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  1. Article ; Online: Endovascular Interventions for Peripheral Artery Disease: A Contemporary Review.

    Watson, Nathan W / Mosarla, Ramya C / Secemsky, Eric A

    Current cardiology reports

    2023  Volume 25, Issue 11, Page(s) 1611–1622

    Abstract: Purpose of review: Peripheral artery disease (PAD) is an increasingly prevalent but frequently underdiagnosed condition that can be associated with high rates of morbidity and mortality. While an initial noninvasive approach is the cornerstone of ... ...

    Abstract Purpose of review: Peripheral artery disease (PAD) is an increasingly prevalent but frequently underdiagnosed condition that can be associated with high rates of morbidity and mortality. While an initial noninvasive approach is the cornerstone of management, revascularization is often pursued for patients with treatment-refractory claudication or chronic limb-threatening ischemia (CLTI). In this review, we discuss the current state of endovascular interventions for PAD and explore the many new emerging technologies.
    Recent findings: The last decade has resulted in numerous advances in PAD interventions including the ongoing evolution of drug-coated devices, novel approaches to complex lesions, and contemporary evidence from large clinical trials for CLTI. Advances in endovascular management have allowed for increasingly complex lesions to be tackled percutaneously. Future directions for the field include the continued evolution in device technology, continued development of state-of-the-art techniques to revascularization of complex lesions, and increased collaboration between a largely multidisciplinary field.
    MeSH term(s) Humans ; Risk Factors ; Endovascular Procedures/methods ; Treatment Outcome ; Peripheral Arterial Disease/surgery ; Peripheral Arterial Disease/diagnosis ; Intermittent Claudication/therapy ; Ischemia/therapy ; Limb Salvage/methods ; Retrospective Studies ; Chronic Disease
    Language English
    Publishing date 2023-10-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2055373-0
    ISSN 1534-3170 ; 1523-3782
    ISSN (online) 1534-3170
    ISSN 1523-3782
    DOI 10.1007/s11886-023-01973-9
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    Zs.A 5524: Show issues Location:
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  2. Article ; Online: Trends in Discharge Rates for Acute Pulmonary Embolism in U.S. Emergency Departments.

    Watson, Nathan W / Carroll, Brett J / Krawisz, Anna / Schmaier, Alec / Secemsky, Eric A

    Annals of internal medicine

    2024  Volume 177, Issue 2, Page(s) 134–143

    Abstract: Background: Outpatient management of select patients with low-risk acute pulmonary embolism (PE) has been proven to be safe and effective, yet recent evidence suggests that patients are still managed with hospitalization. Few studies have assessed ... ...

    Abstract Background: Outpatient management of select patients with low-risk acute pulmonary embolism (PE) has been proven to be safe and effective, yet recent evidence suggests that patients are still managed with hospitalization. Few studies have assessed contemporary real-world trends in discharge rates from U.S. emergency departments (EDs) for acute PE.
    Objective: To evaluate whether the proportion of discharges from EDs for acute PE changed between 2012 and 2020 and which baseline characteristics are associated with ED discharge.
    Design: Serial cross-sectional analysis.
    Setting: U.S. EDs participating in the National Hospital Ambulatory Medical Care Survey.
    Patients: Patients with ED visits for acute PE between 2012 and 2020.
    Measurements: National trends in the proportion of discharges for acute PE and factors associated with ED discharge.
    Results: Between 2012 and 2020, there were approximately 1 635 300 visits for acute PE. Overall, ED discharge rates remained constant over time, with rates of 38.2% (95% CI, 17.9% to 64.0%) between 2012 and 2014 and 33.4% (CI, 21.0% to 49.0%) between 2018 and 2020 (adjusted risk ratio, 1.01 per year [CI, 0.89 to 1.14]). No baseline characteristics, including established risk stratification scores, were predictive of an increased likelihood of ED discharge; however, patients at teaching hospitals and those with private insurance were more likely to receive oral anticoagulation at discharge. Only 35.9% (CI, 23.9% to 50.0%) of patients who were considered low-risk according to their Pulmonary Embolism Severity Index (PESI) class, 33.1% (CI, 21.6% to 47.0%) according to simplified PESI score, and 34.8% (CI, 23.3% to 48.0%) according to hemodynamic stability were discharged from the ED setting.
    Limitations: Cross-sectional survey design and inability to adjudicate diagnoses.
    Conclusion: In a representative nationwide sample, rates of discharge from the ED for acute PE appear to have remained constant between 2012 and 2020. Only one third of low-risk patients were discharged for outpatient management, and rates seem to have stabilized. Outpatient management of low-risk acute PE may still be largely underutilized in the United States.
    Primary funding source: None.
    MeSH term(s) Humans ; United States/epidemiology ; Patient Discharge ; Cross-Sectional Studies ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/therapy ; Pulmonary Embolism/diagnosis ; Emergency Service, Hospital ; Risk Factors
    Language English
    Publishing date 2024-01-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M23-2442
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    Ua VI Zs.178/2: Show issues Location:
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  3. Article ; Online: Clinical Outcomes and Predictors of Advanced Therapy for the Management of Right Heart Thrombus.

    Watson, Nathan W / Weinberg, Ido / Dicks, Andrew B / Carroll, Brett J / Secemsky, Eric A

    Circulation. Cardiovascular interventions

    2024  Volume 17, Issue 4, Page(s) e013637

    Abstract: Background: The role of advanced therapies (systemic thrombolysis, catheter-based treatment, and surgical thrombectomy) for the management of right heart thrombus is poorly defined. In this study, we assessed the clinical predictors and outcomes of ... ...

    Abstract Background: The role of advanced therapies (systemic thrombolysis, catheter-based treatment, and surgical thrombectomy) for the management of right heart thrombus is poorly defined. In this study, we assessed the clinical predictors and outcomes of advanced therapy compared with anticoagulation alone for the acute management of right heart thrombus.
    Methods: In this observational cohort study, we analyzed consecutive patients who were treated for right heart thrombus. The primary end point was 90-day all-cause mortality. Clinical predictors of utilizing advanced therapy were assessed with multivariable logistic regression. Propensity score matching was utilized to compare adjusted outcomes between patients receiving advanced therapies versus anticoagulation alone.
    Results: A total of 345 patients were included in the study. Advanced therapy was utilized in 13.6% (N=47) of patients, of which 25.5% (N=12/47) was systemic thrombolysis, 23.4% (N=11/47) was endovascular thrombectomy, and 53.2% (N=25/47) was surgical thrombectomy. Younger age (odds ratio, 0.98 [95% CI, 0.96-0.99]) and concurrent pulmonary embolism (odds ratio, 5.36 [95% CI, 2.48-12.1]) predicted utilization of advanced therapy. In propensity score-matched analysis, there was no difference in 90-day mortality (hazard ratio, 0.46 [95% CI, 0.17-1.22]), in-hospital mortality (odds ratio, 0.64 [95% CI, 0.17-2.19]), or length of stay (β, -4.39 [95% CI, -14.0 to 5.22]) between advanced therapy and anticoagulation.
    Conclusions: Among a diverse cohort of patients with right heart thrombus, outcomes did not differ between those who underwent advanced therapy and anticoagulation alone. Important predictors for utilizing advanced treatment included younger age and the presence of a concurrent pulmonary embolism. Future studies assessing advanced therapy in larger and broader patient populations are necessary.
    MeSH term(s) Humans ; Thrombolytic Therapy/adverse effects ; Treatment Outcome ; Thrombectomy/adverse effects ; Pulmonary Embolism/therapy ; Thrombosis/therapy ; Thrombosis/drug therapy ; Anticoagulants/adverse effects
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2024-02-27
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2450797-0
    ISSN 1941-7632 ; 1941-7640
    ISSN (online) 1941-7632
    ISSN 1941-7640
    DOI 10.1161/CIRCINTERVENTIONS.123.013637
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    Zs.A 6746: Show issues Location:
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  4. Article ; Online: Cyclin-dependent kinase 4/6 inhibitor-associated thromboembolism: a critical evaluation of the current evidence.

    Watson, Nathan W / Shatzel, Joseph J / Al-Samkari, Hanny

    Journal of thrombosis and haemostasis : JTH

    2022  Volume 21, Issue 4, Page(s) 758–770

    Abstract: Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors are an essential treatment modality for hormone receptor-positive breast cancer. As the rates of breast cancer continue to rise globally and the indications for CDK 4/6 inhibitors now extend beyond ... ...

    Abstract Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors are an essential treatment modality for hormone receptor-positive breast cancer. As the rates of breast cancer continue to rise globally and the indications for CDK 4/6 inhibitors now extend beyond metastatic disease, more patients than ever are receiving these agents. Thrombosis is an emerging clinical concern with this class of agents, particularly venous thromboembolism. Although venous thromboembolism initially emerged as an adverse effect of interest in early trials, more recent studies have demonstrated even higher incidences of thrombosis in real-world clinical practice. In this review, we summarize the evidence to date that has informed the thrombosis risk for these agents both in clinical trials and real-world studies. We review data describing the venous and arterial thromboembolic risks in clinical trials of CDK 4/6 inhibitors as well as the now rather extensive real-world evidence available, including a comparison of risk for each of the 3 agents approved for use in breast cancer: palcociclib, ribociclib, and abemaciclib. As the role of prophylactic anticoagulation continues to remain unknown in women receiving CDK 4/6 inhibitors, future efforts directed at carefully investigating the risks and benefits of thromboprophylaxis may lead to improved outcomes in these patients.
    MeSH term(s) Humans ; Female ; Pyridines/therapeutic use ; Cyclin-Dependent Kinase 4/therapeutic use ; Venous Thromboembolism/chemically induced ; Venous Thromboembolism/drug therapy ; Anticoagulants/therapeutic use ; Protein Kinase Inhibitors/adverse effects ; Aminopyridines/pharmacology ; Aminopyridines/therapeutic use ; Breast Neoplasms/drug therapy ; Breast Neoplasms/pathology
    Chemical Substances Pyridines ; Cyclin-Dependent Kinase 4 (EC 2.7.11.22) ; Anticoagulants ; Protein Kinase Inhibitors ; Aminopyridines
    Language English
    Publishing date 2022-12-22
    Publishing country England
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2112661-6
    ISSN 1538-7836 ; 1538-7933
    ISSN (online) 1538-7836
    ISSN 1538-7933
    DOI 10.1016/j.jtha.2022.12.001
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    Zs.A 5805: Show issues Location:
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    Zs.MO 295: Show issues

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  5. Article ; Online: Predictors of Thrombus Resolution Among Patients Who Undergo Anticoagulation for a Right Heart Thrombus.

    Watson, Nathan W / Dicks, Andrew B / Carroll, Brett J / Schmaier, Alec / Secemsky, Eric A

    Chest

    2023  Volume 164, Issue 5, Page(s) 1298–1301

    MeSH term(s) Humans ; Thrombosis/drug therapy ; Anticoagulants/therapeutic use ; Heart Diseases/drug therapy
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2023-06-20
    Publishing country United States
    Document type Letter
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2023.06.017
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    Ui III Zs.45: Show issues Location:
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    Zs.MO 349: Show issues

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  6. Article ; Online: Venous and arterial thrombosis associated with abemaciclib therapy for metastatic breast cancer.

    Watson, Nathan W / Wander, Seth A / Shatzel, Joseph J / Al-Samkari, Hanny

    Cancer

    2022  Volume 128, Issue 17, Page(s) 3224–3232

    Abstract: Background: The CDK4/6 inhibitor abemaciclib is a mainstay of treatment for hormone receptor-positive breast cancer. However, increased venous thromboembolism (VTE) rates in multiple clinical trials resulted in a black-box warning for this agent. ... ...

    Abstract Background: The CDK4/6 inhibitor abemaciclib is a mainstay of treatment for hormone receptor-positive breast cancer. However, increased venous thromboembolism (VTE) rates in multiple clinical trials resulted in a black-box warning for this agent. Thrombosis rates in unselected real-world populations receiving abemaciclib remain ill defined.
    Methods: A multicenter observational cohort study was conducted of patients with metastatic breast cancer receiving abemaciclib. The primary end point was thrombosis during treatment or within 30 days of discontinuation. Multivariable logistic models assessed predictors of VTE, and a multivariable Cox proportional hazards model assessed mortality.
    Results: A total of 364 patients were included, with a median treatment duration of 5.5 months. Twenty-six patients developed 27 (7.4%) thrombotic events (17 VTE, nine arterial thrombosis, and one with both events). No baseline characteristics were associated with increased VTE risk in multivariable modeling. Patients developing VTE during therapy had a higher risk of death than those who did not (hazard ratio, 2.09; 95% CI, 1.07-4.13). Median survival in patients who developed VTE compared with those who did not was 9.6 vs 25.8 months, respectively. The rate of VTE and any thrombosis during abemaciclib therapy was 9.1 and 13.7 events per 100 person-years, respectively, which is notably higher than rates observed in clinical trials.
    Conclusions: In a real-world setting, abemaciclib was associated with a VTE rate approximately two-fold greater than the already elevated rates reported in the MONARCH trials. Patients developing thrombosis on abemaciclib had a significantly higher risk of death. Given these findings, studies evaluating the role of thromboprophylaxis in patients receiving abemaciclib are needed.
    MeSH term(s) Aminopyridines ; Anticoagulants/therapeutic use ; Benzimidazoles ; Breast Neoplasms/drug therapy ; Female ; Humans ; Thrombosis/drug therapy ; Venous Thromboembolism/chemically induced ; Venous Thromboembolism/epidemiology
    Chemical Substances Aminopyridines ; Anticoagulants ; Benzimidazoles ; abemaciclib (60UAB198HK)
    Language English
    Publishing date 2022-06-29
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 1429-1
    ISSN 1097-0142 ; 0008-543X ; 1934-662X
    ISSN (online) 1097-0142
    ISSN 0008-543X ; 1934-662X
    DOI 10.1002/cncr.34367
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    Uh III Zs.146: Show issues Location:
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  7. Article ; Online: Ototoxicity Review: A Growing Number of Non-Platinum-Based Chemo- and Immunotherapies.

    Naples, James G / Rice-Narusch, Wyatt / Watson, Nathan W / Ghulam-Smith, Melissa / Holmes, Sean / Li, Daqing / Jalisi, Scharukh

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2023  Volume 168, Issue 4, Page(s) 658–668

    Abstract: Objective: To raise awareness of the growing list of non-platinum-based chemo- and immunotherapeutic agents that have been associated with ototoxicity and to introduce the possible mechanism of ototoxicity of these agents.: Data sources: PubMed, ... ...

    Abstract Objective: To raise awareness of the growing list of non-platinum-based chemo- and immunotherapeutic agents that have been associated with ototoxicity and to introduce the possible mechanism of ototoxicity of these agents.
    Data sources: PubMed, Embase, and Web of Science.
    Review methods: A systematic review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). PubMed, Embase, and Web of Science databases were searched for published reports of ototoxicity from non-platinum-based chemo- and immunotherapeutic agents in adult and pediatric patients. Therapies that utilized any platinum-based agent were excluded.
    Conclusions: Ototoxicity from non-platinum-based chemo- and immunotherapies is an evolving problem. There were 54 reports-39 case reports and 15 cohort studies-documenting ototoxicity from 7 agents/combination therapies. Of these reports, 37 (69%) were published within the last 15 years (after 2005). No recovery of hearing was documented in 21 of 56 cases (38%). Pretreatment audiograms were uncommon (19/54 studies, 35%), despite documented ototoxic associations.
    Implications for practice: There is a growing number of novel, ototoxic, non-platinum-based chemo- and immunotherapeutic agents with various potential mechanisms of action. Otolaryngologists will need to prioritize awareness of these agents. This growing list of agents, many of which have reversible effects, suggest a need for standardized ototoxicity monitor protocols so that appropriate and timely management options can be implemented.
    MeSH term(s) Adult ; Child ; Humans ; Antineoplastic Agents/adverse effects ; Cisplatin ; Hearing Loss/complications ; Ototoxicity/drug therapy ; Ototoxicity/etiology ; Immunotherapy/adverse effects
    Chemical Substances Antineoplastic Agents ; Cisplatin (Q20Q21Q62J)
    Language English
    Publishing date 2023-02-05
    Publishing country England
    Document type Systematic Review ; Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1177/01945998221094457
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    Ul II Zs.83/a: Show issues Location:
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  8. Article ; Online: Clinical Significance of Right Heart Thrombus With and Without an Associated Pulmonary Embolism.

    Watson, Nathan W / Weinberg, Ido / Dicks, Andrew B / Fong, Esmond / Strom, Jordan B / Carroll, Brett J / Raja, Aishwarya / Schainfeld, Robert / Secemsky, Eric A

    The American journal of medicine

    2023  Volume 136, Issue 11, Page(s) 1109–1118.e3

    Abstract: Background: Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism. The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ... ...

    Abstract Background: Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism. The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ill-defined.
    Methods: We conducted a multi-center observational cohort study to compare patients presenting with right heart thrombus with and without a concurrent pulmonary embolism. The primary endpoint was 90-day all-cause mortality. Multivariable regression was utilized to assess primary and secondary outcomes.
    Results: Of 231 patients with right heart thrombus, 104 (45.0%) had a pulmonary embolism at admission. The median age of the cohort was 59.4 years (interquartile range 44.9-71.3). Pulmonary embolism in the setting of a right heart thrombus was associated with an increased adjusted hazard of 90-day mortality (hazard ratio 3.68; 95% confidence interval [CI], 1.51-8.97). Additionally, these patients had a higher adjusted risk of in-hospital mortality (odds ratio [OR] 2.55; 95% CI, 1.15-5.94) and admission to the intensive care unit (OR 2.45; 95% CI, 1.23-4.94). Thrombus mobility (OR 2.99; 95% CI, 1.35-6.78) and larger thrombus sizes (OR 1.04; 95% CI, 1.00-1.07) were associated with development of concurrent pulmonary embolism.
    Conclusions: Patients with right heart thrombus and pulmonary embolism had a more severe clinical presentation, required more advanced therapies, and had reduced survival compared with those without a concomitant pulmonary embolism. Important variables associated with development of concomitant pulmonary embolism include thrombus mobility and size. Right heart thrombus in the setting of acute pulmonary embolism represents a unique clinical entity that is associated with worse prognosis compared with right heart thrombus only.
    Language English
    Publishing date 2023-08-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2023.07.014
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