More on: venous thromboembolism and mortality after hip fracture: the ESCORTE study

Abstract

(recurrence rate: 17.6%); first loss from week 10 on: 1167:1931 (recurrence rate: 60.4%; P < 0.0001). The spontaneous recurrence rate in non thrombophilia-associated unexplained pregnancy loss is thus naturally higher if the first loss had occurred from week 10 on. In patients with a first loss from week 10 on, women carrying the FVL or the prothrombin G20210A polymorphism have a spontaneous worse prognosis during the second pregnancy than those with no detectable thrombophilia (recurrences: 31:40 vs. 1167:1931; P ¼ 0.03). A recent evaluation, performed on 230 women, has shown that prior fetal death is globally associated with fewer than 25% of pregnancies resulting in surviving infants [12].These facts are, for us, stimulating arguments for performing a cost-effectiveness analysis on testing women for thrombophilia after the first fetal loss from week 10 on: an appreciable proportion of women in fertile age. Primary analysis should include the investigations and treatment costs, taking in account the few available, still to be improved, therapeutic options [13], and costs induced due to complications. Life without living children, with all its consequences, and quality of life adjusted years should be considered for the secondary analysis.

More on: venous thromboembolism and mortality after hip fracture: the ESCORTE study

“…The authors [1] suggest that ESCORTE presented an ‘unexpected picture’ based on their reference to a previously published pooled analysis that indicated a higher rate of autopsy‐proven fatal pulmonary embolism (PE), and to three recently conducted prospective studies [12–14]. We agree with the authors that the absence of autopsy could lead to underestimation of the true rate of fatal PE; however, autopsies are not performed in daily clinical practice.…”

“…Another advantage of the large population studied in ESCORTE is the identification of precise point estimates. In fact, during this unique period of assessment in 6860 patients, our results provided smaller confidence intervals than any of the previously conducted studies, and are more precise than the pooled analysis of 4076 patients from various trials [11] that was cited by the authors [1]. More importantly, we believe that using symptomatic VTE as a primary endpoint in ESCORTE is more relevant than using asymptomatic VTE; in real‐life practice, systematic screening is not performed and only symptomatic VTE would translate to a therapeutic consequence (i.e.…”

“…We thank the authors [1] for taking the time to review and criticize our publication [2] of the ESCORTE study. However, we strongly disagree with some of their arguments and would like to take the opportunity to comment on several points they have made.…”

“…As we pointed out in our article, in the ESCORTE study mortality rates because of PE were based on both definitive PE and possible PE, judged by the investigators. Although Gianese and Prandoni [1] expressed concern that fatal PE accounted for a ‘mere 0.4% of deaths’ in ESCORTE, PE was judged to be directly responsible for death in 3.9% of the cases, representing the fourth cause of death after other cardiac diseases, deterioration of general condition, and pulmonary infections.…”