Showing papers by "Alfonso Tafur published in 2014"

Coated-Platelets Improve Prediction of Stroke and Transient Ischemic Attack in Asymptomatic Internal Carotid Artery Stenosis

Abstract: Background and Purpose—Coated-platelets, a subset of procoagulant platelets observed on dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased in large artery stroke, and higher levels are associated with early stroke recurrence, suggesting a potential role for risk stratification in asymptomatic patients with carotid artery stenosis. Methods—Three-hundred twenty-nine consecutive patients with technically adequate carotid Doppler evaluation without stroke or transient ischemic attack (TIA) in the previous 6 months were enrolled as part of a prospective cohort study conducted during a 40-month period. The main outcome was occurrence of stroke or TIA according to coated-platelet levels and internal carotid stenosis severity at enrollment. The optimal cutoff value of coated-platelet levels was determined by recursive partitioning analysis. Event-free survival was estimate...

Primary venous thromboembolism prophylaxis in patients with solid tumors: a meta-analysis.

Abstract: Venous thromboembolism (VTE) is a leading cause of death among outpatient chemotherapy patients. However the VTE preventive measures for outpatients are not widely advocated. We did a meta-analysis to evaluate the outpatient VTE prevention's effectiveness and safety. We searched electronic databases until the end of December 2012 and reviewed the abstracts and manuscripts following the PRISMA guidelines. Occurrence of first VTE event was the efficacy outcome. The safety end point was major bleeding. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel-Haenszel fixed-effects method in the absence of heterogeneity. Data were analyzed using the R META package). We identified 1,485 articles and reviewed 37 articles based on initial screening. The number of patients included in 11 selected trials was 7,805. The odds of VTE was lower in the prophylaxis group (OR 0.56; 95% CI 0.45-0.71) and improved when heparin-based prevention was analyzed (OR 0.53; 95% CI 0.41-0.70). We found strong prevention among patients with lung cancer (OR 0.46; 95% CI 0.29-0.74) and pancreatic cancer (OR 0.33; 95% CI 0.16-0.67). Major bleeding events were frequent in the intervention group (OR 1.65; 95% CI 1.12-2.44). Thromboprophylaxis reduced VTE episodes. The VTE events were reduced by 47% in heparin-based prophylaxis trials compared to placebo. The patients receiving heparin-based prophylaxis had a 60% increase in bleeding events. Improving risk stratification tools to personalize prevention strategies may enhance the VTE prevention applicability in cancer patients.

A low Wells score and a negative D-dimer was not safe in patients with cancer for ruling out DVT.

Abstract: In combination with a D-dimer serum test, the Wells rule has long been used and recommended to help clinicians discern the likelihood of lower extremity deep vein thrombosis (DVT).1 The safety and efficacy of these tools have been challenged in their applications to populations with distinct incidences of DVT.2 Specifically, patients with a prior DVT and those with malignancy have a high rate of venous thromboembolism (VTE) which may foreseeably decrease the negative predictive value of prediction rules. These specific populations have not been well represented in individual studies. For the current study, Geersing et al 3 performed a patient-level meta-analysis by combining data extracted from 13 studies published after 2006. The inclusion criteria were restricted to those studies with data on all the predictors of the Wells rule, and D-dimer before the reference test. The accepted reference tests for proximal DVT were compression ultrasound or venography, but if these were absent an uneventful follow-up for 3 months was an acceptable reference for a negative study. When generating …

Abstract 14796: Validity of Smartphone Pedometer Apps as a Tool to Monitor Physical Activity Remotely

Abstract: Introduction: Over 65% of cellphones in the US are smartphones and the market share is rapidly growing. These devices allow many applications through mobile apps. The objective of this study was to evaluate the readiness of free smartphone pedometer apps as a tool to monitor activity. Hypothesis: Free pedometer Apps are a valid tool for activity monitoring. Methods: We reviewed all the pedometer apps from the app stores, Apple (iOS A) and Android (AA)(combined 93% of market share), and selected them for further review if they were free of charge and capable of storing and sharing data (step count and time). Two independent raters downloaded and evaluated all the selected apps to confirm compliance with requisites, background running and user friendliness. We recruited 12 volunteers to test the Apps without adjusted sensitivity settings. We randomized testing to phone location (waist vs shirt pocket) and walking speed on a treadmill (1, 2, and 3 mph for 6 minutes at each speed) and during a 6-minute walk test. All tests were performed at least twice by each volunteer, and the criterion measure of steps was obtained by manual counting using a hand tally counter. For statistical analysis we used Wilcoxon’s signed rank test, in addition to Pearson correlation coefficients and Bland-Altman plots. Results: 219 iOS A and 181 AA were reviewed. Of those, 13 iOS A and 9 AA were selected, downloaded and rated by two independent reviewers. Three apps from each system fulfilled the criteria and were analyzed. Accupedo and Pedometer SP (iOS A) and Accupedo (AA) step counts were not statistically different (p>0.05) than the counted steps, Pearson correlation coefficients were significant (p Conclusion: Despite the number of free pedometer apps, only a small subset is suitable for remote physical activity monitoring. Apps perform better at walking speeds higher than 1 mph without sensitivity adjustment. The technology and ubiquitous nature of smartphones appears that they are ready to use for activity monitoring in a clinical setting, which may aid in monitoring home walking programs.