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Saleh B, Paul C, Combes X, Boleis A, Bleunven P, Lefranc D, Rochetams BB, Guihard B, Di Bernardo S. Pulmonary embolism after a long-haul flight. Intern Emerg Med 2022; 17:65-69. [PMID: 34047911 DOI: 10.1007/s11739-021-02762-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 05/12/2021] [Indexed: 12/30/2022]
Abstract
The relation between long-haul flights (LHF) and venous thromboembolic disease is well established. Nonetheless, the incidence of pulmonary embolisms after these flights is probably underestimated because of the difficulties in case ascertainment. Reunion Island appears to present the ideal geographic conditions for accurately assessing this incidence. We aimed to assess the incidence of pulmonary embolisms in people who had recently taken a LHF to Reunion Island. We conducted a retrospective multi-center descriptive study and included all cases of pulmonary embolisms diagnosed between January 1, 2015, and January 30, 2017 (according to the hospitals' discharge summary database) in the island's four public hospitals within 30 days after taking an LHF to Reunion. We took different delays of diagnosis to calculate the incidence. We have considered the time to diagnosis at 1 month as significant according to the time applied in the Geneva score for risk factors. The study included 45 patients landing on Reunion over a 2-year period. The total number of passengers arriving by LHF during this period was 1,223,001. The incidence of pulmonary embolism after an LHF was thus calculated at 36.8 per million travelers at 1 month. The incidence for PE diagnosed, after 15 days was 29.4 per million travelers, and after 7 days, it was 21.9 per million travelers. The male/female ratio was 0.67. The mean interval between the flight and symptom onset was 7 days. In our population, the incidence of pulmonary embolisms after LHFs in our study is clearly higher than that reported in the literature (36.8 vs 4.8). Our exhaustive data collection probably explains this difference. A case-control study appears necessary to analyze the risk factors for pulmonary embolism after a LHF.
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Affiliation(s)
- Béatrice Saleh
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France
| | - Caroline Paul
- Médecine Polyvalente, Hôpital Felix-Guyon, CHU de La Réunion, Saint Denis, Réunion, France
| | - Xavier Combes
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France
| | - Aude Boleis
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France
| | - Pauline Bleunven
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France
| | - Delphine Lefranc
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France
| | - Bruno-Bernard Rochetams
- Service de Radiologie, Groupe Hospitalier Sud Réunion, CHU de La Réunion, Saint Pierre, Réunion, France
| | - Bertrand Guihard
- Service des urgences, Hôpital Felix-Guyo, CHU de La Réunion, 97400, Saint Denis, Réunion, France.
| | - Servane Di Bernardo
- Médecine Polyvalente, Hôpital Felix-Guyon, CHU de La Réunion, Saint Denis, Réunion, France
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2
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Bertoletti L, Sanchez O. [What are the special features of treatment in "fragile" patients (elderly, renal failure)]. Rev Mal Respir 2021; 38 Suppl 1:e157-e160. [PMID: 33744077 DOI: 10.1016/j.rmr.2019.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Bertoletti
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Équipe dysfonction vasculaire et hémostase, Inserm UMR1059, Inserm, CIC-1408, service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, université Jean-Monnet, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, université Paris Descartes, Sorbonne Paris cité, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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3
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Galanaud J, Genty‐Vermorel C, Rolland C, Comte A, Ouvry P, Bertaina I, Verrière F, Bosson J. Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial. Res Pract Thromb Haemost 2020; 4:1239-1250. [PMID: 33313464 PMCID: PMC7695566 DOI: 10.1002/rth2.12445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%-40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain. We present an overview of published studies assessing the efficacy of ECS to prevent PTS and present the protocol for the CELEST clinical trial. While previous open-label randomized trials have reported a 50% risk reduction in PTS in patients treated with >30 mm Hg ankle pressure ECS, a large double-blind trial reported no effect of ECS. We discuss the main potential limitations of these trials, including a placebo effect and suboptimal compliance to ECS. We present the protocol of the CELEST double-blind randomized trial comparing 2 years of high strength (ankle pressure 35 mm Hg) versus lower strength (ankle pressure 25 mm Hg) ECS in the prevention of PTS after a first acute symptomatic, unilateral, proximal DVT. The use of lower-strength ECS than that used in previous studies should favor compliance. CELEST may provide important evidence about the efficacy of ECS in the prevention of PTS after DVT. The results will be interpreted in the light of results from recent clinical trials assessing ECS for PTS prevention that reported that the duration of ECS use should be tailored to the individual, if ECS are efficacious in the prevention of PTS.
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Affiliation(s)
- Jean‐Philippe Galanaud
- Department of Vascular MedicineMontpellier University HospitalMontpellierFrance
- Department of MedicineSunnybrook Health Sciences Centre and University of TorontoTorontoONCanada
| | - Céline Genty‐Vermorel
- Department of Public HealthUniversity Grenoble AlpesCNRSGrenoble‐Alpes University HospitalTIMC‐IMAGF38000GrenobleFrance
| | - Carole Rolland
- Department of Public HealthUniversity Grenoble AlpesCNRSGrenoble‐Alpes University HospitalTIMC‐IMAGF38000GrenobleFrance
| | - Alexa Comte
- Department of Public HealthUniversity Grenoble AlpesCNRSGrenoble‐Alpes University HospitalTIMC‐IMAGF38000GrenobleFrance
| | - Pierre Ouvry
- Vascular Medicine PhysicianSt Aubin sur ScieFrance
| | | | | | - Jean‐Luc Bosson
- Department of Public HealthUniversity Grenoble AlpesCNRSGrenoble‐Alpes University HospitalTIMC‐IMAGF38000GrenobleFrance
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4
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Benzengli H, Tuligenga R, Assiobo A, Rabus MT, Rwabihama JP. [Impact of an intervention on the practice of venous thromboprophylaxis recommendations in a geriatric setting.]. SOINS. GÉRONTOLOGIE 2020; 25:39-43. [PMID: 32444082 DOI: 10.1016/j.sger.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The practice of prevention of venous thromboembolic disease in hospitalized elderly patients does not comply with published recommendations, in 30% of cases. The objective of this study was to evaluate the impact of recalling the recommendations on the venous thromboprophylaxis.
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Affiliation(s)
- Hind Benzengli
- Service de pharmacie, Hôpital Dupuytren, AP-HP, 1 rue Eugène-Delacroix, 91210 Draveil, France
| | - Richard Tuligenga
- Service de gérontologie 2, Hôpital Émile-Roux, AP-HP, 1 avenue de Verdun, 94450 Limeil-Brévannes, France
| | | | - Marie-Thérèse Rabus
- Service de gériatrie B2, Hôpital Dupuytren, AP-HP, 1 rue Eugène-Delacroix, 91210 Draveil, France
| | - Jean-Paul Rwabihama
- Service de gériatrie B2, Hôpital Dupuytren, AP-HP, 1 rue Eugène-Delacroix, 91210 Draveil, France; Inserm U955, Université Paris Est Créteil, Institut Mondor de recherche biomédicale, équipe Cepia (Clinical Epidemiology and Ageing), 94000 Créteil, France.
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5
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[Risk factors for hospital mortality during pulmonary embolism]. Ann Cardiol Angeiol (Paris) 2020; 69:7-11. [PMID: 32127194 DOI: 10.1016/j.ancard.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of our work is to identify the risk factors for hospital mortality during pulmonary embolism in a pneumology department. MATERIAL AND METHOD All patients admitted to the pneumology department of Habib-Bourguiba hospital between 2014 and 2019, with a final diagnosis of PE are analyzed. RESULTS One hundred patients were included, 62% of whom were female, with an average age of 63±16 years. Pulmonary fibrosis was noted in eight patients. On admission, the mean Simplified Pulmonary Embolism Severity Index score was 1.46±1.05. The mean duration of hospitalization was 10.6±7 days. The hospital mortality rate was 12%. The independent risk factors for intra-hospital mortality were arterial hypotension (OR: 6.13; 95%CI: 2.88-14.35; p=0.001), cancer (OR: 2.66; 95%CI: 1.22-9.54; p=0.026), a VD/LV ratio at echocardiography>0.9 (OR: 1.84; 95%CI: 1.06-7.69; p=0.039) and severe hypoxemia (OR: 4.86; 95%CI: 2.19-11,34; p=0.006). CONCLUSION Pulmonary embolism mortality remains high despite improvements in diagnostic and therapeutic management. It is important for our country to take these results into consideration for a better management of patients admitted for pulmonary embolism, and to improve survival.
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Rezziki A, Hussam A, Oussama A, Taha A, Adnane B, Omar EM. Superficial-vein thrombosis of the lower limb: A pathology that is not always benign. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Couturaud F, Fischer AM, Laporte S, Sanchez O. [What are the options for the initial anticoagulant treatment of a PE and a proximal DVT?]. Rev Mal Respir 2019; 38 Suppl 1:e41-e52. [PMID: 31699457 DOI: 10.1016/j.rmr.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F Couturaud
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine interne et pneumologie, EA3878-GETBO, CIC Inserm1412, université de Bretagne occidentale, centre hospitalo-universitaire de Brest, 29200 Brest, France
| | - A-M Fischer
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service d'hématologie biologique, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - S Laporte
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm, unité de recherche clinique, SAINBOIS U1059 équipe DVH, hôpital Nord, université Jean-Monnet, université de Lyon, innovation, pharmacologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Université de Paris, Service de pneumologie et soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France.
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8
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El Yaagoubi A, Michelet P, Vaïsse B, Deharo JC, Morange P, Sarlon-Bartoli G. [Evaluation of an "Emergency Thrombosis" care system in a university-hospital department of general emergencies]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:184-193. [PMID: 31029272 DOI: 10.1016/j.jdmv.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
GOAL Describe the use of diagnostic, prognostic and therapeutic algorithms for venous thromboembolism (VTE), derived from the 2014 European guidelines, in a teaching hospital's emergencies department and compare two groups: the 2015 group "without a care path" and the 2017 group "with a care path". METHOD Comparative and retrospective study of the characteristics of emergencies department patients admitted for VTE from January to June 2015 for the 2015 group and from January to June 2017 for the 2017 group. RESULTS Seventy-nine patients were included in the 2015 group and 62 patients in the 2017 group. In 24% of cases a clinical probability rule was calculated in the 2017 group (vs. no score in 2015, P<0.05). In the 2015 group, 10% of patients did not have a D-Dimer measurement in case of low clinical probability (vs. 0% in 2017, P<0.05). For both groups, the severity score sPESI was not noted in the medical record. All patients with pulmonary embolism were hospitalized in both groups. A total of 36% of patients with deep vein thrombosis (DVT) were hospitalized in the 2015 group (vs. none in 2017, P<0.05). A total of 52.5% of patients were treated with direct oral anticoagulants (DOAS) in the 2017 group vs. 32.5% in the 2015 group (P<0.05). In 18% of cases DOAS were prescribed by emergency physicians in the 2017 group vs. 2.5% in the 2015 group (P<0.05). Mean hospital stay was 7.4 days in the 2017 group and 9.4 days in the 2015 group (P<0.05). CONCLUSION We observed a change in clinical practices and prescriptions after the establishment of an "Emergency Thrombosis" care system. Indeed, improvement in the calculation of the clinical probability score, increase in the outpatient management of DVT, increase in prescribing DOAS and reducing the length of hospital stay were the main revisions. The implementation of standardized digitally calculated clinical and prognostic probability scores would optimize this care path, as well as allow a better distribution of the post-emergency consultations created for outpatients.
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Affiliation(s)
- A El Yaagoubi
- Unité d'hypertension artérielle et de médecine vasculaire, hôpital de la Timone, CHU de la Timone, AP-HM, 264, rue Saint-pierre, 13385 Marseille cedex 05, France; UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France
| | - P Michelet
- Service d'accueil des urgences de la Timone, CHU de la Timone, AP-HM, 13385 Marseille cedex 05, France; UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France
| | - B Vaïsse
- Unité d'hypertension artérielle et de médecine vasculaire, hôpital de la Timone, CHU de la Timone, AP-HM, 264, rue Saint-pierre, 13385 Marseille cedex 05, France; UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France
| | - J C Deharo
- Unité d'hypertension artérielle et de médecine vasculaire, hôpital de la Timone, CHU de la Timone, AP-HM, 264, rue Saint-pierre, 13385 Marseille cedex 05, France; UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France
| | - P Morange
- UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France; Laboratoire d'hématologie, CHU de la Timone, AP-HM, 13385 Marseille cedex 05, France; Unité Inserm C2VN, AMU, faculté de médecine de Marseille, 27 boulevard Jean-Moulin 13005 Marseille, France
| | - G Sarlon-Bartoli
- Unité d'hypertension artérielle et de médecine vasculaire, hôpital de la Timone, CHU de la Timone, AP-HM, 264, rue Saint-pierre, 13385 Marseille cedex 05, France; UMR MD2, Aix Marseille Université, 27 boulevard Jean-Moulin 13005 Marseille, France; Unité Inserm C2VN, AMU, faculté de médecine de Marseille, 27 boulevard Jean-Moulin 13005 Marseille, France.
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9
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. [Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:e1-e47. [PMID: 30770089 DOI: 10.1016/j.jdmv.2018.12.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38043 Grenoble, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, Hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, Hôpital Nord, CHU St-Étienne, 42, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue de la Maison Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, 38043 Grenoble, France.
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10
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV). JOURNAL DE MEDECINE VASCULAIRE 2019; 44:28-70. [PMID: 30770082 DOI: 10.1016/j.jdmv.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens Picardie, avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU St.-Étienne, 42, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St.-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 1328, avenue Maison-Blanche, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38043 Grenoble, France.
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11
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Couturaud F, Pernod G, Presles E, Duhamel E, Jego P, Provost K, Pan-Petesch B, Sollier CBD, Tromeur C, Hoffmann C, Bressollette L, Lorillon P, Girard P, Le Moigne E, Le Hir A, Guégan M, Laporte S, Mismetti P, Lacut K, Bosson JL, Bertoletti L, Sanchez O, Meyer G, Leroyer C, Mottier D. Six months versus two years of oral anticoagulation after a first episode of unprovoked deep-vein thrombosis. The PADIS-DVT randomized clinical trial. Haematologica 2019; 104:1493-1501. [PMID: 30606789 PMCID: PMC6601089 DOI: 10.3324/haematol.2018.210971] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/02/2019] [Indexed: 11/09/2022] Open
Abstract
The optimal duration of anticoagulation after a first episode of unprovoked deep-vein thrombosis is uncertain. We aimed to assess the benefits and risks of an additional 18 months of treatment with warfarin versus placebo, after an initial 6 months of anticoagulation for a first unprovoked proximal deep-vein thrombosis. We conducted a multicenter, randomized, double-blind, controlled trial comparing an additional 18 months of warfarin with placebo in patients with a unprovoked proximal deep-vein thrombosis initially treated for 6 months (treatment period: 18 months; follow up after treatment period: 24 months). The primary outcome was the composite of recurrent venous thromboembolism or major bleeding at 18 months. Secondary outcomes were the composite at 42 months, as well as each component of the composite, and death unrelated to pulmonary embolism or major bleeding, at 18 and 42 months. All outcomes were centrally adjudicated. A total of 104 patients, enrolled between July 2007 and October 2013 were analyzed on an intention-to-treat basis; no patient was lost to follow-up. During the 18-month treatment period, the primary outcome occurred in none of the 50 patients in the warfarin group and in 16 out of 54 patients (cumulative risk, 29.6%) in the placebo group (hazard ratio, 0.03; 95% confidence interval: 0.01 to 0.09; P<0.001). During the entire 42-month study period, the composite outcome occurred in 14 patients (cumulative risk, 36.8%) in the warfarin group and 17 patients (cumulative risk, 31.5%) in the placebo group (hazard ratio, 0.72; 95% confidence interval: 0.35-1.46). In conclusion, after a first unprovoked proximal deep-vein thrombosis initially treated for 6 months, an additional 18 months of warfarin therapy reduced the composite of recurrent venous thrombosis and major bleeding compared to placebo. However, this benefit was not maintained after stopping anticoagulation. Clinical registration: this trial was registered at www.clinicaltrials.gov as #NCT00740493.
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Affiliation(s)
- Francis Couturaud
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Gilles Pernod
- Département de Médecine Vasculaire, CHU de Grenoble, Université de Grenoble 1, F-CRIN INNOVTE, Grenoble
| | - Emilie Presles
- Unité de Recherche Clinique, Innovation et Pharmacologie, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Elisabeth Duhamel
- Service de Médecine Interne, Centre Hospitalier Général de Saint-Brieuc, F-CRIN INNOVTE, Saint-Brieuc
| | - Patrick Jego
- Service de Médecine Interne, CHU de Rennes, Université de Rennes 1, Rennes
| | - Karine Provost
- Service de Cardiologie, Centre Hospitalier Général de Lannion, Lannion
| | | | - Claire Bal Dit Sollier
- Clinique des Anticoagulants d'Ile de France (C.R.E.A.T.I.F.), CHU de Lariboisière, Paris
| | - Cécile Tromeur
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Clément Hoffmann
- Service d'Echo-Doppler Vasculaire, and EA 3878, CIC INSERM 1412, CHU de Brest, Université de Bretagne Occidentale, F-CRIN INNOVTE, Brest
| | - Luc Bressollette
- Service d'Echo-Doppler Vasculaire, and EA 3878, CIC INSERM 1412, CHU de Brest, Université de Bretagne Occidentale, F-CRIN INNOVTE, Brest
| | - Philippe Lorillon
- Pharmacie Centrale, CHU de Brest, Université de Bretagne Occidentale, Brest
| | - Philippe Girard
- Département Thoracique, Institut Mutualiste Montsouris, F-CRIN INNOVTE, Paris
| | - Emmanuelle Le Moigne
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Aurelia Le Hir
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Marie Guégan
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation et Pharmacologie, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Karine Lacut
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Jean-Luc Bosson
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Oliver Sanchez
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Guy Meyer
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Christophe Leroyer
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Dominique Mottier
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
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Duvillard C, De Magalhaes E, Moulin N, Accassat S, Mismetti P, Bertoletti L. Screening cancer after venous thromboembolism: How many abnormal tests before diagnosing cancer? An analysis of practice. Presse Med 2018; 47:e99-e106. [PMID: 30075951 DOI: 10.1016/j.lpm.2018.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 12/12/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Since Trousseau, we knows that venous thrombemboembolism (VTE) can reveal occult cancer. Different strategies of cancer screening have been evaluated: they are often time-consuming, cause stress and anxiety, and frequently require second-look examinations (due to the risk of false positives), with ultimately a very low yield (about 5%). We evaluated the number of suspect cancer tests before reporting them to the number of cancers finally diagnosed, after a VTE, in the setting of practice's analysis. METHODS We studied retrospectively patients hospitalized for a VTE and with a cancer screening, between 2011 and 2012. Screening cancer was defined by performing at least one of the following tests: PSA, fecal occult blood test, mammography, abdominopelvic iconography (abdominal ultrasound and/or abdominal CT scan). We recorded the suspected cancer tests, the cancers diagnosed, their stage and the survival. These results were expressed as a percentage with a 95% confidence interval. RESULTS Out of the 491 patients treated for a VTE, screening cancer was performed on 295 patients (median age 66.2 years). Nineteen PSA (16.7%, 95% CI [10.3-25]) were abnormal, with 2 localized prostate cancers. Nineteen fecal occult blood tests (15.3%, 95% CI [9.5-23]) were positive, with 2 local cancers. Five mammograms suspected cancer (4.7% 95% CI [1.6-10.8]) for one confirmed. Thirty-eight abdomino-pelvic iconographies (14.4% 95% CI [10.4-19.2]) were suspect, with 7 confirmed cancers, 6 being metastatic at times of diagnostic. CONCLUSION Among the 607 tests performed, 81 were suspected of cancer (13.3%) for only 12 cancers confirmed (2.0%). Screening cancer exposes patients to several false positive tests.
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Affiliation(s)
- Cécile Duvillard
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France.
| | - Elodie De Magalhaes
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, CHU de St-Étienne, centre d'investigation clinique CIC 1401, avenue Albert-Raimond, 42055 St-Étienne cedex, France
| | - Nathalie Moulin
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France
| | - Sandrine Accassat
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, CHU de St-Étienne, centre d'investigation clinique CIC 1401, avenue Albert-Raimond, 42055 St-Étienne cedex, France
| | - Patrick Mismetti
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, CHU de St-Étienne, centre d'investigation clinique CIC 1401, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, Campus santé innovation, UMR 1059 SAINBIOSE, équipe dysfonctions vasculaires et hémostase, 10, rue de la Marandière, 42270 St-Priest-en-Jarez, France
| | - Laurent Bertoletti
- CHU de St-Étienne, hôpital Nord, service de médecine vasculaire et thérapeutique, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, CHU de St-Étienne, centre d'investigation clinique CIC 1401, avenue Albert-Raimond, 42055 St-Étienne cedex, France; Inserm, Campus santé innovation, UMR 1059 SAINBIOSE, équipe dysfonctions vasculaires et hémostase, 10, rue de la Marandière, 42270 St-Priest-en-Jarez, France
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13
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Tezenas du Montcel C, Kowal C, Leherle A, Kabbaj S, Frajerman A, Le Guen E, Hamdani N, Schürhoff F, Leboyer M, Pelissolo A, Pignon B. Isolement et contention mécanique dans les soins psychiatriques : modalités de prescription, prise en charge et surveillance. Presse Med 2018; 47:349-362. [DOI: 10.1016/j.lpm.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
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Impact des recommandations Afssaps 2009 sur la prise en charge de la maladie thromboembolique veineuse aux urgences : étude avant/après. Rev Med Interne 2018; 39:148-154. [DOI: 10.1016/j.revmed.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 11/21/2022]
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Welner S, Kubin M, Folkerts K, Haas S, Khoury H. Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies. Thromb Haemost 2017; 106:600-8. [DOI: 10.1160/th11-03-0168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/06/2011] [Indexed: 12/24/2022]
Abstract
SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.
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Maurizot A, Bura-Rivière A, Gritli K, Bertoletti L, Hernández-Blasco L, Ciammaichella M, Díaz-Pedroche MC, Alfonso M, Lorente MA, Monreal M. [Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:6-13. [PMID: 28705449 DOI: 10.1016/j.jdmv.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.
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Affiliation(s)
- A Maurizot
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Consultations de médecine vasculaire, Centre cardiologique du Nord, 32-36, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - A Bura-Rivière
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - K Gritli
- Service de médecine vasculaire, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Centre de consultation médicale spécialisée Delta Medical, rue Habib Chatti, Manar II, Tunis, Tunisie
| | - L Bertoletti
- SAINBIOSE, DVH, Inserm, département de médecine et thérapeutique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - L Hernández-Blasco
- ISABIAL, Department of Clinical Medicine, Universidad Miguel Hernández, Hospital General Universitario Alicante, Alicante, Espagne
| | - M Ciammaichella
- Department of Emergency Internal Medicine, Ospedale St. John, Rome, Italie
| | - M C Díaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Espagne
| | - M Alfonso
- Department of Pneumonology, Complejo Hospitalario de Navarra, Pamplona, Espagne
| | - M A Lorente
- Department of Internal Medicine. Hospital de la Agencia Valenciana de Salud Vega Baja, Alicante, Espagne
| | - M Monreal
- Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Murcia, Espagne
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17
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Zoubian A, Bertoletti L, Frappé P. After deep vein thrombosis, which patients refer to vascular specialist for anticoagulant withdrawal? A Delphi study results between general practitioners and vascular specialists. Presse Med 2017; 46:e77-e83. [PMID: 28483284 DOI: 10.1016/j.lpm.2016.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/27/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022] Open
Abstract
AIM Deep vein thrombosis (DVT) is a potential serious common disease. Its management is, except in particular cases, on an outpatient basis. General practitioner's (GP) role usually includes the treatment risk/benefit reassessment. The treatment duration can vary and is difficult to define. The national and international guidelines do not explain clearly when to refer, or not, to a vascular specialist in order to stop treatment. The study's objective was to identify, for DVT, when a GP has to refer or not to a vascular specialist, for anticoagulant withdrawal. METHODS A modified Delphi consensus study had been conducted by a panel of general practitioners and vascular specialists to identify, in which situations all clinicians agree that GPs can stop anticoagulation on their own and other situations in which GP have to refer to vascular specialists. Clinical situations and their respective duration of anticoagulant therapy have been identified by a DVT management guideline literature research. RESULTS After two rounds, a strong agreement had been reached for each clinical situation. For 7 clinical situations, GPs were able to stop anticoagulation on their own, for 13 clinical situations; it was necessary to refer to a vascular specialist. We obtained a consensus regarding 3 modulating factors. DISCUSSION Consensual situations, in which the general practitioners may be able to stop anticoagulation themselves, are isolated distal DVT without cancer and proximal DVT caused by a major reversible risk factor. Situations justifying a vascular medical advice were unprovoked DVT, DVT in a context of pregnancy, postpartum, cancer and proximal DVT in a context of hormonal therapy.
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Affiliation(s)
- Antonin Zoubian
- Université Jean-Monnet, faculté Jacques-Lisfranc, département de médecine générale, 42000 Saint-Étienne, France
| | - Laurent Bertoletti
- CHU Hôpital-Nord, CIE3, CIC-EC Inserm, 42000 Saint-Étienne, France; Université Jean-Monnet, Inserm U1059 Sainbiose-DVH, 42000 Saint-Étienne, France; CHU de Saint-Etienne, service de médecine vasculaire et thérapeutique, 42000 Saint-Étienne, France
| | - Paul Frappé
- Université Jean-Monnet, faculté Jacques-Lisfranc, département de médecine générale, 42000 Saint-Étienne, France; CHU Hôpital-Nord, CIE3, CIC-EC Inserm, 42000 Saint-Étienne, France; Université Jean-Monnet, Inserm U1059 Sainbiose-DVH, 42000 Saint-Étienne, France.
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18
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van Lingen CP, Zagra LM, Ettema HB, Verheyen CC. Sequelae of large-head metal-on-metal hip arthroplasties: Current status and future prospects. EFORT Open Rev 2016; 1:345-353. [PMID: 28461912 PMCID: PMC5367524 DOI: 10.1302/2058-5241.1.160014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Large-head metal-on-metal (MoM) bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing (HR), followed closely by large metal head total hip arthroplasty (THA). A worldwide increase in the use of MoM hip arthroplasty subsequently saw a sharp decline, due to serious complications.MoM was rapidly adopted in the early 2000s until medical device alerts were issued by government regulatory agencies and national and international organisations, leading to post-marketing surveillance and discontinuation of these implants.Guidelines for MoM hip implant follow-up differ considerably between regulatory authorities worldwide; this can in part be attributed to missing or conflicting evidence.The authors consider that the use of large-head MoM THA should be discontinued. MoM HR should be approached with caution and, when considered, should be used only in patients who meet all of the recommended selection criteria, which limits its indications considerably.The phased introduction of new prostheses should be mandatory in future. Close monitoring of outcomes and long-term follow-up is also necessary for the introduction of new prostheses. Cite this article: van Lingen CP, Zagra LM, Ettema HB, Verheyen CC. Sequelae of large-head metal-on-metal hip arthroplasties: current status and future prospects. EFORT Open Rev 2016;1:345-353. DOI: 10.1302/2058-5241.1.160014.
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Affiliation(s)
| | | | - Harmen B. Ettema
- Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands
| | - Cees C. Verheyen
- Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands
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19
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Nou M, Laroche JP. [Venous thrombo-embolic disease in cancer. Low molecular weight heparin indications]. JOURNAL DES MALADIES VASCULAIRES 2016; 41:197-204. [PMID: 27146099 DOI: 10.1016/j.jmv.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
Cancer and venous thrombo-embolic disease (VTE) are closely related. Indeed, cancer can reveal VTE and VTE can be the first sign of cancer. Low molecular weight heparin (LWMH) is now the first line treatment in cancer patients. Compliance with marketing authorizations and guidelines are crucial for patient-centered decision-making. This work deals with the prescription of LWMH in patients who develop VTE during cancer in order to better recognize what should or should not be done. The patient's wishes must be taken into consideration when making the final therapeutic decision. The other treatments are discussed: vitamin K antagonists and direct oral anticoagulants (DOACs) may be useful.
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Affiliation(s)
- M Nou
- Département de médecine vasculaire, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
| | - J-P Laroche
- Département de médecine vasculaire, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
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20
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Affiliation(s)
- Laurent Bertoletti
- CHU de Saint-Étienne, service de médecine vasculaire et thérapeutique, 42055 Saint-Étienne, France; Université Jean-Monnet, dysfonction vasculaire et hémostase, Inserm, 42055 Saint-Étienne, France; CHU de Saint-Étienne, INNOVTE network, 42055 Saint-Étienne, France.
| | - Marc Humbert
- Univiversité Paris-Sud, université Paris-Saclay, faculté de médecine, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de pneumologie, 94270 Le Kremlin-Bicêtre, France; Hôpital Marie-Lannelongue, Inserm UMR_S 999, 92060 Le Plessis-Robinson, France
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21
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Galanaud JP, Messas E, Blanchet-Deverly A, Quéré I, Wahl D, Pernod G. Prise en charge de la maladie thromboembolique veineuse en 2015. Rev Med Interne 2015; 36:746-52. [DOI: 10.1016/j.revmed.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/01/2015] [Indexed: 01/16/2023]
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22
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Knutson F, Osselaer J, Pierelli L, Lozano M, Cid J, Tardivel R, Garraud O, Hervig T, Domanovic D, Cukjati M, Gudmundson S, Hjalmarsdottir IB, Castrillo A, Gonzalez R, Brihante D, Santos M, Schlenke P, Elliott A, Lin JS, Tappe D, Stassinopoulos A, Green J, Corash L. A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Vox Sang 2015; 109:343-52. [PMID: 25981525 PMCID: PMC4690512 DOI: 10.1111/vox.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.
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Affiliation(s)
- F Knutson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - J Osselaer
- Cliniques Universitaires de Mont Godinne, Universite Catholique de Louvain, Yvoir, Belgium
| | - L Pierelli
- Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
| | - M Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - J Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - O Garraud
- EFS Auvergne Loire, St. Etienne, France
| | - T Hervig
- Department of Immunology and Transfusion Medicine, University of Bergen, Bergen, Norway
| | - D Domanovic
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - M Cukjati
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - S Gudmundson
- Blood Bank, National University Hospital, Reykjavik, Iceland
| | | | - A Castrillo
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - R Gonzalez
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - D Brihante
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - M Santos
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - P Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | - D Tappe
- Cerus Corporation, Concord, CA, USA
| | | | - J Green
- Cerus Corporation, Concord, CA, USA
| | - L Corash
- Cerus Corporation, Concord, CA, USA
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Messas E, Wahl D, Pernod G. [Management of deep-vein thrombosis: A 2015 update]. ACTA ACUST UNITED AC 2015; 41:42-50. [PMID: 26357937 DOI: 10.1016/j.jmv.2015.07.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/10/2015] [Indexed: 11/26/2022]
Abstract
Deep vein thrombosis (DVT) is a frequent and multifactor disease, with two major complications, post thrombotic syndrome and pulmonary embolism. Both transient (surgery, plaster immobilization, bed rest/hospitalization) and chronic/persistent (age, cancer, clinical or biological thrombophilia…) risk factors modulate treatment duration. Diagnostic management relies on clinical evaluations, probability followed by laboratory tests or imaging. So far, compression ultrasound is the diagnostic test of choice to make a positive diagnosis of DVT. Anticoagulants at therapeutic dose for at least 3 months constitute the cornerstones of proximal (i.e. involving popliteal or more proximal veins) DVT therapeutic management. The arrival of new oral anticoagulants should optimize ambulatory management of DVT.
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Affiliation(s)
- E Messas
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU de Nancy, rue de Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
| | - G Pernod
- Service de médecine vasculaire, université Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, CHU de Grenoble, 38043 Grenoble cedex 09, France
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Almosni J, Meusy A, Frances P, Pontal D, Quéré I, Galanaud JP. Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey. Thromb Res 2015; 136:526-30. [DOI: 10.1016/j.thromres.2015.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/01/2015] [Accepted: 06/11/2015] [Indexed: 11/25/2022]
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Galanaud JP, Blanchet-Deverly A, Pernod G, Quéré I. [Management of pulmonary embolism: A 2015 update]. ACTA ACUST UNITED AC 2015; 41:51-62. [PMID: 26283060 DOI: 10.1016/j.jmv.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/12/2015] [Indexed: 01/21/2023]
Abstract
Pulmonary embolism (PE) is a frequent, serious and multifactorial disease, the incidence of which increases with advanced age. In the absence of pathognomonic clinical signs or symptoms, diagnostic management lies in the evaluation of clinical pre-test probability followed by a laboratory or an imaging test. So far, multidetector computed tomography angiography is the diagnostic test of choice to make a positive diagnosis of PE. Anticoagulants at therapeutic dose for at least 3 months constitute the cornerstones of PE therapeutic management. Duration of anticoagulant treatment is modulated according to the presence of transient (surgery, plaster immobilization, bed rest/hospitalization) and chronic/persistent (age, cancer, clinical or biological thrombophilia…) risk factors of PE. Thrombolysis is usually prescribed only for cases of severe PE with arterial hypotension. Arrival of new oral anticoagulants, which have recently been shown to be as effective and as safe as vitamin K antagonist, should simplify and ease ambulatory management of PE and favor more prolonged treatments with anticoagulant for cases of unprovoked PE or PE provoked by a chronic/persistent risk factor.
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Affiliation(s)
- J-P Galanaud
- Centre d'investigations cliniques, service de médecine vasculaire, département de médecine interne, hôpital Saint-Eloi, CHU de Montpellier, université Montpellier I, Inserm CIC-1001, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - A Blanchet-Deverly
- Service d'explorations cardiovasculaires, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - G Pernod
- Service de médecine vasculaire, CHU de Grenoble, université Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, 38043 Grenoble cedex 09, France
| | - I Quéré
- Centre d'investigations cliniques, service de médecine vasculaire, département de médecine interne, hôpital Saint-Eloi, CHU de Montpellier, université Montpellier I, Inserm CIC-1001, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Tromeur C, Couturaud F. [Optimal duration of anticoagulant treatment after venous thromboembolic disease]. Presse Med 2015; 44:779-90. [PMID: 26276297 DOI: 10.1016/j.lpm.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Determination of the optimal duration of anticoagulant treatment for venous thromboembolic disease (VTED) is a major step in the management of patients with this disease. The assessment depends on the identification of two sets of risk factors: those for recurrence after anticoagulant treatment is stopped and those for hemorrhage in cases of prolonged treatment. Nonetheless, the determination of the optimal duration remains controversial. Recent data finally make it possible to clarify this decision. Recent treatment trials demonstrate that patients at high risk of recurrence receive no sustained benefit from a prolonged but limited anticoagulant treatment. In other words, the choice is simplified: either the risk is low, and treatment for 3months is sufficient, or the risk is high, and treatment must be envisioned for an unlimited duration. Adequate identification of patients eligible for short or unlimited treatment is more crucial than ever and depends on the presence of determinant clinical variables, as the information from laboratory or morphologic tests is generally marginal. The risk of thromboembolic recurrence is low when the initial episode is triggered by a major reversible factor, and a short treatment of 3months is thus indicated. These inducing factors are mainly surgery, lower limb injuries, immobilization for a medical condition, pregnancy, or use of combined estrogen-progestin contraceptives. Among patients with VTED not induced by these factors, the risk of recurrence is high and requires planning anticoagulant treatment for an unlimited duration. Nonetheless, the risk of hemorrhage is a major constraint to such unlimited treatment. Accordingly, the perspectives for secondary prevention that is equally effective but has a lower risk of hemorrhage are currently under evaluation. Finally, patients with cancer are in a separate category, with a very high risk of recurrence that justifies treatment for at least 6months.
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Affiliation(s)
- Cécile Tromeur
- CHU La Cavale-Blanche, département de médecine interne et pneumologie, EA 3878 (GETBO), IFR 148, CIC Inserm 1412, GIRC-Thrombose F-CRIN - INNOVTE, 29609 Brest cedex, France
| | - Francis Couturaud
- CHU La Cavale-Blanche, département de médecine interne et pneumologie, EA 3878 (GETBO), IFR 148, CIC Inserm 1412, GIRC-Thrombose F-CRIN - INNOVTE, 29609 Brest cedex, France.
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Payerols-Ternisien A, Meusy A, Terminet A, Pontal D, Bourdin A, Vergés M, Sebbane M, Georgesu V, Aubas P, Quéré I, Mercier G, Galanaud JP. [Home care for acute pulmonary embolism: Feasibility and general practitioner acceptability]. ACTA ACUST UNITED AC 2015; 40:223-30. [PMID: 26047552 DOI: 10.1016/j.jmv.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/24/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In France, initial management of pulmonary embolism (PE) is performed in the hospital setting. The latest international guidelines suggest that PE at low risk of mortality can be treated in the ambulatory care setting. This means that ambulatory care pathways and general practitioner (GP) opinions concerning such a change in practice need to be determined. OBJECTIVES To determine: (1) rate of patients eligible for an ambulatory management of their PE and reasons for hospitalization of PE at low risk of mortality; (2) acceptability for GPs of PE home care and patient's desired care pathway. METHODS Two-part prospective observational study conducted in Montpellier University Hospital from May 2012 to August 2013: (1) in-hospital study including all consecutive patients with non-hospital acquired PE; (2) telephonic survey on PE patient's ambulatory care pathway conducted among GPs. RESULTS In-hospital study: 99.1% (n=211) of included patients were hospitalized and only 14.1% (n=30) had all criteria for home care. Patient's pathway survey: 68.3% (n=112) of GPs, particularly those aged 40-54 years and those who had already managed patients alone after hospital discharge, were in favour of home care for PE. One hundred and thirty-nine (84.8%) GPs wanted a collaborative management with an expert thrombosis physician and an outpatient follow-up visit at one week. CONCLUSION Few patients managed at Montpellier University Hospital are eligible for ambulatory management of their PE. GPs have a favorable opinion of home care for PE if it is conducted in collaboration with an expert thrombosis physician.
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Affiliation(s)
- A Payerols-Ternisien
- Département de médecine interne, centre d'investigation clinique, CHU de Montpellier, 34000 Montpellier, France.
| | - A Meusy
- Département de l'information médicale, CHRU de Montpellier, 34000 Montpellier, France
| | - A Terminet
- Service de gériatrie, CHU de Montpellier, 34000 Montpellier, France
| | - D Pontal
- Département de médecine interne, centre d'investigation clinique, CHU de Montpellier, 34000 Montpellier, France
| | - A Bourdin
- Service de pneumologie, CHU de Montpellier, 34000 Montpellier, France
| | - M Vergés
- Service de cardiologie, CHU de Montpellier, 34000 Montpellier, France
| | - M Sebbane
- Service d'accueil des urgences, CHU de Montpellier, 34000 Montpellier, France
| | - V Georgesu
- Département de l'information médicale, CHRU de Montpellier, 34000 Montpellier, France
| | - P Aubas
- Département de l'information médicale, CHRU de Montpellier, 34000 Montpellier, France
| | - I Quéré
- Département de médecine interne, centre d'investigation clinique, CHU de Montpellier, 34000 Montpellier, France
| | - G Mercier
- Département de l'information médicale, CHRU de Montpellier, 34000 Montpellier, France
| | - J-P Galanaud
- Département de médecine interne, centre d'investigation clinique, CHU de Montpellier, 34000 Montpellier, France
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Nou M, Rodière M, Schved JF, Laroche JP, Quéré I, Dauzat M, Jeziorski E. [Deep venous thrombosis complications during infections in pediatric patients: analysis of a series of 24 cases]. Arch Pediatr 2014; 21:697-704. [PMID: 24938919 DOI: 10.1016/j.arcped.2014.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/31/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
Venous thromboembolism disease (VTE) is rare in children (5.3 of 10,000 hospitalized children). However, morbidity and mortality are high, especially when the child is already suffering from severe sepsis. We report an analytical study of 24 cases of deep venous thrombosis occurring in children during infection, recorded at the Montpellier University Hospital between 1999 and 2009. Many parameters were studied in each population (age, sex, familial and personal history of thrombosis, history of thrombophilia, the presence of a venous catheter, a causative organism, time to onset of thrombus, topography of lesions, acquired abnormalities of hemostasis, and thrombosis prophylaxis). The children were aged from 1 day of life to 16 years. Thromboses occurred in two clinical contexts: "contact" thrombosis (which appeared near the infection) and disseminated thrombosis. This is an early complication because in most of the cases, it appeared in the first 10 days of sepsis. Infection and coagulation appear to be closely related and the states of latent or decompensated disseminated intravascular coagulation are common. Nevertheless, it is not possible to predict the occurence of a thrombotic event. The presence of risk factors (venous catheters, acquired thrombophilia, or constitutional thrombophilia) may increase the thrombogenic potential of the infection. VTE should always be suspected and sought in case of an unfavorable clinical course, and routine prophylaxis of thrombosis during sepsis should be discussed.
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Affiliation(s)
- M Nou
- Service de médecine interne B et maladie vasculaire, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - M Rodière
- Service de pédiatrie III, hôpital Arnaud de Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J-F Schved
- Service d'hématologie, hôpital Saint-Éloi, 34295 Montpellier, France
| | - J-P Laroche
- Service de médecine interne B et maladie vasculaire, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - I Quéré
- Service de médecine interne B et maladie vasculaire, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Dauzat
- Service d'explorations vasculaires, centre hospitalier universitaire Carémeau (NIMES), rue du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - E Jeziorski
- Service de pédiatrie III, hôpital Arnaud de Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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29
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Filtres caves, quelles indications en 2014 ? Rev Med Interne 2014; 35:349-52. [DOI: 10.1016/j.revmed.2013.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022]
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Galanaud JP, Sevestre MA, Genty C, Kahn SR, Pernod G, Rolland C, Diard A, Dupas S, Jurus C, Diamand JM, Quere I, Bosson JL. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12:436-43. [PMID: 24450376 DOI: 10.1111/jth.12512] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isolated distal deep vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism) represents half of all cases of lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence. METHODS Using data from the OPTIMEV (OPTimisation de l'Interrogatoire dans l'évaluation du risque throMbo-Embolique Veineux) study, a prospective, observational, multicenter study, we compared, 3 years after an index VTE event and after discontinuation of anticoagulants, (i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal DVT (iPDVT) and (ii) predictors of recurrence after iDDVT. RESULTS Compared with patients with iPDVT (n = 259), patients with an iDDVT (n = 490) had a lower annualized incidence of overall VTE recurrence (5.2% [95% confidence interval 3.6-7.6] vs. 2.7% [1.9-3.8], respectively; P = 0.02) but a similar incidence of pulmonary embolism recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6], respectively; P = 0.83). An age of > 50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, with the latter then being ≥ 3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence. CONCLUSIONS After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than did patients with iPDVT but a similar risk of serious recurrent VTE. Age > 50 years, unprovoked iDDVT, and number of thrombosed veins (more than one) influenced the risk of recurrence and may help to define patients at significant risk of recurrence.
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Affiliation(s)
- J-P Galanaud
- Clinical Investigation Center and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
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31
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Meyer G. [Venous thromboembolism and cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:91-94. [PMID: 24566034 DOI: 10.1016/j.pneumo.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/10/2013] [Indexed: 06/03/2023]
Abstract
Incidence of venous thromboembolism (VTE) is high in patients with cancer and varies with the type, the stage and the histologic type of the cancer but also with some anticancer therapies and patient related risk factors. Therapeutic trials on long-term prophylaxis have not provided convincing results. In patients with established VTE, the risk of recurrence and bleeding is high. Although prolonged treatment with low molecular weight heparin (LMWH) is more efficient than vitamin K antagonists in patients with VTE and cancer, it is already associated with a risk of recurrence which is much higher than in non-cancer patients. The nature of the treatment to be administered after the initial six months, which is often required in this context and the treatment of recurrent VTE during anticoagulant treatment are still debated. Some long-standing data suggest that LMWH could play an adjuvant role as specific anticancer treatment. These data have still not been confirmed in clinical trials but several studies in different cancer types are ongoing.
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Affiliation(s)
- G Meyer
- Université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France; Service de pneumologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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32
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Galanaud JP. [Are temporary vena cava filters becoming permanent?]. JOURNAL DES MALADIES VASCULAIRES 2013; 38:333-4. [PMID: 24113390 DOI: 10.1016/j.jmv.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Indexed: 10/26/2022]
Affiliation(s)
- J-P Galanaud
- Centre d'investigation clinique et service de médecine vasculaire, département de médecine interne, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Seinturier C, Dornier C, Thony F, Blaise S, Rodière M, Menez C, Arnoult AC, Imbert B, Pernod G. [Temporary vena caval filters: report on cohort of 72 patients in Grenoble, France]. ACTA ACUST UNITED AC 2013; 38:335-40. [PMID: 24016707 DOI: 10.1016/j.jmv.2013.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/08/2013] [Indexed: 11/28/2022]
Abstract
Patients with a contra-indication for anticoagulation can benefit from temporary vena caval filters for protection against pulmonary embolism or recurrence. The filter can be removed secondarily, once the contra-indication is overcome, enabling better long-term outcome by reducing the risk of thrombotic and mechanic complications inherent in these devices. However, it has been shown in several studies that effective withdrawal rates were low and could be improved by the establishment of protocols and registries. We report a retrospective study of withdrawal in 72 patients in whom an ALN® vena caval filter was implanted at the Grenoble University Hospital over a period of three years with an intention for secondary retrieval. Seventy percent of the indications were related to the coexistence of thrombotic and hemorrhagic conditions. Fifty-five percent of filters were removed, the remaining 45% shared involved patients who died before retrieval (11%), those lost to follow-up (4%), technical failure of retrieval (6%), withdrawal technically unfeasible (3%), retrieval refused by patients (6%) and medical indications for continuing filtration (15%). Despite an effective follow-up of these patients and 91% success rate of withdrawal, nearly one out of two filters remains in place. A long-term follow-up of these patients is needed to learn more about the outcome of these filters.
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Affiliation(s)
- C Seinturier
- Clinique universitaire de médecine vasculaire, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 9, France.
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Nouveaux anticoagulants oraux dans le traitement curatif de la maladie thromboembolique veineuse. Presse Med 2013; 42:1232-8. [DOI: 10.1016/j.lpm.2013.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/12/2013] [Indexed: 11/19/2022] Open
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Thromboprophylaxie en médecine : quelles modifications avec les nouveaux anticoagulants oraux ? Presse Med 2013; 42:1219-24. [DOI: 10.1016/j.lpm.2013.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/12/2013] [Indexed: 11/18/2022] Open
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Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, Martin M, Casado I, Riera-Mestre A, Monreal M. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res 2013; 14:75. [PMID: 23865769 PMCID: PMC3728047 DOI: 10.1186/1465-9921-14-75] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/15/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients. METHODS COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)). RESULTS Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7). CONCLUSIONS COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.
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Affiliation(s)
- Laurent Bertoletti
- Thrombosis Research Group, EA3065, University Saint-Etienne, Jean Monnet, Saint-Etienne F-42023, France
- CIE3, INSERM, Saint-Etienne F- 42055, France
- Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne F-42055, France
| | - Sara Quenet
- Thrombosis Research Group, EA3065, University Saint-Etienne, Jean Monnet, Saint-Etienne F-42023, France
| | - Silvy Laporte
- Thrombosis Research Group, EA3065, University Saint-Etienne, Jean Monnet, Saint-Etienne F-42023, France
- CIE3, INSERM, Saint-Etienne F- 42055, France
- Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne F-42055, France
| | | | - Francisco Conget
- Department of Pneumonology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Mar Martin
- Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain
| | - Ignacio Casado
- Department of Pneumonology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio Riera-Mestre
- Department of Internal Medicine, Hospital Univesitari de Bellvitge - IDIBELL, Barcelona, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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Laroche JP. [Regarding: Benefit/risk ratio analysis from a possible anticoagulation of asymptomatic deep venous thrombosis in major orthopedic surgery]. ACTA ACUST UNITED AC 2013; 38:280-1. [PMID: 23731505 DOI: 10.1016/j.jmv.2013.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Indexed: 11/25/2022]
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39
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Laporte S, Bertoletti L, Romera A, Mismetti P, Pérez de Llano LA, Meyer G. Long-term treatment of venous thromboembolism with tinzaparin compared to vitamin K antagonists: A meta-analysis of 5 randomized trials in non-cancer and cancer patients. Thromb Res 2012; 130:853-8. [DOI: 10.1016/j.thromres.2012.08.290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/23/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
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Superficial venous thrombosis and compression ultrasound imaging. J Vasc Surg 2012; 56:1032-8.e1. [PMID: 22832262 DOI: 10.1016/j.jvs.2012.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/13/2012] [Accepted: 03/04/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND A current debate concerning suspected superficial vein thrombosis (SVT) focuses on the need of performing a compression ultrasound (CUS) exploration for confirming the diagnosis of SVT. This study was conducted to determine the clinical relevance and optimal CUS exploration in patients with symptomatic SVT. METHODS We analyzed the characteristics of SVT and concomitant deep vein thrombosis (DVT) in patients included in the Prospective Observational Superficial Thrombophlebitis (POST) multicenter, observational prospective study. All patients underwent complete bilateral lower limb CUS, exploring both the superficial and deep venous systems. RESULTS A total of 844 patients with clinical symptoms of SVT were recruited, of which 99 isolated SVTs (21.4%) had saphenofemoral/popliteal junction involvement, and 198 (23.5%) had a concomitant DVT, with 41.8% of them proximal DVTs. In 83 patients (41.9%), DVT and SVT were not contiguous. Five of 639 patients (1%) had an isolated contralateral DVT (ie, not bilateral). Age ≥ 75 years (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.6-3.4), inpatient status (OR, 5.4; 95% CI, 3.4-8.7), a personal history of DVT or pulmonary embolism (OR, 1.8; 95% CI, 1.2-2.8), and SVT on nonvaricose veins (OR, 3.3; 95% CI, 2.1-5.0) were significantly and independently associated with an increased risk of concomitant DVT. Half of the patients exhibited none of these risk factors, and the prevalence of concomitant DVT dropped to 11%. CONCLUSIONS In patients with symptomatic SVT, a CUS exploration screening the whole venous system of the affected limb is useful because it provides information that has important consequences for the management of these patients.
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Galanaud JP, Kahn SR, Khau Van Kien A, Laroche JP, Quéré I. [Epidemiology and management of isolated distal deep venous thrombosis]. Rev Med Interne 2012; 33:678-85. [PMID: 22705030 DOI: 10.1016/j.revmed.2012.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/14/2012] [Indexed: 01/19/2023]
Abstract
Isolated distal deep-vein thromboses (DVT) are infra-popliteal DVT without involvement of proximal veins or pulmonary embolism (PE). They can affect deep calf (tibial anterior, tibial posterior, or peroneal) or muscular (gastrocnemius or soleal) veins. They represent half of all lower limbs DVT. Proximal and distal DVTs differ in terms of risk factor profile, proximal DVT being more frequently associated with chronic risk factors and distal DVT with transient ones. Their natural history (rate of spontaneous proximal extension) is debated leading to uncertainties on the need to diagnose and treat them with anticoagulant drugs. In the long term, the risk of venous thromboembolic recurrence is lower than that of proximal DVT and their absolute risk of post-thrombotic syndrome is unknown. French national guidelines suggest treating with anticoagulants for 6 weeks a first episode of isolated distal DVT provoked by a transient risk factor and treating for at least 3 months unprovoked or recurrent or active cancer-related distal DVT. The use of compression stockings use is suggested in case of deep calf vein thrombosis. Ongoing therapeutic trials should provide important data necessary to establish an evidence-based mode of care, especially about the need to treat distal DVT at low risk of extension with anticoagulants.
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Affiliation(s)
- J-P Galanaud
- Unité de médecine vasculaire, département de médecine interne, CHU de Montpellier, 80, avenue Gaston-Fliche, 34295 Montpellier cedex 5, France.
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Compression veineuse et thrombose veineuse profonde. Enquête de pratique en médecine vasculaire. ACTA ACUST UNITED AC 2012; 37:140-5. [DOI: 10.1016/j.jmv.2012.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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Savina EN, Couturaud F. [Optimal duration of anticoagulation of venous thromboembolism]. ACTA ACUST UNITED AC 2012; 36 Suppl 1:S28-32. [PMID: 22177766 DOI: 10.1016/s0398-0499(11)70005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The optimal duration of anticoagulation after venous thromboembolism (VTE) is determined according to the risk of recurrent VTE after stopping anticoagulant therapy and the risk of anticoagulant-related bleeding while on antivitamin K. Clinical risk factors appears to be determinant to predict the risk of recurrence whereas the influence of biochemical and morphological tests is uncertain. The risk of recurrent venous thromboembolism is low when the initial episode was provoked by a reversible major risk factor (surgery): 3 months of anticoagulation is optimal. Conversely, this risk is high when venous thromboembolism was unprovoked or associated with persistent risk factor (cancer): 6 months or more prolonged anticoagulation is warranted. After this first estimation, the duration of anticoagulation may be modulated according to the presence of additional minor risk factors (major thrombophilia, chronic pulmonary hypertension, massive pulmonary embolism): 6 months if VTE was provoked and 12 to 24 months if VTE was unprovoked. If the risk of anticoagulant related bleeding is high, the duration of anticoagulation should be shortened (3 months if VTE was provoked and 6 or 3 months if it was unprovoked). Lastly, if VTE occurred in the setting of a cancer, anticoagulation should be conducted for 6 months or more while cancer is active or on ongoing treatment. Despite an increasing knowledge of the risk factors of recurrent VTE, a number of issues remain unresolved; randomised trial comparing different duration of anticoagulation are needed.
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Affiliation(s)
- E Noel Savina
- EA 3878 (GETBO), IFR 148, CIC INSERM 0502, Département de Médecine interne et Pneumologie, CHU La Cavale Blanche, 29609 Brest cedex, France
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Delluc A, Le Ven F, Mottier D, Le Gal G. Épidémiologie et facteurs de risque de la maladie veineuse thromboembolique. Rev Mal Respir 2012; 29:254-66. [DOI: 10.1016/j.rmr.2011.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 04/03/2011] [Indexed: 10/14/2022]
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Meyer G. [Cancer and venous thromboembolism]. ACTA ACUST UNITED AC 2011; 36 Suppl 1:S42-7. [PMID: 22177769 DOI: 10.1016/s0398-0499(11)70008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer and venous thrombo-embolism is a frequent clinical association. Tumour cells activate the coagulation cascade. Surgery, chemotherapy and antiangiogenic agents are also associated with an increased risk of thrombosis. Current evidence does not suggest that a systematic screening for cancer after an unexplained thrombosis is associated with a clinical benefit. Risk factors for thrombosis specific to the cancer population have been identified. Recent studies suggest that prophylactic treatment may reduce the incidence of venous thrombo-embolism in patients with cancer. These results need to be confirmed. Treatment of venous thrombo-embolism in cancer patients is primarily based on low-molecular weight heparin administered for 3 or 6 months. Experimental data suggest that low-molecular weight heparin may also increase the survival of patients with cancer through a direct effect on tumour biology. Several clinical trials are underway to confirm this hypothesis.
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Affiliation(s)
- G Meyer
- Service de Pneumologie, Université Paris Descartes, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc 75015 Paris, France.
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[The optimal duration of anticoagulant treatment following pulmonary embolism]. Rev Mal Respir 2011; 28:1265-77. [PMID: 22152935 DOI: 10.1016/j.rmr.2011.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 04/07/2011] [Indexed: 11/23/2022]
Abstract
The optimal course of oral anticoagulant therapy is determined according to the risk of recurrent venous thromboembolism after stopping therapy and the risk of anticoagulant-related bleeding. Clinical risk factors appear to be important in predicting the risk of recurrence whereas the influence of biochemical and morphological tests is uncertain. The risk of recurrent venous thromboembolism is low when the initial episode was provoked by a reversible major risk factor (surgery): 3 months of anticoagulation is sufficient. Conversely, the risk is high when venous thromboembolism was unprovoked or associated with persistent risk factor (cancer): 6 months or more prolonged anticoagulation is necessary. After this first estimation, the duration of anticoagulation may be modulated according to the presence or absence of certain additional risk factors (major thrombophilia, chronic pulmonary hypertension, massive pulmonary embolism): 6 months if pulmonary embolism was provoked and 12 to 24 months if pulmonary embolism was unprovoked. If the risk of anticoagulant-related bleeding is high, the duration of anticoagulation should be shortened (3 months if pulmonary embolism was provoked and 3 to 6 months if it was unprovoked). Lastly, if pulmonary embolism occurred in association with cancer, anticoagulation should be conducted for 6 months or more if the cancer is active or treatment is on going. Despite an increasing knowledge of the risk factors for recurrent venous thromboembolism, a number of issues remain unresolved. Randomised trials comparing different durations of anticoagulation are needed.
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Risk factors and early outcomes of patients with symptomatic distal vs. proximal deep-vein thrombosis. Curr Opin Pulm Med 2011; 17:387-91. [DOI: 10.1097/mcp.0b013e328349a9e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Meyer G, Belmont L. [Cancer and venous thromboembolism]. Rev Mal Respir 2011; 28:443-52. [PMID: 21549900 DOI: 10.1016/j.rmr.2011.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/29/2010] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cancer and venous thromboembolism are frequently associated. STATE OF THE ART Venous thromboembolism is associated with a worse prognosis in patients with cancer. Thrombosis in cancer patients is related to the expression of tissue factor and other procoagulants by tumour cells. Surgery, chemotherapy and antiangiogenic agents are also associated with an increased risk of thrombosis. Venous thromboembolism may be the first manifestation of cancer, the risk being especially increased during the first six months following an unexplained episode of idiopathic thrombosis. Current evidence does not suggest that a systematic screening for cancer after an unexplained thrombosis is associated with a clinical benefit. Risk factors for thrombosis specific to the cancer population have been identified. A recent controlled trial suggests that low-molecular weight heparin may reduce the incidence of venous thromboembolism in patients with cancer. These results need to be confirmed. Treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin administered for three or six months. PERSPECTIVES Low-molecular weight heparin may increase the survival of patients with cancer through a direct effect on tumour biology. Several clinical trials are underway to confirm this hypothesis. CONCLUSION Thrombosis in cancer patients is a frequent and difficult to treat condition. The role of long-term prophylaxis remains to be defined. The treatment of venous thromboembolism in cancer patients is primarily based on low-molecular weight heparin. Large clinical trials are currently assessing the effect of low-molecular weight heparin on the long-term survival of patients with cancer.
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Affiliation(s)
- G Meyer
- Service de pneumologie-soins intensifs, hôpital Européen Georges-Pompidou, AP-HP, faculté de médecine, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
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Meyer G, Besse B, Friard S, Girard P, Corbi P, Azarian R, Monnet I, Alifano M, Chouaid C, Descourt R, Dennewald G, Taillade L, De Luca K, Giraud F, Pichon E, Chatellier G. Effet de la tinzaparine sur la mortalité du cancer bronchique non à petites cellules opéré. Rev Mal Respir 2011; 28:654-9. [DOI: 10.1016/j.rmr.2011.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
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[Thrombosis and assisted reproductive techniques (ART)]. ACTA ACUST UNITED AC 2011; 36:145-54. [PMID: 21333476 DOI: 10.1016/j.jmv.2010.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022]
Abstract
Assisted reproductive techniques (ART) concern procedures designed to increase fertility of couples: artificial insemination, in vitro fertilization (IVF), either classical or after intracytoplasmic sperm injection (ICSI), transfer of frozen embryos, or gamete intrafallopian transfer. Their use has greatly increased these last years. They may be associated with severe ovarian hyperstimulation syndrome and one possible major complication is venous or arterial thrombosis. Thromboses are rare but potentially serious with important sequellae. They are mostly observed in unusual sites such as head and neck vessels and the mechanism is still unknown although hypotheses have been proposed. This review is an update of our knowledge and an attempt to consider guidelines for the prevention and treatment of ART-associated thromboses, which frequently occur when the woman is pregnant. Prevention of severe ovarian hyperstimulation by appropriate stimulation procedures, detection of women at risk of hyperstimulation and of women at high risk of thrombosis should allow reduction of the risk of thrombosis, possibly by administration of a thromboprophylaxis at a timing and dose which can be only determined by extrapolation.
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