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Godier A, Llau JV, Ferrandis R, Langenecker S. What is a low low-molecular-weight heparin dose? Eur J Anaesthesiol 2024; 41:393. [PMID: 38567682 DOI: 10.1097/eja.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Anne Godier
- From the Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris and INSERM UMRS-1140, Université Paris Cité, Paris, France (AG), Department of Anaesthesiology and Critical Care, Doctor Peset University Hospital and Department of Surgery, Valencia University, Valencia, Spain (JVL), Department of Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe and Department of Surgery, Valencia University, Valencia, Spain (RF) and Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Vienna, Austria (SL)
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2
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Mansour A, Godier A, Lecompte T, Roullet S. Ten considerations about viscoelastometric tests. Anaesth Crit Care Pain Med 2024; 43:101366. [PMID: 38460888 DOI: 10.1016/j.accpm.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, Rennes, France
| | - Anne Godier
- Université Paris Cité, INSERM UMRS-1140, Innovations Thérapeutiques en Hémostase, Paris, France; Service d'Anesthésie-Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Lecompte
- Université de Lorraine, Faculté de Médecine de Nancy, France
| | - Stéphanie Roullet
- Département d'Anesthésie Réanimation, Hôpital Paul Brousse, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France; Université Paris-Saclay, INSERM, Hémostase Inflammation Thrombose HITH U1176, Le Kremlin-Bicêtre, France.
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3
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Godier A, Vandermeulen E, Kietaibl S. Reply to: regional anaesthesia in patients on antithrombotic drugs. Eur J Anaesthesiol 2023; 40:959-960. [PMID: 37909159 DOI: 10.1097/eja.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Anne Godier
- From the Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris and INSERM UMRS-1140 Université Paris Cité, Paris, France (AG), Department of Anaesthesia, University Hospitals Leuven. Catholic University of Leuven, Leuven, Belgium (EV) and Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Vienna, Austria (SK)
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Lefrant JY, Benhamou D, Fischer MO, Pirracchio R, Allaouchiche B, Bastide S, Biais M, Blet A, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Eley V, Forget P, Fujii T, Godier A, Gopalan D, Guinot PG, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Landau R, Le Guen M, Legrand M, Lorne E, Mercier F, Mongardon N, Myatra SN, Nicolas-Robin A, Peters MJ, Quintard H, Rello J, G Richebe P, Roberts JA, Sanfilippo F, Schneider A, T Sofonea M, Treggiari M, Veyckemans F, Von Ungern-Sternberg BR, Zeidan A, Zieleskiewicz L, Zielinska M, Milman A, Roquilly A. Comments on: Reducing the Risks of Nuclear War-The Role of Health Professionals. Anaesth Crit Care Pain Med 2023; 43:101314. [PMID: 37863196 DOI: 10.1016/j.accpm.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Dan Benhamou
- Paris Sud University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Avenue, San Francisco, USA
| | | | | | - Matthieu Biais
- Société Heva, Lyon, France; University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Lyon University Hospital, Department of Anaesthesiology and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Pediatric Intensive Care Unit, Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anesthesiology and Perioperative Medicine, Jacksonville, Florida, United States of America
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, Montpellier, France
| | - Nicola Clausen
- Department of Anesthesiology and Intensive Care, University Hospital Odense, Denmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Pediatric Anesthesia Department, Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon, Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Victoria Eley
- Royal Brisbane and Women's Hospital, Department of Anaesthesia and Perioperative Medicine, Herston, Australia
| | - Patrice Forget
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, United Kingdom
| | | | - Anne Godier
- The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Dean Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | | | - Ahmed Hasanin
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olivier Joannes-Boyau
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Sébastien Kerever
- Paris University, Lariboisière University Hospital, Departments of Anaesthesiology and Critical Care, Paris, France
| | - Éric Kipnis
- Lille University School of Medicine, Loos, France
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States of America
| | - Morgan Le Guen
- Hospital Foch, Department of Anaesthesiology, Suresnes, France
| | - Matthieu Legrand
- University of California, Zuckerberg San Francisco General Hospital and Trauma Center, Department of Anaesthesia and Perioperative Medicine, San Francisco, California, United States of America
| | - Emmanuel Lorne
- Clinique du Millénaire, Department of Anesthesiology and Intensive Care (Akomé), Montpellier, France
| | - Frédéric Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | | | - Sheila Nainan Myatra
- Homi Bhabha National Institute - Tata Memorial Hospital, Department of Anaesthesiology, Critical Care and Pain, Mumbai, India
| | - Armelle Nicolas-Robin
- Pediatric Palliative Care Mobile Team, University Hospital Robert-Debré, Assistance Publique - Hôpitaux de Paris, Paris University, Paris, France
| | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- Geneva University Hospitals Intensive Care Service, Genève, Switzerland
| | - Jordi Rello
- International University of Cataluna, Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe G Richebe
- University of Montreal, Department of Anesthesiology and Pain Medicine, Montréal, Quebec, Canada
| | | | - Filippo Sanfilippo
- Policlinico, Department of Anaesthesia and Intensive Care, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | - Mircea T Sofonea
- Infectious Diseases and Vectors Ecology Genetics Evolution and Control, Montpellier, France
| | - Miriam Treggiari
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut, United States of America
| | - Francis Veyckemans
- Lille University Hospital, Department of Paediatric Resuscitation, Lille, France
| | | | - Ahed Zeidan
- King Fahad Specialist Hospital-Dammam, Department of Anesthesiology, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandre Milman
- Editorial Office Anaesthesia Critical Care and Pain Medicine, Société Française d'Anesthésie et Réanimation, Paris, France
| | - Antoine Roquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
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Mansour A, Beurton A, Godier A, Rozec B, Zlotnik D, Nedelec F, Gaussem P, Fiore M, Boissier E, Nesseler N, Ouattara A. Combined Platelet and Red Blood Cell Recovery during On-pump Cardiac Surgery Using same™ by i-SEP Autotransfusion Device: A First-in-human Noncomparative Study (i-TRANSEP Study). Anesthesiology 2023; 139:287-297. [PMID: 37294939 DOI: 10.1097/aln.0000000000004642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Centrifugation-based autotransfusion devices only salvage red blood cells while platelets are removed. The same™ device (Smart Autotransfusion for ME; i-SEP, France) is an innovative filtration-based autotransfusion device able to salvage both red blood cells and platelets. The authors tested the hypothesis that this new device could allow a red blood cell recovery exceeding 80% with a posttreatment hematocrit exceeding 40%, and would remove more than 90% of heparin and 75% of free hemoglobin. METHODS Adults undergoing on-pump elective cardiac surgery were included in a noncomparative multicenter trial. The device was used intraoperatively to treat shed and residual cardiopulmonary bypass blood. The primary outcome was a composite of cell recovery performance, assessed in the device by red blood cell recovery and posttreatment hematocrit, and of biologic safety assessed in the device by the washout of heparin and free hemoglobin expressed as removal ratios. Secondary outcomes included platelet recovery and function and adverse events (clinical and device-related adverse events) up to 30 days after surgery. RESULTS The study included 50 patients, of whom 18 (35%) underwent isolated coronary artery bypass graft, 26 (52%) valve surgery, and 6 (12%) aortic root surgery. The median red blood cell recovery per cycle was 86.1% (25th percentile to 75th percentile interquartile range, 80.8 to 91.6) with posttreatment hematocrit of 41.8% (39.7 to 44.2). Removal ratios for heparin and free hemoglobin were 98.9% (98.2 to 99.7) and 94.6% (92.7 to 96.6), respectively. No adverse device effect was reported. Median platelet recovery was 52.4% (44.2 to 60.1), with a posttreatment concentration of 116 (93 to 146) · 109/l. Platelet activation state and function, evaluated by flow cytometry, were found to be unaltered by the device. CONCLUSIONS In this first-in-human study, the same™ device was able to simultaneously recover and wash both platelets and red blood cells. Compared with preclinical evaluations, the device achieved a higher platelet recovery of 52% with minimal platelet activation while maintaining platelet ability to be activated in vitro. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation, Research Institute for Environmental and Occupational Health, Mixed Research Unit S1085, University Hospital Federation Survival Optimization in Organ Transplantation, Univ Rennes, Rennes, France
| | - Antoine Beurton
- CHU Bordeaux, Department of Cardiovascular Anaesthesia and Critical Care, Haut-Lévêque hospital, University Bordeaux, National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Anne Godier
- Université Paris Cité, Department of Anesthesiology and Critical Care, European Hospital Georges Pompidou, Public Hospitals of Paris, National Institute of Health and Medical Research, Mixed Research Unit S1140, Innovative Therapies in Haemostasis, Paris, France
| | - Bertrand Rozec
- Department of Anesthesia and Critical Care, University Hospital of Nantes, France, CHU Nantes
| | - Diane Zlotnik
- Paris Cité University, Department of Anaesthesiology and Critical Care, Hospital Georges Pompidou, Public Hospitals of Paris, Paris, France
| | - Fabienne Nedelec
- Department of Hematology, Pontchaillou, University Hospital of Rennes, France; Univ Rennes, Rennes, France
| | - Pascale Gaussem
- Paris Cité University, Innovative Therapies in Haemostasis, Department of Hematology, National Institute of Health and Medical Research, Mixed Research Unit S1140, European Hospital Georges Pompidou, Public Hospitals of Paris, Paris, France
| | - Mathieu Fiore
- Hematology Laboratory, Reference Centre for Platelet Disorders, Haut-Lévêque Hospital, University Hospital of Bordeaux, Pessac, France; National Institute of Health and Medical Research U1034, Biology of Cardiovascular Diseases, Bordeaux University, Pessac, France
| | - Elodie Boissier
- Department of Hematology, University Hospital of Nantes, France, CHU Nantes
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation, Nutrition, Metabolism, Cancer, Mixed Research Unit S1241, University Hospital Federation Survival Optimization in Organ Transplantation), Univ Rennes, Rennes, France
| | - Alexandre Ouattara
- University Hospital of Bordeaux, CHU Bordeaux, Department of Cardiovascular Anaesthesia and Critical Care, Haut-Lévêque Hospital, National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France
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6
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Gil-Jardiné C, Payen JF, Bernard R, Bobbia X, Bouzat P, Catoire P, Chauvin A, Claessens YE, Douay B, Dubucs X, Galanaud D, Gauss T, Gauvrit JY, Geeraerts T, Glize B, Goddet S, Godier A, Le Borgne P, Rousseau G, Sapin V, Velly L, Viglino D, Vigue B, Cuvillon P, Frasca D, Claret PG. Management of patients suffering from mild traumatic brain injury 2023. Anaesth Crit Care Pain Med 2023; 42:101260. [PMID: 37285919 DOI: 10.1016/j.accpm.2023.101260] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a multidisciplinary French reference that addresses initial pre- and in-hospital management of a mild traumatic brain injury patient. DESIGN A panel of 22 experts was formed on request from the French Society of Emergency Medicine (SFMU) and the French Society of Anaesthesiology and Critical Care Medicine (SFAR). A policy of declaration and monitoring of links of interest was applied and respected throughout the process of producing the guidelines. Similarly, no funding was received from any company marketing a health product (drug or medical device). The expert panel had to respect and follow the Grade® (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the quality of the evidence on which the recommendations were based. Given the impossibility of obtaining a high level of evidence for most of the recommendations, it was decided to adopt a "Recommendations for Professional Practice" (RPP) format, rather than a Formalized Expert Recommendation (FER) format, and to formulate the recommendations using the terminology of the SFMU and SFAR Guidelines. METHODS Three fields were defined: 1) pre-hospital assessment, 2) emergency room management, and 3) emergency room discharge modalities. The group assessed 11 questions related to mild traumatic brain injury. Each question was formulated using a PICO (Patients Intervention Comparison Outcome) format. RESULTS The experts' synthesis work and the application of the GRADE® method resulted in the formulation of 14 recommendations. After two rounds of rating, strong agreement was obtained for all recommendations. For one question, no recommendation could be made. CONCLUSION There was strong agreement among the experts on important, transdisciplinary recommendations, the purpose of which is to improve management practices for patients with mild head injury.
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Affiliation(s)
- Cédric Gil-Jardiné
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service des Urgences-Adultes, Population Health, INSERM U1219, équipe aHeAD, Université de Bordeaux, Bordeaux, France.
| | - Jean-François Payen
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Rémy Bernard
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Bouzat
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Pierre Catoire
- Emergency Consultant, Academic Clinical Fellow (Pitié-Salpétrière University, General Emergency Department, Paris) - Tactical Ultrasound Course for Ukraine (TUSC-UA) Course Director - Mehad, France
| | - Anthony Chauvin
- Service d'Accueil des Urgences/SMUR, CHU Lariboisière, Université de Paris - Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse Grace, Avenue Pasteur, MC-98002, Monaco
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Xavier Dubucs
- Emergency Departement, Centre Hospitalo-Universitaire de Toulouse, Place du Docteur Baylac, 31300 Toulouse, France
| | - Damien Galanaud
- Service de Neuroradiologie, GH Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, University Grenoble Alpes, F-38000 Grenoble, France
| | - Jean-Yves Gauvrit
- Service de Neuroradiologie, Hôpital Pontchaillou, CHU Rennes, Rennes, France
| | - Thomas Geeraerts
- Pole Anesthesie Réanimation et INSERM Tonic, CHU de Toulouse et Universite Toulouse 3, Toulouse, France
| | - Bertrand Glize
- PMR Department, CHU de Bordeaux, ACTIVE Team, BPH INSERM U1219, University of Bordeaux, France
| | - Sybille Goddet
- Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France
| | - Anne Godier
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'anesthésie Réanimation and Inserm UMRS_1140, Paris, France
| | - Pierrick Le Borgne
- Emergency Department, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France - INSERM UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg Cedex, France
| | | | - Vincent Sapin
- Service de Biochimie et de Génétique Moléculaire, Centre de Biologie, CHU de Clermont-Ferrand, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Damien Viglino
- University Grenoble-Alpes, Emergency Department, CHU Grenoble-Alpes, Grenoble, France - HP2 Laboratory INSERM U1300, Grenoble, France
| | - Bernard Vigue
- Département d'Anesthésie Réanimation, Hôpital Universitaire de Bicêtre, Le Kremlin Bicêtre, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, Anaesthesiology Department, CHU Nîmes, University Montpellier, 30000 Nîmes, France
| | - Denis Frasca
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France, Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France, INSERM U1246, Methods in Patients-Centered Outcomes and Health Research - SPHERE, Nantes, France
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7
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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8
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James A, Harrois A, Abback PS, Moyer JD, Jeantrelle C, Hanouz JL, Boutonnet M, Geeraerts T, Godier A, Pottecher J, Garrigue-Huet D, Cotte J, Pasqueron J, Foucrier A, Gauss T, Raux M. Comparison of Injuries Associated With Electric Scooters, Motorbikes, and Bicycles in France, 2019-2022. JAMA Netw Open 2023; 6:e2320960. [PMID: 37389873 DOI: 10.1001/jamanetworkopen.2023.20960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Importance Electric scooter (e-scooter) use is increasing in France and in many urban environments worldwide. Yet little is known about injuries associated with use of e-scooters. Objective To describe characteristics and outcomes of major trauma involving e-scooters. Design, Setting, and Participants A multicenter cohort study was conducted in France using the national major trauma registry between January 1, 2019, and December 20, 2022. All patients admitted to a participating major trauma center following a road traffic crash (RTC) involving an e-scooter, a bicycle, or a motorbike were included. Exposure Included patients were compared according to the 3 mechanisms. Main Outcomes and Measures The primary outcome was trauma severity as defined by the Injury Severity Score (ISS). Secondary outcomes included the trends of the number of patients per year, a comparison of the RTC epidemiologic factors, injury severity, resources used, and in-hospital outcomes. Results A total of 5233 patients involved in RTCs were admitted (median age, 33 [IQR, 24-48] years; 4629 [88.5%] men; median ISS, 13 [IQR, 8-22]). The population included 229 e-scooter RTCs (4.4%), 4094 motorbike RTCs (78.2%), and 910 bicycle RTCs (17.4%). The number of patients treated following e-scooter RTCs increased by 2.8-fold in 4 years (from 31 in 2019 to 88 in 2022), while bicycle RTCs increased by 1.2-fold and motorbike RTCs decreased by 0.9-fold. At admission, 36.7% of e-scooter users had a blood alcohol content higher than the legal threshold (n = 84) and 22.5% wore a protective helmet (n = 32). Among e-scooter RTCs, 102 patients (45.5%) had an ISS of 16 or higher. This proportion was similar for patients with motorbike RTCs (1557 [39.7%]; P = .10) and bicycle RTCs (411 [47.3%]; P = .69). With a proportion of 25.9% (n = 50), patients with e-scooter RTCs had twice as many severe traumatic brain injuries (Glasgow Coma Scale ≤8) as motorbike RTCs (445 [11.8%]) and a proportion comparable to bicycle RTCs (174 [22.1%]). The mortality of e-scooter RTCs was 9.2% (n = 20), compared with 5.2% (n = 196) (P = .02) for motorbikes and 10.0% (n = 84) (P = .82) for bicycles. Conclusions and Relevance The findings of this study suggest that trauma involving e-scooters in France has significantly increased over the past 4 years. These patients presented with injury profiles as severe as those of individuals who experienced bicycle or motorbike RTCs, with a higher proportion of severe traumatic brain injury.
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Affiliation(s)
- Arthur James
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Anatole Harrois
- Department of Anesthesiology and Critical Care, Bicêtre Hospital, AP-HP, University Paris Saclay, Le Kremlin Bicêtre, France
| | - Paer-Selim Abback
- Department of Anesthesiology and Critical Care Medicine, CHU Tours, Tours University Hospital, Tours, France
| | - Jean Denis Moyer
- Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
| | - Caroline Jeantrelle
- Department of Anaesthesiology and Critical Care Medicine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Hospital Beaujon, Clichy, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
- Caen Normandy University, Unicaen, Caen, France
| | - Mathieu Boutonnet
- Intensive Care Unit, Military Teaching Hospital Percy, Clamart, France
- Military Medical Academy, Val-de-Grâce, Paris, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, University Toulouse 3 - Paul Sabatier, Toulouse, France
| | - Anne Godier
- Department of Anesthesia and Critical Care, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Julien Pottecher
- Hôpital de Hautepierre, Service d'Anesthésie, Réanimation & Médecine Péri-Opératoire - Université de Strasbourg, Faculté de Médecine, FMTS, EA3072, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jean Cotte
- Intensive Care Unit, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Jean Pasqueron
- Department of Anesthesiology and Critical Care, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care Medicine, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, Hospital Beaujon, Clichy, France
- Île-de-France Regional Health Agency, Paris, France
| | - Tobias Gauss
- Anaesthesia Critical Care, Grenoble Alpes University Hospital, 38700 Grenoble, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France
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9
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Martin AC, Weizman O, Sellal JM, Algalarrondo V, Amara W, Bouzeman A, Gandjbakhch E, Lellouche N, Louembe J, Menet A, Roumegou P, Treguer F, Godier A, Boveda S, Garcia R, Marijon E. Impact of peri-procedural management of direct oral anticoagulants on pocket haematoma after cardiac electronic device implantation: the StimAOD multicentre prospective study. Europace 2023; 25:euad057. [PMID: 36932714 PMCID: PMC10227661 DOI: 10.1093/europace/euad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/17/2023] [Indexed: 03/19/2023] Open
Abstract
AIMS The study aims to investigate the impact of direct oral anticoagulant (DOAC) management on the incidence of pocket haematoma in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation. METHODS AND RESULTS All consecutive patients receiving DOAC and undergoing cardiac electronic device implantation were included in a large multicentre prospective observational study (NCT03879473). The primary endpoint was clinically relevant haematoma within 30 days after implantation. Overall, 789 patients were enrolled [median age 80 (IQR 72-85) years old, 36.4% women, median CHA2DS2-VASc score 4 (IQR 0-8)], of which 632 (80.1%) received a pacemaker implantation. Antiplatelet therapy was combined with DOAC in 146 patients (18.5%). Direct oral anticoagulants (DOACs) were interrupted 52 (IQR 37-62) h before the procedure and resumed 31 (IQR 21-47) h later. Ninety-six percent of the patients had at least 12 h DOAC interruption before the procedure, and 78% had at least 12 h DOAC interruption after the procedure. Overall, anticoagulation was interrupted for 72 (IQR 48-96) h. Pre- or post-procedural heparin bridging was used in 8.2% and 3.9%, respectively. Timing of DOAC interruption of resumption was not associated with clinically relevant haematoma. Clinically relevant haematoma occurred in 26 patients (3.3%), and thromboembolic events occurred in 5 patients (0.6%). CONCLUSION In this large real-life registry where most patients had DOAC interruption, clinically relevant haematoma was rare. Despite DOAC interruption and high CHA2DS2-VASc score, thromboembolic events occurred seldomly, highlighting that bleeding exceeds thromboembolic risk in this peri-procedural period. Future research is needed to identify risk factors for clinically relevant haematoma and meaningfully guide clinicians in optimizing DOAC management.
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Affiliation(s)
- Anne-Céline Martin
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, 4 Rue de l'Observatoire 75006 Paris, France
| | - Orianne Weizman
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
| | - Jean-Marc Sellal
- Department of Cardiology, Nancy University Hospital, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Vincent Algalarrondo
- Department of Cardiology, Rhythm Disorders Unit, Bichat Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France
- Paris Cité University, Paris, France
| | - Walid Amara
- Department of Cardiology, GHI Le Raincy Montfermeil, 10 Rue du Général Leclerc, 93370 Montfermeil, France
| | - Abdeslam Bouzeman
- Department of Cardiology, Parly 2 Private Hospital, 21 Rue Moxouris, 78150 Le Chesnay-Rocquencourt, France
| | - Estelle Gandjbakhch
- Department of Cardiology, Pitié-Salpêtrière University Hospital, Institute of Cardiology, 47-83 Bd de l'Hôpital, 75013 Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, 1166 Paris, France
| | - Nicolas Lellouche
- Department of Cardiology, Hôpital Henri MONDOR, AP-HP, 1 Rue Gustave Eiffel, 94000 Créteil, France
| | - Jules Louembe
- Department of Cardiology, Hôpital d’Instruction des Armées Percy, 2 Rue Lieutenant Raoul Batany, 92140 Clamart, France
| | - Aymeric Menet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie USIC, Université Catholique de Lille, Rue du Grand But, 59400 Lille, France
| | - Pierre Roumegou
- Department of Cardiology, University Hospital Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Frederic Treguer
- Department of Cardiology, Clinique Saint Joseph, 51 Rue de la Foucaudière, 49800 Trélazé, France
| | - Anne Godier
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, 4 Rue de l'Observatoire 75006 Paris, France
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Serge Boveda
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
- Cardiology—Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
- Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- CIC1402, University Hospital of Poitiers, 86021 Poitiers, France
| | - Eloi Marijon
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
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10
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Lepercq D, Gauss T, Godier A, Bellet J, Bouhours G, Bouzat P, Cailliau E, Cook F, David JS, Drame F, Gauthier M, Lamblin A, Pottecher J, Tavernier B, Garrigue-Huet D. Association of Organizational Pathways With the Delay of Emergency Surgery. JAMA Netw Open 2023; 6:e238145. [PMID: 37052916 PMCID: PMC10102875 DOI: 10.1001/jamanetworkopen.2023.8145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/24/2023] [Indexed: 04/14/2023] Open
Abstract
Importance Delayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date. Objective To examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France. Design, Setting, and Participants This prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded. Exposures Emergency surgery. Main Outcomes and Measures The main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1. Results A total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P < .001). The adjusted odds ratio for delay was 1.80 (95% CI, 1.17-2.78) when comparing NOR with DET. Conclusions and Relevance In this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.
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Affiliation(s)
| | - Tobias Gauss
- Division of Anesthesia–Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université de Paris, Inserm, Innovations Thérapeutiques en Hémostase, Paris, France
| | - Julie Bellet
- Pôle d’anesthésie-réanimation, CHU de Lille, Lille, France
| | - Guillaume Bouhours
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Pierre Bouzat
- University of Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | | | - Fabrice Cook
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
| | - Jean-Stéphane David
- Service d’Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - Fatou Drame
- AP-HP, Beaujon University Hospital, DMU PARBOL, Department of Anaesthesiology and Critical Care, Clichy, France
| | - Marvin Gauthier
- Division of Anesthesia–Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Antoine Lamblin
- Anesthesiology and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Espace Ethique Méditerranéen, Efaculté de Médecine de Marseille, Timone University Hospital, Marseille, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Department of Anaesthesiology, Critical Care and Perioperative Medicine, Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg, ER 3072, Strasbourg, France
| | - Benoit Tavernier
- Pôle d’anesthésie-réanimation, CHU de Lille, Lille, France
- Université Lille, CHU Lille, ULR 2694–METRICS, Lille, France
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11
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Roquet F, Godier A, Garrigue-Huet D, Hanouz JL, Vardon-Bounes F, Legros V, Pirracchio R, Ausset S, Duranteau J, Vigué B, Hamada SR. Comprehensive analysis of coagulation factor delivery strategies in a cohort of trauma patients. Anaesth Crit Care Pain Med 2023; 42:101180. [PMID: 36460214 DOI: 10.1016/j.accpm.2022.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/18/2022] [Accepted: 11/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The 5th edition of The European recommendations for the management of major bleeding and coagulopathy following trauma leaves room for various coagulation factor administration strategies. The present study examines these strategies reporting prevalence and timing of administration, quantity dispensed, and transfusion ratios in French trauma centers and their compliance with recommendations alongside associated mortality data. METHODS All adult patients, admitted directly to participating centers between 2011 and 2019, were extracted from a trauma registry. Two subpopulations were studied: severe hemorrhage (SH) and massive transfusion (MT) groups. RESULTS A total of 19,396 patients were included, among whom 8.4% (1630) experienced SH and 3% (579) received MT. Within the first 24 hours, 10% received fresh frozen plasma (FFP), rising to 93% and 99% in the subgroups of patients experiencing SH and MT respectively. Only, 8% received fibrinogen concentrate (FC), increasing to 75% and 92% in subgroups SH and MT respectively. Co-administration of FFP and FC became the dominant strategy with 68% of patients at 6 h and 72% at 24 h in SH subgroup. In unadjusted data, mortality was systematically lower in groups that complied with recommendations, a lower mortality than expected was mostly observed in contrast to non-compliant subgroups. The per-patient compliance to studied recommendations was 21% and 22% in SH and MT subgroups. CONCLUSION The main hemostatic strategy for major bleeding combined the administration of both FFP and FC, favoring an early additional supply of fibrinogen. Compliance with the recommendations was low in SH and MT subgroups.
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Affiliation(s)
- Florian Roquet
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; INSERM UMR 1153, Université de Paris, Paris, France.
| | - Anne Godier
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; INSERM UMRS-1140, Université de Paris, Paris, France
| | | | - Jean-Luc Hanouz
- CHU de Caen, Département d'Anesthésie Réanimation, Caen, France
| | | | - Vincent Legros
- CHU de Reims, Département d'Anesthésie Réanimation, Reims, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Jacques Duranteau
- Département d'Anesthésie Réanimation, CHU de Bicêtre, Le Kremlin Bicêtre, France
| | - Bernard Vigué
- Centre d'Étude et de Santé des Populations INSERM U 10-18, Université Paris-Saclay, Paris, France
| | - Sophie Rym Hamada
- Département d'Anesthésie Réanimation, Assistance Publique-Hôpitaux de Paris, HEGP, Université de Paris, Paris, France; Centre d'Étude et de Santé des Populations INSERM U 10-18, Université Paris-Saclay, Paris, France
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12
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Godier A, Boucebci KJ, Delhaye N, Gendron N, Achouh P, Hamada SR. Cangrelor for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia: it is not so easy. Blood Coagul Fibrinolysis 2023; 34:224-227. [PMID: 36719810 DOI: 10.1097/mbc.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anticoagulation management for cardiopulmonary bypass (CPB) is challenging in patients with acute heparin-induced thrombocytopenia (HIT). The strategy of combining cangrelor intraoperatively with heparin for CPB anticoagulation is of increasing interest but exposes to specific unresolved problems. We report the case of a patient requiring surgical pulmonary embolectomy for pulmonary embolism at the very acute phase of HIT, with a high titre of anti-PF4/heparin antibodies and severe thrombocytopenia. For CPB management, cangrelor was administered in combination with heparin prescribed and monitored as usual. Surgery was successfully performed, but postoperatively, the patient developed a new thrombotic event. We discussed the specific problems associated with such strategy, including the dose of cangrelor and its monitoring, the management of the cell-saver, the risk of heparin rebound and the risk of platelet transfusion. These issues must be addressed before considering the combination of cangrelor and unfractionated heparin as a standard of care for CBP.
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Affiliation(s)
- Anne Godier
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou
| | - Karim-John Boucebci
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou
| | - Nathalie Delhaye
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou
| | - Nicolas Gendron
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis
- Department of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital
| | - Paul Achouh
- INSERM U970, Université Paris Cité
- Department of Cardiovascular Surgery, APHP, Hôpital Européen Georges Pompidou
| | - Sophie Rym Hamada
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou
- CESP, INSERM U 10-18, Université Paris-Saclay, Paris, France
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13
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Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Godier A, Haas T, Jacob M, Lancé MD, Llau JV, Meier J, Molnar Z, Mora L, Rahe-Meyer N, Samama CM, Scarlatescu E, Schlimp C, Wikkelsø AJ, Zacharowski K. Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. Eur J Anaesthesiol 2023; 40:226-304. [PMID: 36855941 DOI: 10.1097/eja.0000000000001803] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.
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Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University Vienna, Austria (SK), Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust (AAh), Department of Cardiovascular Sciences, University of Leicester, UK (AAh), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AAf), Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (AAf), Department of Anaesthesiology & Critical Care, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University Hospital, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery, University of Perugia, Italy (EDR), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA (DFa), University of Medicine and Pharmacy Carol Davila, Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology & Critical Care, APHP, Université Paris Cité, Paris, France (AG), Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA (TH), Department of Anaesthesiology, Intensive Care and Pain Medicine, St.-Elisabeth-Hospital Straubing, Straubing, Germany (MJ), Department of Anaesthesiology, Medical College East Africa, The Aga Khan University, Nairobi, Kenya (MDL), Department of Anaesthesiology & Post-Surgical Intensive Care, University Hospital Doctor Peset, Valencia, Spain (JVL), Department of Anaesthesiology & Intensive Care, Johannes Kepler University, Linz, Austria (JM), Department of Anesthesiology & Intensive Care, Semmelweis University, Budapest, Hungary (ZM), Department of Anaesthesiology & Post-Surgical Intensive Care, University Trauma Hospital Vall d'Hebron, Barcelona, Spain (LM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP. Centre - Université Paris Cité - Cochin Hospital, Paris, France (CMS), Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (ES), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz and Ludwig Boltzmann-Institute for Traumatology, The Research Centre in Co-operation with AUVA, Vienna, Austria (CS), Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark (AW) and Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ)
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Zlotnik D, Abdallah GA, Lang E, Boucebci KJ, Gautier CH, François A, Gaussem P, Godier A. Assessment of a Quantra-Guided Hemostatic Algorithm in High-Bleeding-Risk Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:724-731. [PMID: 36822891 DOI: 10.1053/j.jvca.2023.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess whether a Quantra-guided hemostatic algorithm would reduce transfusion requirement and major bleeding compared with laboratory-guided testing in patients facing high-bleeding-risk cardiac surgery. DESIGN Single-center before-and-after study. SETTING University hospital. PARTICIPANTS Patients facing high-bleeding-risk cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Hemostatic algorithm was based on standard laboratory testing during the control period, then on the Quantra during the Quantra period. The primary endpoint was the number of red blood cell (RBC) units transfused on day 1 after surgery. MEASUREMENTS AND MAIN RESULTS After propensity-score matching, 66 patients were included in the Quantra group and 117 in the control group. The Quantra group received fewer RBC units on day 1 than the control group (2 [0-5] v 4 [2-6], p = 0.016, respectively). Intraoperatively, the Quantra group received fewer RBC (2 [0-3] v 3 [1-5], p = 0.005), less fresh frozen plasma (0 [0-3] v 3[2-5], p < 0.0001), and fewer platelet units (7.5 [0-10] v 8.2 [6.3-11.7], p = 0.014). The intraoperative rates of RBC, plasma, and platelet transfusion were reduced (64% v 78%, p = 0.05; 41% v 85%, p < 0.001; 55% v 82%, p = 0.001, respectively). The RBC and plasma transfusions were reduced on days 1, 2, and 7. The incidence of major bleeding on day 1 also was reduced (36% v 56%, p = 0.014). In multivariate analysis, implementation of the Quantra-guided hemostatic algorithm was associated independently with reductions in major bleeding. CONCLUSION Implementation of a Quantra-based hemostatic algorithm was associated with a decrease in transfusion requirement and major bleeding after high-bleeding-risk cardiac surgery. Randomized trials are needed to confirm these results.
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Affiliation(s)
- Diane Zlotnik
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France; Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Georges Abi Abdallah
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France; Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Elodie Lang
- Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Karim-John Boucebci
- Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Charles-Henri Gautier
- AP-HP, Fédération de Chirurgie Cardiovasculaire, Service de Chirurgie Cardiaque, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne François
- Établissement Français Du Sang (EFS), Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Pascale Gaussem
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France; AP-HP, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Godier
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France; Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
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15
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Duranteau J, Gauss T, Harrois A, Delhaye N, Cholley B, Godier A. In memoriam Sophie Rym Hamada. Intensive Care Med 2022; 48:1686-1687. [PMID: 36194260 PMCID: PMC9531636 DOI: 10.1007/s00134-022-06876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jacques Duranteau
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin-Bicetre, France.
| | - Tobias Gauss
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin-Bicetre, France.,Déchocage- Bloc des urgences, Pole Anesthésie- Réanimation, CHU Grenoble Alpes, CHU Grenoble Alpes, La Tronche, France
| | - Anatole Harrois
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin-Bicetre, France.,Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin-Bicetre, France.,Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Anne Godier
- Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France
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16
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Godier A, Delhaye N, Gauss T, Duranteau J, Cholley B. In memoriam : Sophie Rym Hamada (1978-2022). Anesthésie & Réanimation 2022. [DOI: 10.1016/j.anrea.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Lefrant JY, Pirracchio R, Benhamou D, Fischer MO, Njeim R, Allaouchiche B, Bastide S, Biais M, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Du B, Einav S, Eley V, Forget P, Fujii T, Godier A, Gopalan DP, Hamada S, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Kolodzie K, Landau R, Le Gall A, Le Guen M, Legrand M, Lorne E, Mercier FJ, Mongardon N, Myatra S, Nicolas-Robin A, John Peters M, Quintard H, Rello J, Richebé P, Roberts JA, Rocquilly A, Sanfilippo F, Schneider A, Sofonea MT, Veyckemans F, Zetlaoui P, Zeidan A, Zieleskiewicz L, Zielinska M, Von Ungern-Sternberg B, Abou Arab O, Blet A, Bounes F, Boisson M, Caillard A, Carillion A, Clavier T, Frasca D, James A, Sigaut S, Rozencwajg S, Albaladejo P, Bouaziz H. Peace, not war in Ukraine or anywhere else, please. Anaesth Crit Care Pain Med 2022; 41:101068. [PMID: 35460922 DOI: 10.1016/j.accpm.2022.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jean-Yves Lefrant
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Université de Montpellier-Nîmes, CHU de Nîmes, 30029 Nîmes, France; Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA; Deputy Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Dan Benhamou
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Marc-Olivier Fischer
- Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France; Caen University Hospital, Anaesthesiology and Critical Care Medicine Department, Caen, France
| | - Rosanna Njeim
- Editorial Assistant of ACCPM, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 74, rue Raynouard, 75016 Paris, France
| | | | | | - Matthieu Biais
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, 33300 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-33600 Pessac, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Groupement Hospitalier Est - Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Paediatric Intensive Care Unit, 33300 Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anaesthesiology and Perioperative Medicine, Jacksonville, United States
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, 34090 Montpellier, France
| | - Nicola Clausen
- Anæstesiologisk Intensiv Afdeling V, Odense, Odense Universitetshospital, J.B. Winsløws Vej 4, 5000 Odense C, Danmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, 30029 Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Paediatric Anaesthesia Department, 34090 Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia
| | - Patrice Forget
- University of Aberdeen, Institute of Applied Health Sciences, Department of Anaesthesia, Aberdeen, United Kingdom
| | - Tomoko Fujii
- Jikei University Hospital, Intensive Care Unit, Tokyo, Japan
| | - Anne Godier
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Dean P Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Sophie Hamada
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Ahmed Hasanin
- epartment of Anesthesia and Critical Care, Cairo University, Cairo, Egypt
| | | | - Sébastien Kerever
- Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, DMU PARABOL, AP-HP. Nord, Paris, France; Fédération Hospitalo-Universitaire PROMICE, INSERM UMR-S 942 MASCOT, Université de Paris, Paris, France
| | - Éric Kipnis
- Department of Anaesthesia and Intensive Care, Lille University Hospital, 1, rue Michel-Polonowski, 59037 Lille, France
| | - Kerstin Kolodzie
- Department of Anaesthesia and & Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States
| | - Arthur Le Gall
- Department of Anaesthesia, Critical Care and Peri-operative Medicine, Rennes University Hospital, Rennes, France
| | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Matthieu Legrand
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Clinique du Millénaire, 34960 Montpellier Cedex 2, France
| | - Frédéric J Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Faculté de Santé, F-94010 Créteil, France
| | - Sheila Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- University Hospital Centre Nice Anesthesia, Resuscitation Emergency Department, Nice, France
| | - Jordi Rello
- International University of Cataluna Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe Richebé
- niversity of Montreal Department of Anaesthesiology and Pain Medicine, Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, Montréal, Canada
| | | | - Antoine Rocquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico University Hospital, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | | | - Francis Veyckemans
- Department of Paediatric Anaesthesia, Jeanne de Flandre hospital, University Hospitals of Lille, 59037 Lille, France
| | - Paul Zetlaoui
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Ahed Zeidan
- King Fahad Specialist Hospital, Anesthesiology Department, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Wroclaw Medical University, Department of Paediatric Anaesthesiology and Intensive Care, Poland
| | - Britta Von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia; Team Perioperative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - Osama Abou Arab
- Anesthésie réanimation cardiovasculaire et thoracique, CHU Amiens, Laboratoire MP3CV, EA 7517, Université Picardie Jules Verne, 1 rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fanny Bounes
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France; Pôle Anesthesie Réanimation Médecine peri operatoire CHU Toulouse, 1av du Pr J Poulhes, 31000 Toulouse, France
| | - Matthieu Boisson
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1070, « Pharmacologie des anti-infectieux et résistances », Université de Poitiers, Poitiers, France
| | - Anaïs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical care and Perioperative medicine Department, Brest, France
| | - Aude Carillion
- Département d'Anesthésie-Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France; UMR-S 1166 ICAN, Unité de recherche sur les maladies cardiovasculaires et métaboliques, Sorbonne Université, France
| | - Thomas Clavier
- Département de Réanimation, Anesthésie et Médecine Périopératoire, Unité de Réanimation Chirurgicale Polyvalente, CHU de Rouen, 37 Bd Gambetta, 76000 Rouen, France; Laboratoire INSERM U1096, Université de Rouen-Normandie, France
| | - Denis Frasca
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1246, SPHERE, Université de Nantes, France
| | - Arthur James
- Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France
| | - Stéphanie Sigaut
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Paris, France
| | - Sacha Rozencwajg
- Department of Anaesthesiology and Surgical Intensive Care, Bichat Claude-Bernard Hospital, AP-HP, DMU PARABOL, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France; Current President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
| | - Hervé Bouaziz
- Department of Anaesthesiology and Obstetric Critical Care Unit, University Maternity Hospital of Nancy, 54000 Nancy, France; Past President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
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18
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Jourdi G, Marquis-Gravel G, Martin AC, Lordkipanidzé M, Godier A, Gaussem P. Antiplatelet Therapy in Atherothrombotic Diseases: Similarities and Differences Across Guidelines. Front Pharmacol 2022; 13:878416. [PMID: 35571090 PMCID: PMC9092185 DOI: 10.3389/fphar.2022.878416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Antiplatelet therapy, mainly consisting of aspirin and P2Y12 receptor antagonists, is the cornerstone of the pharmacological treatment and prevention of atherothrombotic diseases. Its use, especially in secondary cardiovascular prevention, has significantly improved patient clinical outcomes in the last decades. Primary safety endpoint (i.e., bleeding complications) remain a major drawback of antiplatelet drugs. National and international societies have published and regularly updated guidelines for antiplatelet therapy aiming to provide clinicians with practical recommendations for a better handling of these drugs in various clinical settings. Many recommendations find common ground between international guidelines, but certain strategies vary across the countries, particularly with regard to the choice of molecules, dosage, and treatment duration. In this review, we detail and discuss the main antiplatelet therapy indications in the light of the different published guidelines and the significant number of recently published clinical trials and meta-analyses and highlight the areas that deserve further investigation in order to improve antiplatelet therapy in patients with atherothrombotic diseases.
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Affiliation(s)
- Georges Jourdi
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Marquis-Gravel
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne-Céline Martin
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France.,Service de Cardiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Anne Godier
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France.,Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Pascale Gaussem
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France.,Service d'Hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
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Hamada SR, Garrigue D, Nougue H, Meyer A, Boutonnet M, Meaudre E, Culver A, Gaertner E, Audibert G, Vigué B, Duranteau J, Godier A, Abback PS, Audibert G, Gauss T, Geeraerts T, Harrois A, Langeron O, Leone M, Pottecher J, Stecken L, Hanouz JL. Impact of platelet transfusion on outcomes in trauma patients. Crit Care 2022; 26:49. [PMID: 35189930 PMCID: PMC8862339 DOI: 10.1186/s13054-022-03928-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome.
Methods
Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression.
Results
Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05).
Conclusions
PCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.
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Kietaibl S, Ferrandis R, Godier A, Llau J, Lobo C, Macfarlane AJ, Schlimp CJ, Vandermeulen E, Volk T, von Heymann C, Wolmarans M, Afshari A. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol 2022; 39:100-132. [PMID: 34980845 DOI: 10.1097/eja.0000000000001600] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. DESIGN A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. RESULTS Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. DISCUSSION Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. CONCLUSION In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.
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Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University, Vienna, Austria (SK), Department of Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, Valencia, Spain (RF), Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris (AG), INSERM UMRS-1140 Paris University, Paris, France (AG), Department of Anaesthesiology and Critical Care, Doctor Peset University Hospital (JL), Department of Surgery, Valencia University, Valencia, Spain (JL), Serviço de Anestesiologia Hospital das Forças Armadas, Pólo Porto, Porto, Portugal (CL), Department of Anaesthesia Pain Medicine and Critical Care, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK (AM), Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Linz, Linz (CJS); Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria (CJS), Department of Anaesthesia, University Hospitals Leuven. Catholic University of Leuven, Leuven, Belgium (EV), Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar (TV), Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany (CVH), Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK (MW), and Department of Pediatric and Obstetric Anesthesia, Juliane Marie Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA)
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21
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Jourdi G, Godier A, Lordkipanidzé M, Marquis-Gravel G, Gaussem P. Antiplatelet Therapy for Atherothrombotic Disease in 2022—From Population to Patient-Centered Approaches. Front Cardiovasc Med 2022; 9:805525. [PMID: 35155631 PMCID: PMC8832164 DOI: 10.3389/fcvm.2022.805525] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
Antiplatelet agents, with aspirin and P2Y12 receptor antagonists as major key molecules, are currently the cornerstone of pharmacological treatment of atherothrombotic events including a variety of cardio- and cerebro-vascular as well as peripheral artery diseases. Over the last decades, significant changes have been made to antiplatelet therapeutic and prophylactic strategies. The shift from a population-based approach to patient-centered precision medicine requires greater awareness of individual risks and benefits associated with the different antiplatelet strategies, so that the right patient gets the right therapy at the right time. In this review, we present the currently available antiplatelet agents, outline different management strategies, particularly in case of bleeding or in perioperative setting, and develop the concept of high on-treatment platelet reactivity and the steps toward person-centered precision medicine aiming to optimize patient care.
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Affiliation(s)
- Georges Jourdi
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- *Correspondence: Georges Jourdi
| | - Anne Godier
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Department of Anesthesiology and Critical Care, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Marquis-Gravel
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Pascale Gaussem
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Service d'Hématologie Biologique, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fritz C, Claude LA, Hamada S, Trosdorf M, de la Barre H, Yavchitz A, Clausse D, Lemogne C, Godier A, Flahault C. Daily Telephone Call During the COVID-19 Pandemic: Perceptions of Families and Providers. Am J Crit Care 2022; 31:77-81. [PMID: 34549261 DOI: 10.4037/ajcc2022797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In intensive care units (ICUs), the quality of communication with families is a key point in the caregiver-patient-family relationship. During the COVID-19 pandemic, hospital visits were prohibited, and many ICUs implemented a daily telephone call strategy to ensure continuity of communication with patients' families. OBJECTIVE To assess how family members and health care providers perceived this communication strategy. METHODS The study was conducted in a 45-bed ICU during the COVID-19 pandemic. Communication with families consisted of a single daily telephone call from the senior physician in charge of the patient to the patient's surrogate decision maker. Satisfaction was qualitatively assessed via an anonymous online questionnaire with open-ended questions. RESULTS Participants completed 114 questionnaires. Forty-six percent of surrogate decision makers stated that the key medical messages were understandable, but 57% of other family members expressed that the frequency of information delivery was insufficient. Fifty-six percent of the physicians described the practice as functional for the organization of the unit. Among health care providers other than physicians, 55% felt that not having to interact with families decreased their emotional load and 50% mentioned saving time and the absence of task interruptions as positive aspects. CONCLUSION Fixed-time, daily telephone calls in the ICU allowed satisfactory transmission of information between physicians and surrogate decision makers, as perceived by both parties. However, the telephone-based communication strategy could still be improved.
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Affiliation(s)
- Caroline Fritz
- Caroline Fritz is a physician, Assistance Publique–Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Paris, France and a researcher, Université de Lorraine, Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS-1116, Groupe Choc Équipe 2, Nancy, France
| | - Laurie-Anne Claude
- Laurie-Anne Claude is a physician, AP-HP, Centre-Université de Paris, Hôpital Européen Georges Pompidou, Service de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Âgé
| | - Sophie Hamada
- Sophie Hamada is a physician, AP-HP, Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou and a professor, Université Paris-Sud, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), INSERM, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, Paris, France
| | - Mathilde Trosdorf
- Mathilde Trosdorf is a doctoral student, Laboratoire de Psychopathologie et Processus de Santé EA4057, Institut de Psychologie, Université de Paris
| | - Hugues de la Barre
- Hugues de la Barre is a physician, AP-HP, Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou
| | - Amélie Yavchitz
- Amélie Yavchitz is a physician, AP-HP, Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou
| | - Darless Clausse
- Darless Clausse is a physician, AP-HP, Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou
| | - Cédric Lemogne
- Cédric Lemogne is a physician, AP-HP, Centre-Université de Paris, Hôpital Européen Georges Pompidou, Service de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Âgé, and a professsor, Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Anne Godier
- Anne Godier is a physician, AP-HP, Centre-Université de Paris, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou and a professor, Université de Paris, INSERM UMRS-1140, Paris, France
| | - Cécile Flahault
- Cécile Flahault is a researcher, AP-HP, Centre-Université de Paris, Hôpital Européen Georges Pompidou, Service de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Âgé and Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Siguret V, Boissier E, Maistre ED, Gouin-Thibault I, James C, Lasne D, Mouton C, Godon A, Nguyen P, Lecompte T, Ajzenberg N, Bauters A, Béjot Y, Crassard I, Dahmani B, Desconclois C, Flaujac C, Frère C, Godier A, Gruel Y, Hézard N, Jourdi G, Kuadjovi C, Laurichesse M, Mémier V, Mourey G, Reiner P, Tardy B, Toussaint-Hacquard M. GFHT Proposals On The Practical Use Of Argatroban - With Specifics Regarding Vaccine-Induced Immune Thrombotic Thrombocytopaenia (VITT). Anaesth Crit Care Pain Med 2021; 40:100963. [PMID: 34673303 DOI: 10.1016/j.accpm.2021.100963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
Argatroban is a direct anti-IIa (thrombin) anticoagulant, administered as a continuous intravenous infusion; it has been approved in many countries for the anticoagulant management of heparin-induced thrombocytopaenia (HIT). Argatroban was recently proposed as the non-heparin anticoagulant of choice for the management of patients diagnosed with Vaccine-induced Immune Thrombotic Thrombocytopaenia (VITT). Immunoglobulins are also promptly intravenously administered in order to rapidly improve platelet count; concomitant therapy with steroids is also often considered. An ad hoc committee of the French Working Group on Haemostasis and Thrombosis members has worked on updated and detailed proposals regarding the management of anticoagulation with argatroban, based on previously released guidance for HIT, and adapted for VITT. In case of VITT, the initial dose to be preferred is 1.0 µg x kg-1 x min-1, with further dose-adjustments based on iterative and frequent clinical and laboratory assessments. It is strongly advised to involve a health practitioner experienced in the management of difficult cases in haemostasis. The first laboratory assessment should be performed 4 hours after the initiation of argatroban infusion, with further controls at 2-4-hour intervals until steady state, and at least once daily thereafter. Importantly, full anticoagulation should be rapidly achieved in case of widespread thrombosis. Cerebral vein thrombosis (which is typical of VITT) should not call for an overly cautious anticoagulation scheme. Argatroban administration requires baseline laboratory assessment and should rely on an anti-IIa assay to derive argatroban plasma levels using a dedicated calibration, with a target range between 0.5 and 1.5 µg/mL. Target argatroban plasma levels can be refined based on meticulous appraisal of risk factors for bleeding and thrombosis, on frequent reassessments of clinical status with appropriate vascular imaging, and on the changes in daily platelet counts. Regarding the use of aPTT, baseline value and possible causes for alterations of the clotting time must be taken into account. Specifically, in case of VITT, an aPTT ratio (patient's / mean normal clotting time) between 1.5 and 2.5 is suggested, to be refined according to the sensitivity of the reagent to the effect of a direct thrombin inhibitor. The sole use of aPTT is discouraged: one has to resort to a periodical check with an anti-IIa assay at least, with the help of a specialised laboratory if necessary. Dose modifications should proceed in a stepwise manner with 0.1 to 0.2 µg x kg-1 x min-1 up- or downward changes, taking into account the initial dose, laboratory results, and the whole individual setting. Nomograms are available to adjust the infusion rate. Haemoglobin level, platelet count, fibrinogen plasma level and liver tests should be periodically checked, depending on the clinical status, the more so when unstable.
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Affiliation(s)
- Virginie Siguret
- Hématologie biologique - Hôpital Lariboisière (AP-HP), UMR_S1140, Université de Paris, Paris, France.
| | - Elodie Boissier
- Laboratoire d'hématologie, Hôpital Laënnec, CHU de Nantes, France
| | | | | | - Chloé James
- Laboratoire d'hématologie, CHU de Bordeaux, Pessac, France
| | - Dominique Lasne
- Hématologie biologique - Hôpital Necker-Enfants malades (AP-HP), Paris, UMR_S1176 Université Paris Saclay, Le Kremlin Bicêtre, France
| | | | | | | | - Thomas Lecompte
- Départements de médecine, Hôpitaux Universitaires de Genève, Unité d'hémostase, & Faculté de Médecine - GpG, Université de Genève, Genève, Suisse
| | | | - Anne Bauters
- Service d'hématologie et transfusion, Université de Lille, CHU de Lille, Lille, France
| | | | - Isabelle Crassard
- Neurologie, Hôpital Lariboisière (APHP), FHU NeuroVasculaire, Université de Paris, Paris, France
| | - Bouhadjar Dahmani
- Hémostase et Thrombose, Centre Hospitalier Princesse Grace de Monaco, Monaco
| | | | - Claire Flaujac
- Laboratoire de biologie médicale, secteur hémostase, CH de Versailles, Le Chesnay, France
| | - Corinne Frère
- Hématologie Biologique, Hôpital Pitié Salpêtrière (AP-HP); Sorbonne Université, UMRS 1166, Institut hospitalo-universitaire ICAN, Paris, France
| | - Anne Godier
- Département d'Anesthésie Réanimation, Hôpital Européen Georges Pompidou (AP-HP), Paris, France
| | - Yves Gruel
- Hématologie biologique, CHU Tours, Tours, France
| | | | - Georges Jourdi
- Centre de recherche, Institut de Cardiologie de Montréal, Faculté de Pharmacie, Université de Montréal, Canada
| | - Charlène Kuadjovi
- Laboratoire du GCS Nord-Ouest Val d'Oise, CH Pontoise, Pontoise, France
| | | | - Vincent Mémier
- Laboratoire d'Hématologie, CHU Toulouse, Toulouse, France
| | - Guillaume Mourey
- Laboratoire d'Hématologie et d'Immunologie, Établissement Français du Sang Bourgogne -Franche-Comté, Besançon, France
| | - Peggy Reiner
- Service d'hématologie et transfusion, Université de Lille, CHU de Lille, Lille, France
| | - Brigitte Tardy
- INSERM U1059, Université J Monnet, Saint Etienne, France
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Mansour A, Beurton A, Godier A, Rozec B, Degryse C, Cholley B, Nedelec-Gac F, Gaussem P, Fiore M, Boissier E, Nesseler N, Ouattara A. COMBINED PLATELET AND ERYTHROCYTE SALVAGE DURING ON-PUMP CARDIAC SURGERY USING SAME™ BY I-SEP AUTOTRANSFUSION DEVICE: INTERIM ANALYSIS OF THE I-TRANSEP STUDY. J Cardiothorac Vasc Anesth 2021. [DOI: 10.1053/j.jvca.2021.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Godon A, Tacquard CA, Mansour A, Albaladejo P, Gruel Y, Susen S, Godier A. Reply to the authors of "Age-adjusted D-dimer cut-off levels to exclude venous thromboembolism in COVID-19 patients". Anaesth Crit Care Pain Med 2021; 40:100940. [PMID: 34400387 PMCID: PMC8362657 DOI: 10.1016/j.accpm.2021.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexandre Godon
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
| | - Charles Ambroise Tacquard
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alexandre Mansour
- Department of Anaesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Hôpital Universitaire de Tours, France
| | - Sophie Susen
- Department of Haematology and transfusion, Université de Lille, Lille, France
| | - Anne Godier
- Department of Anaesthesia and intensive care, AP-HP, Hôpital Européen Georges Pompidou, and INSERM UMRS-1140, Université de Paris, France
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Tacquard C, Godon A, Mansour A, Gruel Y, Susen S, Godier A. Response. Chest 2021; 160:e250. [PMID: 34366060 PMCID: PMC8339421 DOI: 10.1016/j.chest.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Charles Tacquard
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Alexandre Godon
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Alexandre Mansour
- Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, Rennes, France
| | - Yves Gruel
- Department of Hematology-Hemostasis, Tours University Hospital, Tours, France
| | - Sophie Susen
- Heart and Lung Institute, Hemostasis Department, CHU Lille, Lille, France
| | - Anne Godier
- Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
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Godon A, Tacquard CA, Mansour A, Garrigue D, Nguyen P, Lasne D, Testa S, Levy JH, Albaladejo P, Gruel Y, Susen S, Godier A. Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021): From the French working group on perioperative haemostasis (GIHP) and the French study group on thrombosis and haemostasis (GFHT), in collaboration with the French society of anaesthesia and intensive care (SFAR). Anaesth Crit Care Pain Med 2021; 40:100919. [PMID: 34182166 PMCID: PMC8233055 DOI: 10.1016/j.accpm.2021.100919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Alexandre Godon
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
| | - Charles Ambroise Tacquard
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alexandre Mansour
- Department of Anaesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, France
| | | | | | - Dominique Lasne
- Department of Haematology Laboratory, Hôpital Necker, AP-HP, Paris, France
| | | | - Jerrold H Levy
- Department of Anaesthesiology, Critical Care, and Surgery, Duke University Hospital, Durham, NC, USA
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Hôpital Universitaire de Tours, France
| | - Sophie Susen
- Department of Haematology and Transfusion, Université de Lille, Lille, France
| | - Anne Godier
- Department of Anaesthesia and Intensive Care, AP-HP, Hôpital Européen Georges Pompidou, and INSERM UMRS-1140, Université de Paris, France
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Tacquard C, Godon A, Mansour A, Gruel Y, Susen S, Godier A. Response. Chest 2021; 160:e95-e96. [PMID: 34246407 PMCID: PMC8261102 DOI: 10.1016/j.chest.2021.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Charles Tacquard
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Alexandre Godon
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Alexandre Mansour
- Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, Rennes University Hospital, Rennes, France
| | - Yves Gruel
- Department of Hematology-Hemostasis, Tours University Hospital, Tours, France
| | - Sophie Susen
- Hemostasis Department, Heart and Lung Institute, Lille, France
| | - Anne Godier
- Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
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Karras A, Livrozet M, Lazareth H, Benichou N, Hulot JS, Fayol A, Chauvet S, Jannot AS, Penet MA, Diehl JL, Godier A, Sanchez O, Mirault T, Thervet E, Pallet N. Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study. Clin J Am Soc Nephrol 2021; 16:514-521. [PMID: 33661756 PMCID: PMC8092053 DOI: 10.2215/cjn.09130620] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney involvement is frequent among patients with coronavirus disease 2019 (COVID-19), and occurrence of AKI is associated with higher mortality in this population. The objective of this study was to describe occurrence and significance of proteinuria in this setting. DESIGN , SETTING, PARTICIPANTS MEASUREMENTS We conducted a single-center retrospective study to describe the characteristic features of proteinuria measured within 48 hours following admission among patients with COVID-19 admitted in a tertiary care hospital in France, and to evaluate its association with initiation of dialysis, intensive care unit admission, and death. RESULTS Among 200 patients with available data, urine protein-creatinine ratio at admission was ≥1 g/g for 84 (42%), although kidney function was normal in most patients, with a median serum creatinine of 0.94 mg/dl (interquartile range, 0.75-1.21). Median urine albumin-creatinine ratio was 110 mg/g (interquartile range, 50-410), with a urine albumin-protein ratio <50% in 92% of patients. Urine retinol binding protein concentrations, available for 85 patients, were ≥0.03 mg/mmol in 62% of patients. Urine protein-creatinine ratio ≥1 g/g was associated with initiation of dialysis (odds ratio, 4.87; 95% confidence interval, 2.03 to 13.0; P <0.001), admission to the intensive care unit (odds ratio, 3.55; 95% confidence interval, 1.93 to 6.71; P <0.001), and death (odds ratio, 3.56; 95% confidence interval, 1.90 to 6.54; P <0.001). CONCLUSIONS Proteinuria is very frequent among patients admitted for COVID-19 and may precede AKI. Low levels of albuminuria suggest a predominant tubular origin, confirmed by the elevated levels of urine retinol binding protein. Urine protein-creatinine ratio ≥1 g/g at admission is strongly associated with poor kidney and patient outcome.
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Affiliation(s)
- Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Marine Livrozet
- Université de Paris, Paris, France,Centre d'Investigation Clinique1418 and Departement Medico-Universitaire, CArdiologie Rein Transplantation nEurovasculaire, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Lazareth
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Nicolas Benichou
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris, Paris, France,Centre d'Investigation Clinique1418 and Departement Medico-Universitaire, CArdiologie Rein Transplantation nEurovasculaire, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Fayol
- Université de Paris, Paris, France,Centre d'Investigation Clinique1418 and Departement Medico-Universitaire, CArdiologie Rein Transplantation nEurovasculaire, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Chauvet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Anne-Sophie Jannot
- Université de Paris, Paris, France,Department of Bioinformatics, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Aude Penet
- Université de Paris, Paris, France,Department of Internal Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Diehl
- Université de Paris, Paris, France,Department of Intensive Care Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Godier
- Université de Paris, Paris, France,Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Sanchez
- Université de Paris, Paris, France,Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tristan Mirault
- Université de Paris, Paris, France,Department of Vascular Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Nicolas Pallet
- Université de Paris, Paris, France,Department of Clinical Chemistry, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Sanchez O, Benhamou Y, Bertoletti L, Constans J, Couturaud F, Delluc A, Elias A, Fischer AM, Frappé P, Gendron N, Girard P, Godier A, Gut-Gobert C, Laporte S, Mahé I, Mauge L, Meneveau N, Meyer G, Mismetti P, Parent F, Pernod G, Quéré I, Revel MP, Roy PM, Salaün PY, Smadja DM, Sevestre MA. [Recommendations for best practice in the management of venous thromboembolic disease in adults. Long version]. Rev Mal Respir 2021; 38 Suppl 1:e1-e6. [PMID: 31280989 DOI: 10.1016/j.rmr.2019.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O Sanchez
- Université de Paris, Service de pneumologie et soins intensifs, AH-HP, hôpital Européen Georges-Pompidou, 75015 Paris, France; F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France.
| | - Y Benhamou
- Service de médecine interne, Normandie université UNI Rouen U1096, CHU Charles-Nicolle, 76000 Rouen, France
| | - L Bertoletti
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm UMR1059, Inserm, CIC-1408, équipe dysfonction vasculaire et hémostase, service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, université Jean-Monnet, 42000 Saint-Étienne, France
| | - J Constans
- Service de médecine vasculaire, hôpital Saint-André, université de Bordeaux, 33000 Bordeaux, France
| | - 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 Delluc
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; EA 3878 GETBO, université de Bretagne occidentale, 29200 Brest, France
| | - A Elias
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine vasculaire, hôpital Sainte-Musse, 83100 Toulon, 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
| | - P Frappé
- Inserm UMR 1059 Sainbiose DVH, Inserm CIC-EC 1408, département de médecine générale, université de Saint-Étienne, 42000 Saint-Étienne, France
| | - N Gendron
- Inserm UMR 1148, laboratoire d'hématologie, hôpital Bichat-Claude-Bernard, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 75018 Paris, France
| | - P Girard
- Institut du Thorax-Curie-Montsouris, l'institut Mutualiste Montsouris, 75014 Paris, France
| | - A Godier
- Inserm UMR-S 1140, service d'anesthésie réanimation, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - C Gut-Gobert
- 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
| | - 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 Saint-Étienne, 42000 Saint-Étienne, France
| | - I Mahé
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de médecine interne, hôpital Louis-Mourier, université Paris 7, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm UMR S1140, 75006 Paris, France
| | - L Mauge
- UMR-S 970, Paris-Cardiovascular Research Center (PARCC), service d'hématologie biologique, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - N Meneveau
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de cardiologie, EA3920, université de Bourgogne-Franche Comté, CHU Jean-Minjoz, boulevard Fleming, 25030 Besançon cedex, France
| | - G Meyer
- 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; Inserm UMRS 970, 75015 Paris, France; Inserm CIC 1418, 75015 Paris, France
| | - P Mismetti
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm, SAINBOIS U1059 équipe DVH, unité de recherche clinique, innovation, pharmacologie, service de médecine vasculaire et thérapeutique, hôpital Nord, université Jean-Monnet, université de Lyon, CHU Saint-Étienne, 42000 Saint-Étienne, France
| | - F Parent
- Service de pneumologie, centre de référence de l'hypertension pulmonaire, hôpital Bicêtre, faculté de médecine, université Paris-Sud, université Paris-Saclay, AP-HP, 94270 Le Kremlin-Bicêtre, France; Inserm UMR-S 999, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France
| | - G Pernod
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service universitaire de médecine vasculaire, CNRS, TIMC-IMAG UMR-5525, Thèmas, CHU Grenoble, université Grenoble Alpes, 38700 La Tronche, France
| | - I Quéré
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine vasculaire, centre de référence des maladies vasculaires rares, EA2992, université de Montpellier, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - M-P Revel
- Service de radiologie A, hôpital Cochin, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - P-M Roy
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine d'urgence et service de médecine vasculaire, CHU d'Angers, 49000 Angers, France; Institut Mitovasc, UMR 1083, UFR santé, université d'Angers, 49000 Angers, France
| | - P-Y Salaün
- Inserm EA3878 (GETBO), service de médecine nucléaire, université de Bretagne occidentale, CHRU de Brest, 29200 Brest, France
| | - D M Smadja
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Unversité de Paris, Service d'hématologie, AH-HP, Hôpital Européen Georges-Pompidou, 75015 Paris, France; Laboratoire de recherche biochirurgicale, fondation Carpentier, Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France
| | - M-A Sevestre
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de médecine vasculaire, EA 7516 Chimère, CHU d'Amiens, 80080 Amiens, France
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Affiliation(s)
- Charles Tacquard
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091 Strasbourg Cedex, France.
| | - Alexandre Mansour
- Department of Anaesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, Rennes, France
| | - Alexandre Godon
- Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Yves Gruel
- Department of Haematology-Haemostasis, Tours University Hospital, France
| | - Sophie Susen
- Heart and Lung Institute, Haemostasis Department, CHU Lille, 59037 Lille Cedex, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
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Godier A, Clausse D, Meslin S, Bazine M, Lang E, Huche F, Cholley B, Hamada SR. Major bleeding complications in critically ill patients with COVID-19 pneumonia. J Thromb Thrombolysis 2021; 52:18-21. [PMID: 33646501 PMCID: PMC7919235 DOI: 10.1007/s11239-021-02403-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/22/2022]
Abstract
As patients with COVID-19 pneumonia admitted to intensive care unit (ICU) have high rates of thrombosis, high doses of thromboprophylaxis have been proposed. The associated bleeding risk remains unknown. We investigated major bleeding complications in ICU COVID-19 patients and we examined their relationship with inflammation and thromboprophylaxis. Retrospective monocentric study of consecutive adult patients admitted in ICU for COVID-19 pneumonia requiring mechanical ventilation. Data collected included demographics, anticoagulation status, coagulation tests and outcomes including major bleeding and thrombotic events. Among 56 ICU COVID-19 patients, 10 (18%) patients had major bleeding and 16 (29%) thrombotic events. Major bleeding occurred later than thrombosis after ICU admission [17(14–23) days versus 9(3–11) days respectively (p = 0.005)]. Fibrinogen concentration always decreased several days [4(3–5) days] before bleeding; D-dimers followed the same trend. All bleeding patients were treated with anticoagulants and anticoagulation was overdosed for 6 (60%) patients on the day of bleeding or the day before. In the whole cohort, overdose was measured in 22 and 78% of patients receiving therapeutic anticoagulation during fibrinogen increase and decrease respectively (p < 0.05). Coagulation disorders had biphasic evolution during COVID-19: first thrombotic events during initial hyperinflammation, then bleeding events once inflammation reduced, as confirmed by fibrinogen and d-dimers decrease. Most bleeding events complicated heparin overdose, promoted by inflammation decrease, suggesting to carefully monitor heparin during COVID-19. Thromboprophylaxis may be adapted to this biphasic evolution, with initial high doses reduced to standard doses once the high thrombotic risk period ends and fibrinogen decreases, to prevent bleeding events.
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Affiliation(s)
- Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.
- INSERM UMRS-1140, Université de Paris, Paris, France.
- Service D'Anesthésie-Réanimation, Hôpital Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - Darless Clausse
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Simon Meslin
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Myriame Bazine
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Elodie Lang
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Florian Huche
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
| | - Bernard Cholley
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
- INSERM UMRS-1140, Université de Paris, Paris, France
| | - Sophie Rym Hamada
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France
- CESP, Inserm, Maison de Solenn, Université Paris Sud, Université Paris-Saclay, Paris, France
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Tacquard C, Mansour A, Godon A, Godet J, Poissy J, Garrigue D, Kipnis E, Rym Hamada S, Mertes PM, Steib A, Ulliel-Roche M, Bouhemad B, Nguyen M, Reizine F, Gouin-Thibault I, Besse MC, Collercandy N, Mankikian S, Levy JH, Gruel Y, Albaladejo P, Susen S, Godier A. Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia. Chest 2021; 159:2417-2427. [PMID: 33465342 PMCID: PMC7832130 DOI: 10.1016/j.chest.2021.01.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/23/2020] [Accepted: 01/09/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Because of the high risk of thrombotic complications (TCs) during SARS-CoV-2 infection, several scientific societies have proposed to increase the dose of preventive anticoagulation, although arguments in favor of this strategy are inconsistent. RESEARCH QUESTION What is the incidence of TC in critically ill patients with COVID-19 and what is the relationship between the dose of anticoagulant therapy and the incidence of TC? STUDY DESIGN AND METHODS All consecutive patients referred to eight French ICUs for COVID-19 were included in this observational study. Clinical and laboratory data were collected from ICU admission to day 14, including anticoagulation status and thrombotic and hemorrhagic events. The effect of high-dose prophylactic anticoagulation (either at intermediate or equivalent to therapeutic dose), defined using a standardized protocol of classification, was assessed using a time-varying exposure model using inverse probability of treatment weight. RESULTS Of 538 patients included, 104 patients experienced a total of 122 TCs with an incidence of 22.7% (95% CI, 19.2%-26.3%). Pulmonary embolism accounted for 52% of the recorded TCs. High-dose prophylactic anticoagulation was associated with a significant reduced risk of TC (hazard ratio, 0.81; 95% CI, 0.66-0.99) without increasing the risk of bleeding (HR, 1.11; 95% CI, 0.70-1.75). INTERPRETATION High-dose prophylactic anticoagulation is associated with a reduction in thrombotic complications in critically ill patients with COVID-19 without an increased risk of hemorrhage. Randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04405869; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Charles Tacquard
- Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alexandre Mansour
- Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, CHU de Rennes, Rennes, France
| | - Alexandre Godon
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Godet
- Groupe Méthodes en Recherche Clinique, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Poissy
- University of Lille, Inserm U1285, CHU Lille, Pôle de Réanimation, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Delphine Garrigue
- Department of Anesthesiology and Critical Care, Surgical Critical Care, Centre Hospitalier Universitaire Lille, Lille, France
| | - Eric Kipnis
- University of Lille, CNRS, Inserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
| | - Sophie Rym Hamada
- Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Paul Michel Mertes
- Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Annick Steib
- Department of Anesthesiology and Intensive Care, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mathilde Ulliel-Roche
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Bélaïd Bouhemad
- Department of Anesthesiology and Intensive Care, Dijon University Hospital and University of Burgundy, Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Dijon, France
| | - Maxime Nguyen
- Department of Anesthesiology and Intensive Care, Dijon University Hospital and University of Burgundy, Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, Dijon, France
| | - Florian Reizine
- Service des Maladies Infectieuses et Réanimation Médicale, Rennes University Hospital, Rennes, France
| | | | | | - Nived Collercandy
- Service de Médecine Intensive-Réanimation, CHU de Tours, Tours, France
| | - Stefan Mankikian
- Service de Médecine Intensive-Réanimation, CHU de Tours, Tours, France
| | - Jerrold H Levy
- Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC
| | - Yves Gruel
- Department of Hematology-Hemostasis, Tours University Hospital, Tours, France
| | - Pierre Albaladejo
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
| | - Sophie Susen
- Hemostasis Department, Heart and Lung Institute, CHU Lille, Lille, France.
| | - Anne Godier
- Department of Anesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
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Martin AC, Godier A, Karam N. Pitfalls of Unfractionated Heparin Use During ST-Segment Elevation Myocardial Infarction in Patients With COVID-19 Infection. J Am Coll Cardiol 2021; 77:104. [PMID: 33413932 PMCID: PMC7781527 DOI: 10.1016/j.jacc.2020.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
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Godier A, Nouette-Gaulain K, Cittanova ML, Beloeil H, Paugam-Burtz C, Lukaszewicz AC. Women in Anaesthesia and Intensive Care Medicine in France: Are we making any progress? Anaesth Crit Care Pain Med 2020; 39:507-511. [DOI: 10.1016/j.accpm.2020.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 10/23/2022]
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38
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Susen S, Tacquard CA, Godon A, Mansour A, Garrigue D, Nguyen P, Godier A, Testa S, Levy JH, Albaladejo P, Gruel Y. Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring. Crit Care 2020; 24:364. [PMID: 32560658 PMCID: PMC7303590 DOI: 10.1186/s13054-020-03000-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is an infection induced by the SARS-CoV-2 coronavirus, and severe forms can lead to acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) management. Severe forms are associated with coagulation changes, mainly characterized by an increase in D-dimer and fibrinogen levels, with a higher risk of thrombosis, particularly pulmonary embolism. The impact of obesity in severe COVID-19 has also been highlighted.In this context, standard doses of low molecular weight heparin (LMWH) may be inadequate in ICU patients, with obesity, major inflammation, and hypercoagulability. We therefore urgently developed proposals on the prevention of thromboembolism and monitoring of hemostasis in hospitalized patients with COVID-19.Four levels of thromboembolic risk were defined according to the severity of COVID-19 reflected by oxygen requirement and treatment, the body mass index, and other risk factors. Monitoring of hemostasis (including fibrinogen and D-dimer levels) every 48 h is proposed. Standard doses of LMWH (e.g., enoxaparin 4000 IU/24 h SC) are proposed in case of intermediate thrombotic risk (BMI < 30 kg/m2, no other risk factors and no ARDS). In all obese patients (high thrombotic risk), adjusted prophylaxis with intermediate doses of LMWH (e.g., enoxaparin 4000 IU/12 h SC or 6000 IU/12 h SC if weight > 120 kg), or unfractionated heparin (UFH) if renal insufficiency (200 IU/kg/24 h, IV), is proposed. The thrombotic risk was defined as very high in obese patients with ARDS and added risk factors for thromboembolism, and also in case of extracorporeal membrane oxygenation (ECMO), unexplained catheter thrombosis, dialysis filter thrombosis, or marked inflammatory syndrome and/or hypercoagulability (e.g., fibrinogen > 8 g/l and/or D-dimers > 3 μg/ml). In ICU patients, it is sometimes difficult to confirm a diagnosis of thrombosis, and curative anticoagulant treatment may also be discussed on a probabilistic basis. In all these situations, therapeutic doses of LMWH, or UFH in case of renal insufficiency with monitoring of anti-Xa activity, are proposed.In conclusion, intensification of heparin treatment should be considered in the context of COVID-19 on the basis of clinical and biological criteria of severity, especially in severely ill ventilated patients, for whom the diagnosis of pulmonary embolism cannot be easily confirmed.
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Affiliation(s)
- Sophie Susen
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France.
- Department of Hemostasis and Transfusion, CHU Lille, Lille, France.
| | | | - Alexandre Godon
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, La Tronche, France
| | - Alexandre Mansour
- Department of Anesthesiology and Critical Care Medicine, Rennes University Hospital, Rennes, France
| | - Delphine Garrigue
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
| | - Philippe Nguyen
- Department of Hematology Laboratory, Reims University Hospital, Reims, France
| | - Anne Godier
- Department of Anesthesia and Intensive Care, HEGP-AP-HP, Paris, France
| | | | | | - Pierre Albaladejo
- Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, La Tronche, France
| | - Yves Gruel
- Department of Hematology-Hemostasis, Tours University Hospital, CHRU Tours, Tours, France.
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Elhorany M, Lenck S, Degos V, Sourour NA, Frasca Polara G, Shotar E, Godier A, Drir M, Mahtout J, Premat K, Alamowitch S, Samson Y, Clarençon F. Cangrelor and Stenting in Acute Ischemic Stroke : Monocentric Case Series. Clin Neuroradiol 2020; 31:439-448. [PMID: 32382875 DOI: 10.1007/s00062-020-00907-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/15/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Cangrelor is an intravenous P2Y12 receptor inhibitor with a rapid onset/offset of action and a short half-life (3-6 min). The objective was to present a preliminary experience regarding the safety and effectiveness using cangrelor, in combination with aspirin, in acute ischemic stroke patients requiring acute stenting. MATERIAL AND METHODS Retrospective analysis for patients who underwent stenting (intracranial and/or extracranial) in the setting of acute ischemic stroke with cangrelor and aspirin as antiplatelet therapy. RESULTS Cangrelor was used in 12 patients, 4 (33%) with extracranial stenting, 6 (50%) with intracranial stenting and 2 (17%) with combined extracranial and intracranial stenting. The mean age was 67 years (44-88) and 9 patients (75%) were female. The median National Institutes of Health Stroke Score at admission was 15 (IQR: 8-22). Of the patients, six (50%) received intravenous thrombolysis. All patients (100%) obtained modified thrombolysis in cerebral infarction score ≥2b. Good clinical outcome, defined as modified Rankin scale score ≤2 at 3‑months follow-up, was observed in 7 patients (58%). None of the patients experienced intraprocedural thromboembolic complications. Postprocedural stent thrombosis after cessation of cangrelor infusion due to emergency craniotomy surgery to manage malignant cerebral infarction occurred in one patient (8%). Of the patients, two (17%) experienced asymptomatic intracranial hemorrhage (ICH), one patient (8%) experienced symptomatic ICH and one (8%) retroperitoneal hematoma was observed, which was managed conservatively. CONCLUSION Cangrelor might be a safe and effective antiplatelet medication owing to its on/off activity for acute stenting in the setting of acute ischemic stroke. Further investigations through randomized studies with larger samples are necessary.
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Affiliation(s)
- Mahmoud Elhorany
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris VI University, Paris, France.,GRC Biofast, Paris VI University, Paris, France.,Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stephanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris VI University, Paris, France.,GRC Biofast, Paris VI University, Paris, France.,Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Giulia Frasca Polara
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Anne Godier
- Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, Paris Descartes University, Paris, France
| | - Mehdi Drir
- Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Jugurtha Mahtout
- Department of Neuro Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris VI University, Paris, France
| | - Sonia Alamowitch
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Saint-Antoine University Hospital, Paris, France
| | - Yves Samson
- Sorbonne University, Paris VI University, Paris, France.,Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris VI University, Paris, France. .,GRC Biofast, Paris VI University, Paris, France.
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Porta Bonete G, Godier A, Gaussem P, Belleville-Rolland T, Leuci A, Poirault-Chassac S, Bachelot-Loza C, Martin AC. Comparative In Vitro Study of Various α 2-Adrenoreceptor Agonist Drugs for Ticagrelor Reversal. J Clin Med 2020; 9:jcm9030809. [PMID: 32188130 PMCID: PMC7141185 DOI: 10.3390/jcm9030809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
Ticagrelor, an antiplatelet adenosine diphosphate (ADP)-P2Y12 receptor antagonist, increases the risk of bleeding. Its management is challenging because platelet transfusion is ineffective and no specific antidote is currently available. Epinephrine, a vasopressor catecholamine prescribed during shock, restores platelet functions inhibited by ticagrelor through stimulation of α2A-adrenoreceptors. It subsequently inhibits cyclic adenosine monophosphate (cAMP) pathway and PI3K signaling. However, since epinephrine may expose a patient to deleterious hemodynamic effects, we hypothesized that other α2-adrenoreceptor agonist drugs used in clinical practice with fewer side effects could reverse the antiplatelet effects of ticagrelor. We compared in vitro the efficacy of clonidine, dexmedetomidine, brimonidine, and norepinephrine with epinephrine to restore ADP- and PAR-1-AP-induced washed platelet aggregation inhibited by ticagrelor, as well as resulting platelet cAMP levels. In ticagrelor-free samples, none of the α2-adrenoreceptor agonists induced aggregation by itself but all of them potentiated ADP-induced aggregation. Compared with epinephrine, norepinephrine, and brimonidine partially restored ADP- and fully restored PAR-1-AP-induced aggregation inhibited by ticagrelor while clonidine and dexmedetomidine were ineffective. Indeed, this lack of effect resulted from a lower decrease in cAMP concentration elicited by these partial α2-adrenoreceptor agonists, clonidine, and dexmedetomidine, compared with full α2-agonists. Our results support the development of specific full and systemic α2-adrenoreceptor agonists for ticagrelor reversal.
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Affiliation(s)
- Guillaume Porta Bonete
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
| | - Anne Godier
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
- AP-HP, Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Pascale Gaussem
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
- AP-HP, Service d’Hématologie Biologique, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Tiphaine Belleville-Rolland
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
- AP-HP, Service d’Hématologie Biologique, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Alexandre Leuci
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
| | - Sonia Poirault-Chassac
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
| | - Christilla Bachelot-Loza
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
| | - Anne-Céline Martin
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 75006 Paris, France; (G.P.B.); (A.G.); (P.G.); (T.B.-R.); (A.L.); (S.P.-C.); (C.B.-L.)
- AP-HP, Service de Cardiologie, Hôpital Européen Georges Pompidou, 75015 Paris, France
- Correspondence: ; Tel.: +33-1-56-09-54-09
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Martin AC, Kyheng M, Foissaud V, Duhamel A, Marijon E, Susen S, Godier A. Activated Clotting Time Monitoring during Atrial Fibrillation Catheter Ablation: Does the Anticoagulant Matter? J Clin Med 2020; 9:jcm9020350. [PMID: 32012701 PMCID: PMC7074080 DOI: 10.3390/jcm9020350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
Atrial fibrillation (AF) catheter ablation is performed in patients receiving direct oral anticoagulants (DOACs) with intra-procedural unfractionated heparin (UFH) administration to achieve activated clotting time (ACT) at 300 s, as for vitamin K antagonist (VKA). We determined whether ACT monitoring might be transposed from VKA to DOAC-treated patients. Blood was taken from 124 patients receiving uninterrupted dabigatran, rivaroxaban, apixaban, or VKA or being untreated. DOAC concentration or INR (VKA) were measured. ACT was determined at baseline, and after spiking with UFH doses equivalent to 1000, 2500, 5000 and 10000 IU in vivo. At baseline, anticoagulants prolonged ACT differently, ACT was longer with dabigatran and shorter with apixaban despite similar concentrations. ACT strongly correlated with INR and dabigatran concentration, but not with apixaban or rivaroxaban concentrations. Moreover, UFH effects on ACT prolongation depended on the anticoagulant: dose-response curves in samples with VKA and dabigatran were parallel whereas ACT prolongation in response to UFH was significantly smaller with rivaroxaban and especially apixaban. Therefore, UFH to achieve ACT at 300 s might be transposed from VKA to uninterrupted dabigatran-treated patients but not to patients receiving FXa-inhibitors, especially apixaban. Targeting 300 s might expose to UFH overdosing and bleeding, questioning the current anticoagulation strategy.
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Affiliation(s)
- Anne-Céline Martin
- Hôpital Européen Georges Pompidou, Service de Cardiologie, 20 Rue Leblanc, F-75015 Paris, France
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 4 avenue de l’observatoire F-75006 Paris, France
- Correspondence: ; Tel.: +33-1-56-09-54-09
| | - Maeva Kyheng
- Université de Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, 1, place de Verdun, F-59000 Lille, France; (M.K.); (A.D.)
| | - Vincent Foissaud
- Hôpital d’Instruction des Armées Percy, Laboratoire de biologie, 101 avenue Henri Barbusse, F-92140 Clamart, France;
| | - Alain Duhamel
- Université de Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, 1, place de Verdun, F-59000 Lille, France; (M.K.); (A.D.)
| | - Eloi Marijon
- Hôpital Européen Georges Pompidou, Service de Cardiologie, 20 Rue Leblanc, F-75015 Paris, France
- PARCC-Inserm UMR-S970, Université Paris Descartes, 56 Rue Leblanc, F-75015 Paris, France
| | - Sophie Susen
- Institut d’Hématologie-transfusion, University Lille, CHU Lille, Boulevard du Pr Jules Leclercq, F-59037 Lille CEDEX, France
| | - Anne Godier
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM 1140, 4 avenue de l’observatoire F-75006 Paris, France
- Fondation Rothschild, Service d’Anesthésie-Réanimation, 29 rue Manin, F-75019 Paris, France
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Affiliation(s)
- Anne Godier
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, 25, rue Leblanc, 75015 Paris, France; Inserm UMRS 1140, université Paris Descartes, Paris, France.
| | - Florian Roquet
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, 25, rue Leblanc, 75015 Paris, France; Service de biostatistique et informatique médicale, unité Inserm UMR 1153, université Paris Diderot, Paris, France
| | - Sophie Rym Hamada
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, 25, rue Leblanc, 75015 Paris, France; CESP, Inserm, CESP, Inserm, Maison de Solenn, université paris Sud, université Paris-Saclay, Paris, France
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Martin AC, Zlotnik D, Bonete GP, Baron E, Decouture B, Belleville-Rolland T, Le Bonniec B, Poirault-Chassac S, Alessi MC, Gaussem P, Godier A, Bachelot-Loza C. Epinephrine restores platelet functions inhibited by ticagrelor: A mechanistic approach. Eur J Pharmacol 2019; 866:172798. [PMID: 31738933 DOI: 10.1016/j.ejphar.2019.172798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/29/2022]
Abstract
Ticagrelor, an antagonist of the platelet adenosine diphosphate (ADP)-P2Y12 receptor is recommended for patients with acute coronary syndromes. However, ticagrelor exposes to a risk of bleeding, the management of which is challenging because platelet transfusion is ineffective, and no antidote is yet available. We hypothesized that the vasopressor drug epinephrine could counter the antiplatelet effects of ticagrelor and restore platelet functions. We assessed in vitro the efficiency of epinephrine in restoring platelet aggregation inhibited by ticagrelor and investigated the underlying mechanisms. Washed platelet aggregation and secretion were measured upon stimulation by epinephrine alone or in combination with ADP, in the presence or absence of ticagrelor. Mechanistic investigations used P2Y1 and phosphoinositide 3-kinase (PI3K) inhibitors and included vasodilator-stimulated phosphoprotein (VASP) and Akt phosphorylation assays as well as measurement of Ca2+ mobilisation. We found that epinephrine restored ADP-induced platelet aggregation, but not dense granule release. Epinephrine alone failed to induce aggregation whereas it fully induced VASP dephosphorylation and Akt phosphorylation regardless of the presence of ticagrelor. In the presence of ticagrelor, blockage of the P2Y1 receptor prevented restoration of platelet aggregation by the combination of epinephrine and ADP, as well as intracellular Ca2+ mobilisation. In combination with ADP, epinephrine induced platelet aggregation of ticagrelor-treated platelets through inhibition of the cAMP pathway and activation of the PI3K pathway, thus enabling the P2Y1 receptor signalling and subsequent Ca2+ mobilisation. This proof-of-concept study needs to be challenged in vivo for the management of bleeding in ticagrelor-treated patients.
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Affiliation(s)
- Anne-Céline Martin
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France; AP-HP, Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France.
| | - Diane Zlotnik
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France; AP-HP, Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Porta Bonete
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France
| | - Elodie Baron
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France
| | - Benoît Decouture
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France
| | - Tiphaine Belleville-Rolland
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France; AP-HP, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Bernard Le Bonniec
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France
| | - Sonia Poirault-Chassac
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France
| | | | - Pascale Gaussem
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France; AP-HP, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Godier
- Université de Paris, Innovations Thérapeutiques en Hémostase, INSERM, F-75006 Paris, France; AP-HP, Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
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Godier A, Gut-Gobert C, Sanchez O. [How to manage anticoagulant treatment in case of invasive procedures (surgery, endoscopy…)]. Rev Mal Respir 2019; 38 Suppl 1:e120-e124. [PMID: 31703827 DOI: 10.1016/j.rmr.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Godier
- Université de Paris, Service d'Anesthésie Réanimation, AH-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France
| | - C Gut-Gobert
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine interne et pneumologie, EA3878-GETBO, CIC Inserm 1412, université de Bretagne occidentale, centre hospitalo-universitaire de Brest, 29200 Brest, France
| | - O Sanchez
- Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, 75006 Paris, France; F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Université de Paris, Service de pneumologie et soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France.
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Godier A, Bloc S. How to deal with peripheral regional anaesthesia while antithrombotics on board? Anaesth Crit Care Pain Med 2019; 38:457-459. [PMID: 31585764 DOI: 10.1016/j.accpm.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Anne Godier
- Service d'anesthésie-réanimation, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France; Inserm UMRS 1140, Faculté de Pharmacie, Université Paris Descartes, Paris, France.
| | - Sébastien Bloc
- CMC Ambroise-Paré, Département d'anesthésie, Neuilly-sur-Seine, France
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Affiliation(s)
- Anne-Céline Martin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 4 Avenue de l'Observatoire, Paris, France
| | - Yann Hemery
- Service de Cardiologie, Centre Hospitalier de la Côte Basque, 13 Avenue de l'Interne Jacques Loeb, Bayonne, France
| | - Anne Godier
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 4 Avenue de l'Observatoire, Paris, France
- AP-HP, Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, 20-40 Rue Leblanc, Paris Cedex 15, France
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Abdennour L, Sourour N, Drir M, Premat K, Shotar E, Taylor G, Godier A, Mathout J, Lenck S, Bernard R, Carpentier A, Degos V, Clarençon F. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clin Neuroradiol 2019; 30:453-461. [PMID: 31309241 DOI: 10.1007/s00062-019-00811-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications. MATERIAL AND METHODS From October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed. RESULTS Of the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS ≤2 at follow-up. CONCLUSION Cangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents.
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Affiliation(s)
- Lamine Abdennour
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Mehdi Drir
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Guillaume Taylor
- Neuro-Intensive Care Unit, Fondation A. de Rothschild, Paris, France
| | - Anne Godier
- Department of Anesthesiology, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, université Paris Descartes, Paris, France
| | - Jugurtha Mathout
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Remy Bernard
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Carpentier
- Sorbonne University, Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Degos
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris, France.
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Susen S, Gruel Y, Godier A, Harroche A, Chambost H, Lasne D, Rauch A, Roullet S, Fontana P, Goudemand J, de Maistre E, Chamouard V, Wibaut B, Albaladejo P, Négrier C. Management of bleeding and invasive procedures in haemophilia A patients with inhibitor treated with emicizumab (Hemlibra ® ): Proposals from the French network on inherited bleeding disorders (MHEMO), the French Reference Centre on Haemophilia, in collaboration with the French Working Group on Perioperative Haemostasis (GIHP). Haemophilia 2019; 25:731-737. [PMID: 31294904 DOI: 10.1111/hae.13817] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Emicizumab (Hemlibra® ) recently became available and requires an adaptation for managing bleeding, suspected bleeding and emergency or scheduled invasive procedures in haemophilia A patients with inhibitor. This implicates a multidisciplinary approach and redaction of recommendations for care that must be regularly adapted to the available data. AIM The following text aims to provide a guide for the management of people with haemophilia A with inhibitor treated with emicizumab in case of bleeding or invasives procedures. METHODS The French network on inherited bleeding disorders (MHEMO), the French Reference Centre on Haemophilia (CRH), in collaboration with the French Working Group on Perioperative Haemostasis (GIHP) have been working together to make proposals for the management of these situations. RESULTS Haemostatic treatment and other medications should be given stepwise, according to the severity and location of the bleeding or the risk of bleeding of the procedure as well as the haemostatic response obtained at each step in order to ensure an optimal benefit/risk ratio. CONCLUSION The lack of data means that it is only possible to issue proposals rather than recommendations.
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Affiliation(s)
| | - Yves Gruel
- Département d'Hématologie-Hémostase, Hôpital Universitaire de Tours, Tours, France
| | - Anne Godier
- Service d'Anesthésie Réanimation, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Inserm UMR-S1140, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Annie Harroche
- CRC MHC, Service d'Hématologie Clinique Hôpital Universitaire Necker Enfants Malades, Laboratoire d'Hématologie Générale, Hôpital Necker, AP-HP, Paris, France
| | - Herve Chambost
- APHM, Hôpital d'Enfants La Timone, Service d'Hématologie Oncologie Pédiatrique et Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
| | - Dominique Lasne
- CRC MHC, Service d'Hématologie Clinique Hôpital Universitaire Necker Enfants Malades, Laboratoire d'Hématologie Générale, Hôpital Necker, AP-HP, Paris, France
| | | | - Stephanie Roullet
- Inserm U 1034, Service Anesthésie-Réanimation Pellegrin, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Pierre Fontana
- Service d'Angiologie et d'Hémostase, Département de Médecine, Hôpitaux Universitaires de Genève, Genève, Switzerland.,Geneva Platelet Group, Faculté de Médecine, Université de Genève, Genève, Switzerland
| | | | - Emmanuel de Maistre
- Service d'Hématologie Biologique - Secteur Hémostase, Plateau Technique de Biologie, CHU Dijon-Bourgogne, Dijon, France
| | - Valerie Chamouard
- Unité d'Hémostase Clinique, Louis Pradel Hospital, University Claude Bernard, Lyon, France
| | | | - Pierre Albaladejo
- Département d'Anesthésie-Réanimation, CHU Grenoble-Alpes, Grenoble, France.,ThEMAS, TIMC, UMR CNRS 5525, Université Grenoble-Alpes, Grenoble, France
| | - Claude Négrier
- Unité d'Hémostase Clinique, Louis Pradel Hospital, University Claude Bernard, Lyon, France
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49
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Godier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet JP, de Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2019; 38:289-302. [DOI: 10.1016/j.accpm.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022]
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50
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Oddo M, Bracard S, Cariou A, Chanques G, Citerio G, Clerckx B, Godeau B, Godier A, Horn J, Jaber S, Jung B, Kuteifan K, Leone M, Mailles A, Mazighi M, Mégarbane B, Outin H, Puybasset L, Sharshar T, Sandroni C, Sonneville R, Weiss N, Taccone FS. Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care. Ann Intensive Care 2019; 9:47. [PMID: 30993550 PMCID: PMC6468018 DOI: 10.1186/s13613-019-0523-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/08/2019] [Indexed: 02/08/2023] Open
Abstract
The 2018 Paris Intensive Care symposium entitled "Update in Neurocritical Care" was organized in Paris, June 21-22, 2018, under the auspices of the French Intensive Care Society. This 2-day post-graduate educational symposium comprised several chapters, aiming first to provide all-board intensivists with current standards for the clinical assessment of altered consciousness states (including coma and delirium) and peripheral nervous system in critically ill patients, monitoring of brain function (specifically, electro-encephalography) and best practices for sedation-analgesia-delirium management. An update on the treatment of specific severe brain pathologies-including ischaemic/haemorrhagic stroke, cerebral venous thrombosis, hypoxic-ischaemic brain injury, immune-mediated and infectious encephalitis and refractory status epilepticus-was also provided. Finally, we discuss how to approach some difficult decisions, namely the role of decompressive craniectomy and prognostication models in patients with head injury. For each chapter, the scope of the present review was to provide important issues and key messages, provide most recent and relevant literature in the field, and briefly describe new developments in the field.
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Affiliation(s)
- Mauro Oddo
- Department of Intensive Care Medicine, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Université Paris Descartes, Paris, France
| | - Gérald Chanques
- Department of Anaesthesia and Intensive Care, Montpellier Saint Eloi University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295, Montpellier Cedex 5, France
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Béatrix Clerckx
- Department of Intensive Care Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Hôpital Henri-Mondor, Créteil, France
| | - Anne Godier
- Fondation Adolphe de Rothschild, Department of Anesthesiology and Intensive Care, Paris Descartes University, Paris, France
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care, Montpellier Saint Eloi University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295, Montpellier Cedex 5, France
| | - Boris Jung
- Medical Intensive Care Unit, Montpellier Teaching Hospital, PhyMedex, University of Montpellier, Montpellier, France
| | | | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Alexandra Mailles
- ESGIB, ESCMID Study Group for Infectious Diseases of the Brain, Santé Publique France, 12, rue du Val-d'Osne, 94415, Saint-Maurice Cedex, France
| | - Mikael Mazighi
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France
| | - Hervé Outin
- Service de Réanimation Médico-Chirurgicale, CHI de Poissy-Saint Germain en Laye, Poissy, France
| | - Louis Puybasset
- Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Paris, France
| | - Tarek Sharshar
- Medical and Surgical Neurointensive Care Centre, Hospital Sainte Anne, Paris, France
| | - Claudio Sandroni
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Hôpital Bichat-Claude, Université Paris Diderot, Paris, France
| | - Nicolas Weiss
- Neurocritical Care Unit, Department of Neurology, Assistance Publique - Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
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