. At a mean follow-up of 23 months, the preventive multivessel PCI group had a 65% reduction in the relative risk of the primary outcome, a composite of cardiac death, nonfatal MI, or refractory angina (N. Engl. J. Med. 2013;369:1115-23).

The yet-to-be-published CvLPRIT study was presented at the 2014 European Society of Cardiology meeting in Barcelona. The multicenter study included 296 STEMI patients with angiographically established significant multivessel disease who were randomized to primary PCI of the culprit vessel only or to complete revascularization. The primary outcome, the 12-month composite of all-cause mortality, recurrent MI, heart failure, or ischemia-driven revascularization, occurred in 10% of the complete revascularization group, compared with 21.2% of patients assigned to culprit artery–only PCI.

Also at the ESC conference, CvLPRIT investigator Dr. Anthony Gershlick of the University of Leicester (England) presented a meta-analysis combining the weighted results of PRAMI, CvLPRIT, and two earlier randomized trials: HELP AMI (Int. J. Cardiovasc. Intervent. 2004;6:128-33) and an Italian trial (Heart 2010;96:662-7). The results strongly favored multivessel PCI, with a 45% reduction in mortality and a 61% decrease in recurrent MI, compared with culprit vessel–only PCI at the time of admission for STEMI.

“Maybe there aren’t any innocent bystanders,” commented Dr. Holmes. “Maybe if you have somebody who has multivessel disease and you see something you think might be an innocent bystander but is a significant lesion, maybe it’s not so innocent. Maybe by treating them all at the time of the initial intervention the patient is going to do better.”

He reported having no financial conflicts of interest regarding his presentation.

[email protected]

SNOWMASS, COLO. – Recent data seem to refute the 2013 American Heart Association/American College of Cardiology class III recommendation to avoid multivessel percutaneous coronary intervention at the time of primary PCI for ST-elevation MI, Dr. David R. Holmes Jr. observed at the Annual Cardiovascular Conference at Snowmass.

“The current AHA/ACC guidelines for STEMI should be and are being reevaluated regarding clarifications for the indications and timing of non–infarct artery revascularization,” according to Dr. Holmes, a cardiologist at the Mayo Clinic in Rochester, Minn., and an ACC past president.

Indeed, the ACC has already withdrawn from its ‘Choosing Wisely’ campaign its former recommendation discouraging multivessel revascularization at the time of primary PCI for STEMI. The college cited “new science showing that complete revascularization of all significant blocked arteries leads to better outcomes in some heart attack patients.”

Dr. Holmes was coauthor of a meta-analysis of 4 prospective and 14 retrospective studies involving more than 40,000 patients that concluded multivessel PCI for STEMI should be discouraged, and that significant nonculprit lesions should only be treated during staged procedures (J. Am. Coll. Cardiol. 2011;58:692-703). This meta-analysis was influential in the creation of the class III ‘don’t do it’ recommendation in the AHA/ACC guidelines. But Dr. Holmes said that in hindsight, the data included in the meta-analysis were something of a mishmash and “wound up being very hard to interpret.”

Greater clarity has been brought by two more recent randomized trials: PRAMI and CvLPRIT. Both were relatively small by cardiology standards, but they ended up showing similarly striking advantages in favor of using the STEMI hospitalization to perform preventive PCI of both the infarct-related artery and non–infarct arteries with major stenoses.

PRAMI included 465 acute STEMI patients who underwent infarct artery PCI and were then randomized to preventive PCI or infarct artery–only PCI. At a mean follow-up of 23 months, the preventive multivessel PCI group had a 65% reduction in the relative risk of the primary outcome, a composite of cardiac death, nonfatal MI, or refractory angina (N. Engl. J. Med. 2013;369:1115-23).

The yet-to-be-published CvLPRIT study was presented at the 2014 European Society of Cardiology meeting in Barcelona. The multicenter study included 296 STEMI patients with angiographically established significant multivessel disease who were randomized to primary PCI of the culprit vessel only or to complete revascularization. The primary outcome, the 12-month composite of all-cause mortality, recurrent MI, heart failure, or ischemia-driven revascularization, occurred in 10% of the complete revascularization group, compared with 21.2% of patients assigned to culprit artery–only PCI.

Also at the ESC conference, CvLPRIT investigator Dr. Anthony Gershlick of the University of Leicester (England) presented a meta-analysis combining the weighted results of PRAMI, CvLPRIT, and two earlier randomized trials: HELP AMI (Int. J. Cardiovasc. Intervent. 2004;6:128-33) and an Italian trial (Heart 2010;96:662-7). The results strongly favored multivessel PCI, with a 45% reduction in mortality and a 61% decrease in recurrent MI, compared with culprit vessel–only PCI at the time of admission for STEMI.

“Maybe there aren’t any innocent bystanders,” commented Dr. Holmes. “Maybe if you have somebody who has multivessel disease and you see something you think might be an innocent bystander but is a significant lesion, maybe it’s not so innocent. Maybe by treating them all at the time of the initial intervention the patient is going to do better.”

He reported having no financial conflicts of interest regarding his presentation.

[email protected]

SNOWMASS, COLO. – Recent data seem to refute the 2013 American Heart Association/American College of Cardiology class III recommendation to avoid multivessel percutaneous coronary intervention at the time of primary PCI for ST-elevation MI, Dr. David R. Holmes Jr. observed at the Annual Cardiovascular Conference at Snowmass.

“The current AHA/ACC guidelines for STEMI should be and are being reevaluated regarding clarifications for the indications and timing of non–infarct artery revascularization,” according to Dr. Holmes, a cardiologist at the Mayo Clinic in Rochester, Minn., and an ACC past president.

Indeed, the ACC has already withdrawn from its ‘Choosing Wisely’ campaign its former recommendation discouraging multivessel revascularization at the time of primary PCI for STEMI. The college cited “new science showing that complete revascularization of all significant blocked arteries leads to better outcomes in some heart attack patients.”

Dr. Holmes was coauthor of a meta-analysis of 4 prospective and 14 retrospective studies involving more than 40,000 patients that concluded multivessel PCI for STEMI should be discouraged, and that significant nonculprit lesions should only be treated during staged procedures (J. Am. Coll. Cardiol. 2011;58:692-703). This meta-analysis was influential in the creation of the class III ‘don’t do it’ recommendation in the AHA/ACC guidelines. But Dr. Holmes said that in hindsight, the data included in the meta-analysis were something of a mishmash and “wound up being very hard to interpret.”

Greater clarity has been brought by two more recent randomized trials: PRAMI and CvLPRIT. Both were relatively small by cardiology standards, but they ended up showing similarly striking advantages in favor of using the STEMI hospitalization to perform preventive PCI of both the infarct-related artery and non–infarct arteries with major stenoses.

PRAMI included 465 acute STEMI patients who underwent infarct artery PCI and were then randomized to preventive PCI or infarct artery–only PCI. At a mean follow-up of 23 months, the preventive multivessel PCI group had a 65% reduction in the relative risk of the primary outcome, a composite of cardiac death, nonfatal MI, or refractory angina (N. Engl. J. Med. 2013;369:1115-23).

The yet-to-be-published CvLPRIT study was presented at the 2014 European Society of Cardiology meeting in Barcelona. The multicenter study included 296 STEMI patients with angiographically established significant multivessel disease who were randomized to primary PCI of the culprit vessel only or to complete revascularization. The primary outcome, the 12-month composite of all-cause mortality, recurrent MI, heart failure, or ischemia-driven revascularization, occurred in 10% of the complete revascularization group, compared with 21.2% of patients assigned to culprit artery–only PCI.

Also at the ESC conference, CvLPRIT investigator Dr. Anthony Gershlick of the University of Leicester (England) presented a meta-analysis combining the weighted results of PRAMI, CvLPRIT, and two earlier randomized trials: HELP AMI (Int. J. Cardiovasc. Intervent. 2004;6:128-33) and an Italian trial (Heart 2010;96:662-7). The results strongly favored multivessel PCI, with a 45% reduction in mortality and a 61% decrease in recurrent MI, compared with culprit vessel–only PCI at the time of admission for STEMI.

“Maybe there aren’t any innocent bystanders,” commented Dr. Holmes. “Maybe if you have somebody who has multivessel disease and you see something you think might be an innocent bystander but is a significant lesion, maybe it’s not so innocent. Maybe by treating them all at the time of the initial intervention the patient is going to do better.”

He reported having no financial conflicts of interest regarding his presentation.

[email protected]

NASHVILLE, TENN. – Patients with upper limbs affected by ischemic stroke who paired traditional rehabilitation exercises with pulsed vagus nerve stimulation boosted functional scores significantly higher than did those who performed exercises alone in a small, randomized pilot trial.

Taken together with the low rate of adverse events associated with device implantation, the study suggests that coupling the interventions is feasible and likely to be beneficial, Dr. Jesse Dawson of the University of Glasgow, Scotland, said at the International Stroke Conference, sponsored by the American Heart Association.

The vagus nerve stimulator (VNS) is typically used to suppress epileptiform discharges and circumvent seizures. The usual stimulation pattern is continuous cycles of 30 seconds on and 5 minutes off. In his randomized, controlled trial, Dr. Dawson set the device to deliver 0.5-second pulses that coincided with each repetition of a rehabilitative movement. When simulated, the nerve releases two proneuroplastic neurotransmitters, acetylcholine and norepinephrine, which then disperse over the cerebral cortex.

“Our theory was that if we timed these releases at specific periods during rehabilitation therapy, we might be able to drive neuroplasticity toward those specific tasks,” Dr. Dawson said at the conference. The technique has proved effective in both aged rats and rat stroke models, he added.

The trial comprised 20 patients who had experienced an ischemic stroke about 2 years prior. Each was left with residual dysfunction in an upper extremity; seven had a paretic limb. The mean Action Research Arm Test (ARAT) score was 33, and the mean upper extremity Fugl-Meyer score was 43, indicating moderate impairment.

Ten patients underwent VNS implantation. Nine completed the trial. One withdrew after 2 weeks because of a transient vocal cord palsy. This later resolved spontaneously.

Other adverse events related to the VNS were also transient. They included taste disturbance, chest pain, mild dysphagia, and nausea after a therapy session.

The 6-week intervention consisted of 18 sessions, each lasting 2 hours. In each, the rehabilitative movement was repeated 300-400 times.

In a per-protocol analysis, there was no significant difference in the upper extremity Fugl-Meyer score at the study’s end. However, when the patient who had withdrawn was excluded from the analysis, the results did become statistically significant. Patients in the dual-therapy group gained almost 10 points, compared with a 3-point gain in the exercise-only group. The ARAT scores were not different at study’s end.

In light of the positive initial results, a sham-controlled, randomized trial is in the works. The trial will randomize 20-25 patients to either the VNS-paired exercise or exercise-only interventions. All participants will receive the VNS device, but only the paired intervention group will receive actual stimuli.

Patricia Smith, Ph.D., the Doris E. Porter Professor in Physical Therapy at the University of Texas Southwestern, Dallas, is the lead investigator.

MicroTransponder, which makes the VNS unit, is sponsoring both the studies. Neither Dr. Dawson nor Dr. Smith have any financial ties to the company.

[email protected]

On Twitter @alz_gal

NASHVILLE, TENN. – Patients with upper limbs affected by ischemic stroke who paired traditional rehabilitation exercises with pulsed vagus nerve stimulation boosted functional scores significantly higher than did those who performed exercises alone in a small, randomized pilot trial.

Taken together with the low rate of adverse events associated with device implantation, the study suggests that coupling the interventions is feasible and likely to be beneficial, Dr. Jesse Dawson of the University of Glasgow, Scotland, said at the International Stroke Conference, sponsored by the American Heart Association.

The vagus nerve stimulator (VNS) is typically used to suppress epileptiform discharges and circumvent seizures. The usual stimulation pattern is continuous cycles of 30 seconds on and 5 minutes off. In his randomized, controlled trial, Dr. Dawson set the device to deliver 0.5-second pulses that coincided with each repetition of a rehabilitative movement. When simulated, the nerve releases two proneuroplastic neurotransmitters, acetylcholine and norepinephrine, which then disperse over the cerebral cortex.

“Our theory was that if we timed these releases at specific periods during rehabilitation therapy, we might be able to drive neuroplasticity toward those specific tasks,” Dr. Dawson said at the conference. The technique has proved effective in both aged rats and rat stroke models, he added.

The trial comprised 20 patients who had experienced an ischemic stroke about 2 years prior. Each was left with residual dysfunction in an upper extremity; seven had a paretic limb. The mean Action Research Arm Test (ARAT) score was 33, and the mean upper extremity Fugl-Meyer score was 43, indicating moderate impairment.

Ten patients underwent VNS implantation. Nine completed the trial. One withdrew after 2 weeks because of a transient vocal cord palsy. This later resolved spontaneously.

Other adverse events related to the VNS were also transient. They included taste disturbance, chest pain, mild dysphagia, and nausea after a therapy session.

The 6-week intervention consisted of 18 sessions, each lasting 2 hours. In each, the rehabilitative movement was repeated 300-400 times.

In a per-protocol analysis, there was no significant difference in the upper extremity Fugl-Meyer score at the study’s end. However, when the patient who had withdrawn was excluded from the analysis, the results did become statistically significant. Patients in the dual-therapy group gained almost 10 points, compared with a 3-point gain in the exercise-only group. The ARAT scores were not different at study’s end.

In light of the positive initial results, a sham-controlled, randomized trial is in the works. The trial will randomize 20-25 patients to either the VNS-paired exercise or exercise-only interventions. All participants will receive the VNS device, but only the paired intervention group will receive actual stimuli.

Patricia Smith, Ph.D., the Doris E. Porter Professor in Physical Therapy at the University of Texas Southwestern, Dallas, is the lead investigator.

MicroTransponder, which makes the VNS unit, is sponsoring both the studies. Neither Dr. Dawson nor Dr. Smith have any financial ties to the company.

[email protected]

On Twitter @alz_gal

NASHVILLE, TENN. – Patients with upper limbs affected by ischemic stroke who paired traditional rehabilitation exercises with pulsed vagus nerve stimulation boosted functional scores significantly higher than did those who performed exercises alone in a small, randomized pilot trial.

Taken together with the low rate of adverse events associated with device implantation, the study suggests that coupling the interventions is feasible and likely to be beneficial, Dr. Jesse Dawson of the University of Glasgow, Scotland, said at the International Stroke Conference, sponsored by the American Heart Association.

The vagus nerve stimulator (VNS) is typically used to suppress epileptiform discharges and circumvent seizures. The usual stimulation pattern is continuous cycles of 30 seconds on and 5 minutes off. In his randomized, controlled trial, Dr. Dawson set the device to deliver 0.5-second pulses that coincided with each repetition of a rehabilitative movement. When simulated, the nerve releases two proneuroplastic neurotransmitters, acetylcholine and norepinephrine, which then disperse over the cerebral cortex.

“Our theory was that if we timed these releases at specific periods during rehabilitation therapy, we might be able to drive neuroplasticity toward those specific tasks,” Dr. Dawson said at the conference. The technique has proved effective in both aged rats and rat stroke models, he added.

The trial comprised 20 patients who had experienced an ischemic stroke about 2 years prior. Each was left with residual dysfunction in an upper extremity; seven had a paretic limb. The mean Action Research Arm Test (ARAT) score was 33, and the mean upper extremity Fugl-Meyer score was 43, indicating moderate impairment.

Ten patients underwent VNS implantation. Nine completed the trial. One withdrew after 2 weeks because of a transient vocal cord palsy. This later resolved spontaneously.

Other adverse events related to the VNS were also transient. They included taste disturbance, chest pain, mild dysphagia, and nausea after a therapy session.

The 6-week intervention consisted of 18 sessions, each lasting 2 hours. In each, the rehabilitative movement was repeated 300-400 times.

In a per-protocol analysis, there was no significant difference in the upper extremity Fugl-Meyer score at the study’s end. However, when the patient who had withdrawn was excluded from the analysis, the results did become statistically significant. Patients in the dual-therapy group gained almost 10 points, compared with a 3-point gain in the exercise-only group. The ARAT scores were not different at study’s end.

In light of the positive initial results, a sham-controlled, randomized trial is in the works. The trial will randomize 20-25 patients to either the VNS-paired exercise or exercise-only interventions. All participants will receive the VNS device, but only the paired intervention group will receive actual stimuli.

Patricia Smith, Ph.D., the Doris E. Porter Professor in Physical Therapy at the University of Texas Southwestern, Dallas, is the lead investigator.

MicroTransponder, which makes the VNS unit, is sponsoring both the studies. Neither Dr. Dawson nor Dr. Smith have any financial ties to the company.

[email protected]

On Twitter @alz_gal

NASHVILLE, TENN. – In patients with symptomatic vertebrobasilar disease, low distal flow measured noninvasively predicted a patient’s subsequent risk for stroke in a multicenter, prospective study of 72 patients.

The finding “has implications for investigating interventional or aggressive medical treatments,” which should be aimed at this high-risk subgroup of patients, Dr. Sepideh Amin-Hanjani said at the International Stroke Conference, sponsored by the American Heart Association.

Mitchel L. Zoler/Frontline Medical News

Patients with “the highest risk for recurrence have the best chance to benefit from intervention,” said Dr. Amin-Hanjani, professor of neurosurgery and codirector of neurovascular surgery at the University of Illinois at Chicago. For the time being, no interventions for vertebrobasilar disease have proven efficacy and safety, but the new finding provides a way to identify the highest risk patients who stand to gain the most from intervention and should serve as the target population for future trials.

The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) trial enrolled 72 adults at any of five U.S. centers or at one in Canada. Enrolled patients had a recent stroke or transient ischemic attack in their vertebrobasilar territory plus angiographic evidence of at least 50% stenosis in an extra- or intracranial vertebral or basilar artery. All patients underwent quantitative MR angioplasty of their large vertebrobasilar arteries using software, Noninvasive Optimal Vessel Analysis (NOVA), that measures volumetric flow rates through vessels. Eighteen patients (25%) had low distal flow, defined as a greater than 20% reduction in flow, compared with normal, and 54 patients (75%) who had normal flow.

The study’s primary endpoint was an incident ischemic stroke in the vertebrobasilar territory during 12 months of follow-up. During a median follow-up of 23 months, 10 patients had this type of new stroke.

Among the 18 low-flow patients, four (22%) had a primary endpoint after 12 months, and among the 54 normal-flow patients, 2 (4%) had a primary endpoint after 12 months, a statistically significant difference, Dr. Amin-Hanjani reported at the conference.

In a multivariate analysis, low-flow at baseline linked with a significant, ninefold increased risk for incident stroke, compared with normal-flow patients. The location of the blockage – in the basilar region, vertebral region, or both – had no apparent impact on outcome.

About 30% of ischemic strokes occur in the posterior circulation, and about a third of those are caused by vertebrobasilar disease secondary to atherosclerosis. Overall patients who have had strokes of this type face a 10%-15% rate of new stroke annually despite receiving standard medical treatment, Dr. Amin-Hanjani said.

Dr. Amin-Hanjanihas received research grants from GE Healthcare and VasSol, the company that markets the NOVA software used in VERiTAS. A coauthor on the report has a significant ownership interest in VasSol.

[email protected]

On Twitter @mitchelzoler

NASHVILLE, TENN. – In patients with symptomatic vertebrobasilar disease, low distal flow measured noninvasively predicted a patient’s subsequent risk for stroke in a multicenter, prospective study of 72 patients.

The finding “has implications for investigating interventional or aggressive medical treatments,” which should be aimed at this high-risk subgroup of patients, Dr. Sepideh Amin-Hanjani said at the International Stroke Conference, sponsored by the American Heart Association.

Mitchel L. Zoler/Frontline Medical News

Patients with “the highest risk for recurrence have the best chance to benefit from intervention,” said Dr. Amin-Hanjani, professor of neurosurgery and codirector of neurovascular surgery at the University of Illinois at Chicago. For the time being, no interventions for vertebrobasilar disease have proven efficacy and safety, but the new finding provides a way to identify the highest risk patients who stand to gain the most from intervention and should serve as the target population for future trials.

The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) trial enrolled 72 adults at any of five U.S. centers or at one in Canada. Enrolled patients had a recent stroke or transient ischemic attack in their vertebrobasilar territory plus angiographic evidence of at least 50% stenosis in an extra- or intracranial vertebral or basilar artery. All patients underwent quantitative MR angioplasty of their large vertebrobasilar arteries using software, Noninvasive Optimal Vessel Analysis (NOVA), that measures volumetric flow rates through vessels. Eighteen patients (25%) had low distal flow, defined as a greater than 20% reduction in flow, compared with normal, and 54 patients (75%) who had normal flow.

The study’s primary endpoint was an incident ischemic stroke in the vertebrobasilar territory during 12 months of follow-up. During a median follow-up of 23 months, 10 patients had this type of new stroke.

Among the 18 low-flow patients, four (22%) had a primary endpoint after 12 months, and among the 54 normal-flow patients, 2 (4%) had a primary endpoint after 12 months, a statistically significant difference, Dr. Amin-Hanjani reported at the conference.

In a multivariate analysis, low-flow at baseline linked with a significant, ninefold increased risk for incident stroke, compared with normal-flow patients. The location of the blockage – in the basilar region, vertebral region, or both – had no apparent impact on outcome.

About 30% of ischemic strokes occur in the posterior circulation, and about a third of those are caused by vertebrobasilar disease secondary to atherosclerosis. Overall patients who have had strokes of this type face a 10%-15% rate of new stroke annually despite receiving standard medical treatment, Dr. Amin-Hanjani said.

Dr. Amin-Hanjanihas received research grants from GE Healthcare and VasSol, the company that markets the NOVA software used in VERiTAS. A coauthor on the report has a significant ownership interest in VasSol.

[email protected]

On Twitter @mitchelzoler

NASHVILLE, TENN. – In patients with symptomatic vertebrobasilar disease, low distal flow measured noninvasively predicted a patient’s subsequent risk for stroke in a multicenter, prospective study of 72 patients.

The finding “has implications for investigating interventional or aggressive medical treatments,” which should be aimed at this high-risk subgroup of patients, Dr. Sepideh Amin-Hanjani said at the International Stroke Conference, sponsored by the American Heart Association.

Mitchel L. Zoler/Frontline Medical News

Patients with “the highest risk for recurrence have the best chance to benefit from intervention,” said Dr. Amin-Hanjani, professor of neurosurgery and codirector of neurovascular surgery at the University of Illinois at Chicago. For the time being, no interventions for vertebrobasilar disease have proven efficacy and safety, but the new finding provides a way to identify the highest risk patients who stand to gain the most from intervention and should serve as the target population for future trials.

The VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) trial enrolled 72 adults at any of five U.S. centers or at one in Canada. Enrolled patients had a recent stroke or transient ischemic attack in their vertebrobasilar territory plus angiographic evidence of at least 50% stenosis in an extra- or intracranial vertebral or basilar artery. All patients underwent quantitative MR angioplasty of their large vertebrobasilar arteries using software, Noninvasive Optimal Vessel Analysis (NOVA), that measures volumetric flow rates through vessels. Eighteen patients (25%) had low distal flow, defined as a greater than 20% reduction in flow, compared with normal, and 54 patients (75%) who had normal flow.

The study’s primary endpoint was an incident ischemic stroke in the vertebrobasilar territory during 12 months of follow-up. During a median follow-up of 23 months, 10 patients had this type of new stroke.

Among the 18 low-flow patients, four (22%) had a primary endpoint after 12 months, and among the 54 normal-flow patients, 2 (4%) had a primary endpoint after 12 months, a statistically significant difference, Dr. Amin-Hanjani reported at the conference.

In a multivariate analysis, low-flow at baseline linked with a significant, ninefold increased risk for incident stroke, compared with normal-flow patients. The location of the blockage – in the basilar region, vertebral region, or both – had no apparent impact on outcome.

About 30% of ischemic strokes occur in the posterior circulation, and about a third of those are caused by vertebrobasilar disease secondary to atherosclerosis. Overall patients who have had strokes of this type face a 10%-15% rate of new stroke annually despite receiving standard medical treatment, Dr. Amin-Hanjani said.

Dr. Amin-Hanjanihas received research grants from GE Healthcare and VasSol, the company that markets the NOVA software used in VERiTAS. A coauthor on the report has a significant ownership interest in VasSol.

[email protected]

On Twitter @mitchelzoler