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Vicenza, Italy

Bleeding assessment tools were first developed essentially as research tools, for the quantification of bleeding symptoms and the study of phenotype/genotype correlations. Interestingly, these tools have been proven useful also for clinicians diagnosing and treating bleeding disorders. The main advantage of these tools is the standardization of the diagnostic process, allowing the introduction of criteria with known specificity and sensitivity for the diagnosis of the most common mild bleeding disorders, particularly von Willebrand disease. This is important also for a rational approach to the laboratory diagnosis because for many mild bleeding disorders, a complex laboratory workup is required. Bleeding assessment tools should always be complemented by ancillary coagulation screening tests to exclude the presence of a bleeding disorder, however. Finally, bleeding severity assessed by such tools has been shown to correlate with the long-term probability of bleeding. Therefore, the bleeding assessment could become an important marker of disease severity. Source

Attanasio P.,Applied Cachexia Research | Ronco C.,S. Bortolo Hospital | Anker S.D.,Applied Cachexia Research | Anker S.D.,Center for Clinical and Basic Research | And 2 more authors.
Seminars in Nephrology

Chronic heart failure is a common disorder associated with unacceptably high mortality rates. Chronic renal disease and anemia are two important comorbidities that significantly influence morbidity and mortality in patients with chronic heart failure (CHF). Progress in CHF again may cause worsening of kidney function and anemia. To describe this vicious cycle, the term cardio-renal anemia syndrome has been suggested. Iron deficiency is part of the pathophysiology of anemia in both CHF and chronic kidney disease, which makes it an interesting target for treatment of anemia in cardio-renal anemia syndrome. Recently, studies have highlighted the potential clinical benefits of treating iron deficiency in patients with CHF, even if these patients are nonanemic. This article summarizes studies investigating the influence of iron deficiency with or without anemia in chronic kidney disease and CHF and gives an overview of preparations of intravenous iron currently available. © 2012. Source

Tasca A.,S. Bortolo Hospital
Current Opinion in Urology

Purpose of Review: To review the prevalence and mechanisms of stone formation in patients with metabolic syndrome and in those submitted to bariatric surgery. Recent Findings: MetS is associated with urinary stone disease, which appears to be sustained by dietetic factors and insulin resistance. The latter represented in obesity and diabetes favors uric acid precipitation in urine via a more acidic urinary load. Patients submitted to modern bariatric surgery are at risk of nephrolithiasis and nephropathy as a consequence of malabsorption and hyperoxaluria, which are more consistent after Roux-en-Y gastric bypass than after gastric banding. Other stone risk factors such as hypocitraturia may also be present. Summary: Patients with metabolic syndrome and those submitted to modern bariatric surgery are both at risk of nephrolithiasis and nephropathy. Accurate stone screening careful monitoring of renal function and diet counseling are strongly encouraged in these patients. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Tosetto A.,S. Bortolo Hospital | Iorio A.,McMaster University | Marcucci M.,University of Perugia | Baglin T.,Addenbrookes Hospital | And 6 more authors.
Journal of Thrombosis and Haemostasis

Background: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. Objectives: We aimed to develop a score that could predict the recurrence risk following a first episode of unprovoked VTE, pooling individual patient data from seven prospective studies. Methods: One thousand eight hundred and eighteen cases with unprovoked VTE treated for at least 3months with a vitamin K antagonist were available for analysis. Optimism-corrected Cox regression coefficients were used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. Results: Abnormal D-dimer after stopping anticoagulation, age <50years, male sex and VTE not associated with hormonal therapy (in women) were the main predictors of recurrence and were used to derive a prognostic recurrence score (DASH, D-dimer, Age, Sex, Hormonal therapy) showing a satisfactory predictive capability (ROC area=0.71). The annualized recurrence risk was 3.1% (95% confidence interval [CI], 2.3-3.9) for a score≤1, 6.4% (95% CI, 4.8-7.9) for a score=2 and 12.3% (95% CI, 9.9-14.7) for a score≥3. By considering at low recurrence risk those patients with a score≤1, life-long anticoagulation might be avoided in about half of patients with unprovoked VTE. Conclusions: The DASH prediction rule appears to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3 months. © 2012 International Society on Thrombosis and Haemostasis. Source

Cosmi B.,University of Bologna | Legnani C.,University of Bologna | Tosetto A.,S. Bortolo Hospital | Pengo V.,University of Padua | And 7 more authors.

The PROLONG randomized trial showed that a normal D-dimer (D-d) 1 month after anticoagulation suspension for unprovoked venous thromboembolism (VTE) was associated with a low risk of late recurrences (4.4% patient years). However, it is unknown whether D-d changes subsequently. The aim of this prospective multicenter study was to assess D-d time course and its relation with late recurrences in patients with normal D-d 1 month after anticoagulation suspension for a first episode of unprovoked VTE. D-d was measured with a qualitative method (Clearview Simplify D-dimer; Inverness Medical Professional Diagnostics). Patients with a normal D-d 1 month after stopping anticoagulation repeated D-d testing every 2 months for 1 year. D-d was normal in 68% (243/355) of patients 1 month after anticoagulation suspension. Patients in whom D-d became abnormal at the third month and remained abnormal afterward had a higher risk of recurrence (7/31; 27% patient years; 95% confidence interval [CI]: 12-48) than patients in whom D-d remained normal at the third month and afterward (4/149; 2.9% patient years; 95% CI: 1-7; adjusted hazard ratio: 7.9; 95% CI: 2.1-30; P = .002). Repeated D-d testing after anticoagulation suspension for a first episode of unprovoked VTE could help tailor the duration of treatment. This trial is registered at http://clinicaltrials.gov as NCT00266045. © 2010 by The American Society of Hematology. Source

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