Results from an Expert-Based Cross-Sectional National Survey on Antithrombotic TREATment After PEDiatric Peripheral Vascular Injuries. (The TREAT-PED-PVI Survey) Gabriele Piffaretti, Mario D'Oria, Marco Paolo Donadini, Sandro Lepidi, Antonio Freyrie, Domenico Angiletta, Sergio Zacà, Andrea Kahlberg, Pasqualino Sirignano, Luca Bertoglio, Laura Banov, Luca Spiezia, Giuseppe Camporese, Gian Franco Veraldi, Nicola Troisi, Walter Ageno, Yamume Tshomba, Wassim Mansour, Romeo Martini, Felice Pecoraro, Michele Antonello, Michele Piazza, Rossella Marcucci, Raffaello Bellosta, Ilenia D'Alessio, Walter Dorigo, Fabio Verzini, Mauro Gargiulo, Filippo Benedetto, Emanuele Gatta, Santi Trimarchi, Paolo Simioni Annals of Vascular Surgery, 2026
Pathogenic interplay between markedly elevated plasma lipoprotein(a) levels and prothrombotic mechanisms: a case report Marta Biolo, Angela Napolitano, Luca Spiezia, Cristiana Bulato, Serena Toffanin, Daniela Regazzo, Camilla Portinari, Alberto Zambon, Paolo Simioni Frontiers in Cardiovascular Medicine, 2026 Lipoprotein(a) [Lp(a)] is a well-established genetic risk factor for atherosclerotic cardiovascular disease, though its role as a prothrombotic risk factor remains only partially understood. We report the case of a 64-year-old woman with markedly elevated Lp(a) levels (925 nmol/L, reference range < 105 nmol/L) and a history of recurrent major cardiovascular events, despite optimal lipid-lowering and antiplatelet therapies. We confirmed a hypercoagulable profile via comprehensive functional assessment of hemostasis: enhanced thrombin generation, reduced sensitivity to thrombomodulin, platelet hyperreactivity, and increased clot firmness at thromboelastometry — with residual platelet activity despite antiplatelet treatment. This case suggests a possible association between markedly elevated plasma Lp(a) levels and a hypercoagulable profile, which may enhance atherogenesis. Global coagulation and platelet function assays may help identify high-risk patients with elevated Lp(a) levels who may benefit from tailored antithrombotic strategies.
Successful Treatment of Severe Purpura Fulminans With Anakinra Francesco Zulian, Luca Spiezia, Antonio Amabile, Francesca Tirelli, Alessandra Meneghel Pediatric Dermatology, 2026 Purpura fulminans (PF) is a rare, often fatal pediatric condition characterized by intravascular thrombosis and hemorrhagic infarction of the skin. A timely diagnosis and treatment are paramount to prevent the involvement of internal organs, causing disseminated intravascular coagulation and gangrene of the extremities. The management of PF requires a comprehensive approach, including the treatment of the underlying infection, anticoagulation, and anti‐inflammatory therapy. Herein we present the case of a child with severe PF successfully treated with anakinra, an anti‐IL1‐receptor monoclonal antibody.
Sex and the Multidimensional Prognostic Index in 3.5-year post-COVID-19 mortality among older adults: evidence of a time-varying effect Chiara Ceolin, Veronica Liberati, Margherita Vergadoro, Cristina Simonato, Sara Cazzavillan, Mario Virgilio Papa, Giulia Salerno Trapella, Benedetta Di Marzio, Bruno Micael Zanforlini, Chiara Curreri, Anna Bertocco, Giulia Gasparini, Maria Devita, Alessandra Coin, Luca Spiezia, Giuseppe Sergi, Marina De Rui Internal and Emergency Medicine, 2026 Purpose The long-term prognostic impact of frailty in older adults recovering from COVID-19 remains underexplored. The Multidimensional Prognostic Index (MPI) has shown utility in predicting short-term outcomes, but its role over extended follow-up requires further investigation. The objective of this study is to evaluate the ability of an MPI-based model to predict 3.5-year mortality in older adults hospitalized for COVID-19. Methods This single-center cohort study with prospective follow-up included 183 patients aged ≥ 65 years hospitalized with confirmed SARS-CoV-2 infection. MPI was calculated at admission and dichotomized into low (classes 1–2) and high (class 3). Multivariable Cox regression was used to estimate the hazard of mortality over a 3.5-year follow-up. Discriminative performance was assessed using time-dependent ROC analysis, with AUC values compared between the multivariable model and MPI alone. Results During follow-up, 81/183 patients (44.3%) died. Kaplan–Meier curves showed lower survival in high-MPI patients (log-rank p = 0.0043). A Cox model with a time-varying effect for sex (sex × log(time)) confirmed that high MPI was associated with higher mortality (HR = 1.59, 95% CI 1.00–2.52), age was also associated (HR per year = 1.04, 95% CI 1.00–1.07), while vaccination was not. The female-to-male hazard ratio changed over time (HR at 180/365/730/1250 days: 0.90/1.31/1.87/2.48). AUCs for the full model at 180/365/730/1250 days were 0.704/0.654/0.680/0.659, derived from the sex-stratified Cox linear predictor, and exceeded the MPI-only model. Conclusions The MPI demonstrated moderate prognostic ability for long-term mortality among older adults after COVID-19. Adding demographic and clinical variables modestly improved prediction, supporting the role of multidimensional assessment in geriatric prognosis, while highlighting the need for cautious interpretation over extended follow-up.
Efficacy and Safety of Paracetamol and NSAIDs for Fever and Pain Management in Children with Chronic Diseases: A Narrative Review Gregorio Paolo Milani, Giangiacomo Nicolini, Mara Cananzi, Luca Spiezia, Enrico Vidal Children, 2026 Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain.
Diagnosing neurological comorbidities in patients with alcohol use disorder: Case report Margherita Vergadoro, Giulia Stinziani, Chiara Di Gesù, Giovanni Gottardi, Luca Spiezia, Erika Zola, Paolo Simioni Journal of Addictive Diseases, 2026 BACKGROUND Long-term complications of alcohol use disorder (AUD) include severe neurological diseases like Wernicke-Korsakoff syndrome and alcohol-related dementia. Furthermore, acute alcohol intoxication and acute withdrawal syndrome can mimic neurological symptoms. Clinicians may overlook underlying comorbidities by focusing excessively on AUD in these patients. We report two cases wherein AUD was a significant confounding factor in the diagnosis of underlying neurological conditions. CASE PRESENTATIONS A 46-year-old male with AUD developed delirium tremens due to severe AAI. Despite initiating treatment for acute withdrawal syndrome which resolved delirium tremens, space-time disorientation persisted for a week. A brain MRI showed signal abnormalities in the centra semiovalia. A rachicentesis and repeat brain and spine MRI later revealed oligoclonal bands in cerebrospinal fluid and bone marrow signal abnormalities, indicating multiple sclerosis. A 61-year-old female with AUD presented with disorientation and memory deficits following a car accident. One month after discharge, the patient developed left hemidysesthesia, walking instability, strength deficits and hallucinations. Biohumoral tests confirmed that she was still in recovery. An electroencephalogram and brain CT scan and MRI raised the suspicion of Creutzfeldt-Jakob disease; elevated tau protein levels confirmed the diagnosis. The patient's condition deteriorated rapidly, leading to death. CONCLUSIONS Persistent neurological symptoms in AUD patients even after receiving treatment for acute alcohol intoxication or withdrawal syndrome, may indicate the presence of underlying neurodegenerative conditions such as multiple sclerosis and Creutzfeldt-Jakob disease.
Impact of vitamin D levels on mortality in older covid-19 vaccinated patients Chiara Ceolin, Margherita Vergadoro, Cristina Simonato, Sara Cazzavillan, Mario Virgilio Papa, Giulia Salerno Trapella, Benedetta Di Marzio, Riccardo Sermasi, Bruno Micael Zanforlini, Chiara Curreri, Anna Bertocco, Maria Devita, Alessandra Coin, Luca Spiezia, Giuseppe Sergi, Marina De Rui BMC Geriatrics, 2025 Background Vitamin D plays a key role in regulating the immune system and vaccine response, and hypovitaminosis D is a known risk factor for mortality. However, its potential influence on mortality in SARS-CoV-2 vaccinated older adults remains underexplored. This study aims to examine survival differences between unvaccinated and vaccinated older adults with varying vitamin D levels, and to assess the impact of vitamin D on mortality. Methods We recruited patients aged 65 and over from the Geriatrics Unit of Azienda Ospedale - Università Padova. Clinical, pharmacological data, including vaccination status and vitamin D levels, were collected at admission, alongside mortality data 12 months post-hospitalization. Participants were divided into three groups: unvaccinated, vaccinated with vitamin D levels of 25–50 nmol/L, and vaccinated with levels > 50 nmol/L. Results A total of 126 participants were included (56% women, mean age 83 years). No significant differences were found in COVID-19 severity among the three groups. After 12 months, 24 deaths were recorded: 17% in unvaccinated, 19% in vaccinated with low vitamin D, and 20% in vaccinated with high vitamin D (p = 0.94). Kaplan-Meier curves showed that mortality risk for vaccinated individuals with low vitamin D was similar to unvaccinated patients but significantly higher than vaccinated individuals with high vitamin D (p = 0.04). Vitamin D levels of 25–50 nmol/L were associated with a threefold increased risk of 12-month mortality (HR: 3.79, p < 0.001). Conclusions Vitamin D levels can impact mortality in older vaccinated individuals. Early correction of vitamin D deficiency could potentially enhance outcomes.
Procoagulant phenotype of virus-infected pericytes is associated with portal thrombosis and intrapulmonary vascular dilations in fatal COVID-19 Massimiliano Cadamuro, Alberto Lasagni, Claudia Maria Radu, Arianna Calistri, Matteo Pilan, Clarissa Valle, Pietro Andrea Bonaffini, Adriana Vitiello, Serena Toffanin, Camilla Venturin, Yahima Friòn-Herrera, Sandro Sironi, Maria Grazia Alessio, Giulia Previtali, Michela Seghezzi, Andrea Gianatti, Mario Strazzabosco, Alastair J. Strain, Elena Campello, Luca Spiezia, Giorgio Palù, Anna Chiara Frigo, Antonella Tosoni, Manuela Nebuloni, Cristina Parolin, Aurelio Sonzogni, Paolo Simioni, Luca Fabris Journal of Hepatology, 2024
Tyrosine Kinase Inhibitor Sunitinib Delays Platelet-Induced Coagulation: Additive Effects of Aspirin Delia I. Fernández, Alicia Veninga, Bibian M. E. Tullemans, Constance C. F. M. J. Baaten, Linsey J. F. Peters, Maureen J. B. Aarts, Johannes A. Eble, Elena Campello, Luca Spiezia, Paolo Simioni, Emiel P. C. van der Vorst, Paola E. J. van der Meijden, Johan W. M. Heemskerk, Marijke J. E. Kuijpers Thrombosis and Haemostasis, 2022
Thrombin generation in patients with COVID-19 with and without thromboprophylaxis Elena Campello, Cristiana Bulato, Luca Spiezia, Annalisa Boscolo, Francesco Poletto, Marco Cola, Sabrina Gavasso, Chiara Simion, Claudia Maria Radu, Annamaria Cattelan, Ivo Tiberio, Roberto Vettor, Paolo Navalesi, Paolo Simioni Clinical Chemistry and Laboratory Medicine, 2021
Platelet-primed interactions of coagulation and anticoagulation pathways in flow-dependent thrombus formation Sanne L. N. Brouns, Johanna P. van Geffen, Elena Campello, Frauke Swieringa, Luca Spiezia, René van Oerle, Isabella Provenzale, Remco Verdoold, Richard W. Farndale, Kenneth J. Clemetson, Henri M. H. Spronk, Paola E. J. van der Meijden, Rachel Cavill, Marijke J. E. Kuijpers, Elisabetta Castoldi, Paolo Simioni, Johan W. M. Heemskerk Scientific Reports, 2020
COVID-19 and Venous Thromboembolism in Intensive Care or Medical Ward Giampiero Avruscio, Giuseppe Camporese, Elena Campello, Enrico Bernardi, Paolo Persona, Christian Passarella, Franco Noventa, Marco Cola, Paolo Navalesi, Annamaria Cattelan, Ivo Tiberio, Annalisa Boscolo, Luca Spiezia, Paolo Simioni, for the COVID‐VTE Study Group Clinical and Translational Science, 2020
Clinical Cases Daniele Penzo, Lesley De Pietri, Paolo Simioni, Luca Spiezia, Elena Campello, Sara Maggiolo, Marco Ranucci, Ekaterina Baryshnikova, Giuseppe Nardi, Alberto Grassetto, Lucio Bucci Point of Care Tests for Severe Hemorrhage A Manual for Diagnosis and Treatment, 2015
Effects of long-term administration of recombinant human protein C in xenografted primates Paolo Simioni, Massimo Boldrin, Sabrina Gavasso, Michela Seveso, Claudia Radu, Cristiana Bulato, Fiorella Calabrese, Laura Cavicchioli, Diana Bertini, Giulia M. De Benedictis, Federica Besenzon, Nicola Baldan, Luca Spiezia, Mario Plebani, Ermanno Ancona, Emanuele Cozzi Transplantation, 2011
Predictive value of D-dimer test, persistent residual venous thrombosis, and thrombophilia for venous thromboembolism recurrence Asia Pacific Journal of Oncology and Hematology, 2010
X-linked thrombophilia with a mutant factor IX (factor IX Padua) Paolo Simioni, Daniela Tormene, Giulio Tognin, Sabrina Gavasso, Cristiana Bulato, Nicholas P. Iacobelli, Jonathan D. Finn, Luca Spiezia, Claudia Radu, Valder R. Arruda New England Journal of Medicine, 2009
Inherited thrombophilia and venous thromboembolism Paolo Simioni, Daniela Tormene, Luca Spiezia, Giulio Tognin, Valeria Rossetto, Claudia Radu, Paolo Prandoni Seminars in Thrombosis and Hemostasis, 2006
