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Morau E, Grossetti E, Bonnin M. [Maternal mortality due to Amniotic Fluid Embolism in France 2016-2018]. Gynecol Obstet Fertil Senol 2024; 52:231-237. [PMID: 38373494 DOI: 10.1016/j.gofs.2024.02.015] [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] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Amniotic embolism remains the 3rd leading cause of maternal death in France, with 21 maternal deaths over the 2016-2018 triennium. The women who died were more likely to be obese (25%), to benefit from induction of labor (71%) and be cared in a maternity hospital <1500 deliveries/year (45%), compared with the reference population (ENP 2016). The symptom occurred mainly during labor (95%) and the course was rapid, with a symptom-to-fatality interval of 4hours 45minutes (min: 25minutes - max: 8 days). Preventability was proposed for 35% of the deaths assessed, with areas for improvement identified in terms of technical skills (haemostasis procedures, management of polytransfusion), non-technical skills (communication) and health care organization (human resources, vital emergency plan, wide access to PSL). An autopsy was performed in 38% of deaths.
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Affiliation(s)
- Estelle Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, Nîmes, France.
| | | | - Martine Bonnin
- Service d'anesthésie réanimation, pôle femme et enfant, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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2
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Verspyck E, Morau E, Chiesa-Dubruille C, Bonnin M. [Maternal mortality due to obstetric haemorrhage in France 2016-2018]. Gynecol Obstet Fertil Senol 2024; 52:238-245. [PMID: 38373487 DOI: 10.1016/j.gofs.2024.02.016] [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] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.
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Affiliation(s)
- Eric Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Estelle Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, Nîmes, France
| | - Coralie Chiesa-Dubruille
- Département de Maïeutique, Paris Saclay, UFR Simone Veil-Santé, université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Service de gynécologie-obstétrique, centre hospitalier de Rambouillet, Rambouillet, France
| | - Martine Bonnin
- Pôle femme et enfant, hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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3
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Malka D, Girard N, Smadja DM, Chevreau C, Culine S, Lesur A, Rouzier R, Rozet F, Spano JP, Blay JY. [Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use]. Bull Cancer 2023; 110:212-224. [PMID: 36494243 DOI: 10.1016/j.bulcan.2022.10.008] [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] [Received: 06/16/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
Cancer-associated thrombosis (CAT) is a common complication resulting from various vascular mechanisms related to cancer, antitumoral therapy and patient status, and is associated with a poor prognosis. Anticoagulants recommended for CAT treatment or prevention mainly include low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). Regarding thromboprophylaxis, a situation for which LMWH is a preferred option due to a lower risk of hemorrhage especially in patients with unresected gastro-intestinal and genito-urinary malignancies, the identification of patients at risk is a major issue. For patients with established CAT, the main issue is the choice of the most appropriate anticoagulant therapy. Because of the convenience of oral formulation, DOACs are an attractive option, and their efficacy has been shown in randomized trials. However, such studies are limited by selection biases, which make the analyzed population not representative of the real-life setting, as for instance cancers associated with a high risk of hemorrhage, or antitumoral therapies (e.g., tyrosine kinase inhibitors) known to interact with DOACs and then modifying their bioavailability. Caution associated with DOAC use is highlighted by most updated guidelines that recommend a case-by-case-based approach. The aim of the present paper is to help the oncologists make the most appropriate decision regarding the choice of anticoagulant therapy in a context of thromboprophylaxis or established CAT management in a patient with a solid tumor. The main issues are addressed through key practical questions, the answers of which are based on the current guidelines and additional published data or expert opinions.
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Affiliation(s)
- David Malka
- Institut mutualiste Montsouris, département d'oncologie médicale, Paris, France; Université Paris-Saclay, unité dynamique des cellules tumorales INSERM U1279, Gustave Roussy, Villejuif, France.
| | - Nicolas Girard
- Institut Curie, institut du Thorax Curie-Montsouris, Paris, France
| | - David M Smadja
- Université de Paris, INSERM innovations thérapeutiques en hémostase, Paris, France; Hôpital Européen Georges-Pompidou, AP-HP, département d'hématologie, Paris, France; Réseau F-CRIN INNOVTE, Paris, France
| | | | - Stéphane Culine
- Université Paris Cité, service d'oncologie médicale, AP-HP Saint-Louis, Paris, France
| | - Anne Lesur
- Mutuelle générale éducation nationale, Nancy, France
| | - Roman Rouzier
- Centre François Baclesse, département de Chirurgie, Caen, France
| | - François Rozet
- Institut mutualiste Montsouris, département d'urologie, Paris, France
| | - Jean-Philippe Spano
- Hôpital La Pitié-Salpêtrière, service d'oncologie médicale, AP-HP-SU, IUC, Paris, France
| | - Jean-Yves Blay
- Centre Leon Bérard and UCBL1, département d'oncologie médicale, Lyon, France
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Senni N, Gerfaud-Valentin M, Hot A, Huissoud C, Gaucherand P, Tebib J, Broussolle C, Jamilloux Y, Sève P. [Spontaneous adrenal hematomas. Retrospective analysis of 20 cases from a tertiary center]. Rev Med Interne 2021; 42:375-383. [PMID: 33775473 DOI: 10.1016/j.revmed.2021.03.009] [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: 04/03/2020] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Spontaneous adrenal hemorrhages (AH) are a rare condition with no consensus about their management. METHODS Patients were identified using the Medicalization of the Information System Program database, imaging software and a call for observations to internists, intensivists and obsetricians working at our institution. Adult patients whose medical records were complete and whose diagnosis was confirmed by medical imaging were included. RESULTS From 2000 to 2007, 20 patients were identified, including 15 were women. The clinical onset of AH was non-specific. In five cases, AH occurred during pregnancy; four of them were unilateral and right sided. The etiology of the other fifteen (bilateral adrenal hemorrhage in 11) were as follows: antiphospholipid syndrome (n=8), heparin-induced thrombocytopenia (n=4), essential thrombocythemia (n=3), spontaneous AH due to oral anticoagulants (n=1), complication of a surgical act (n=3), and sepsis (n=3). In seven cases, two causes were concomitant. The diagnosis of AH was often confirmed by abdominal CT. An anticoagulant treatment was initiated in 16 cases. Ten of the eleven patients presenting with bilateral adrenal hematomas were treated using a long-term substitute opotherapy. One patient died because of a catastrophic antiphospholipid syndrome. CONCLUSION The clinical onset of HS is heterogeneous and non-specific. The confirmatory diagnosis is often based on abdominal CT. The search for an underlying acquired thrombophilia is essential and we found in this study etiological data comparable to the main series in the literature. Adrenal insufficiency is most of the time definitive in cases of bilateral involvement.
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Affiliation(s)
- N Senni
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - M Gerfaud-Valentin
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - A Hot
- Service de médecine interne, hôpital Edouard-Herriot, Lyon, France
| | - C Huissoud
- Service d'obstétrique, hôpital de la Croix-Rousse, Lyon, France
| | - P Gaucherand
- Service d'obstétrique, hôpital Femme Mère-Enfant, Lyon, France
| | - J Tebib
- Service de rhumatologie, hôpital Lyon Sud, Lyon, France
| | - C Broussolle
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - Y Jamilloux
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Hospices civils de Lyon, pôle IMER, 69003 Lyon, France; University Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France.
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5
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Morau E, Ducloy JC, Proust A. [Maternal Deaths due to Amniotic Fluid Embolism in France 2013-2015]. ACTA ACUST UNITED AC 2020; 49:47-52. [PMID: 33161194 DOI: 10.1016/j.gofs.2020.11.009] [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] [Indexed: 11/30/2022]
Abstract
Amniotic fluid embolism remains the 3rd cause of maternal death in France, with a stable rate and 28 deaths in this triennium, representing 10.7% of maternal deaths and a maternal mortality ratio of 1.2/100,000 live births. Cases are characterized by the suddenness of symptoms: the median delay between symptoms and death was 4h [0.75-696] with 20/28 patients did not reach the intensive care unit. Initial circulatory failure or cataclysmic haemorrhage was the two modes of presentation. Prodromes were reported in 17 (63%) cases and induction of labour was present in 12/27 (44%). One or more factors of sub-optimal care were present in 72% of the cases, and 52% of deaths were considered possibly or probably preventable. This preventability most often concerned the content of care but also the organisation of care (including human resources, communication, sites of care and referrals). The delay in establishing a well-conducted cardio-circulatory resuscitation or the delay in setting up an optimal transfusion strategy were the most frequent elements of substandard care. Absence or delay at hysterectomy during haemorrhagic situations was reported in 15/20 cases. The experts suggest being on the alert to diagnose amniotic embolism at an early stage, initiating intense resuscitation "outside the walls", envisaging a hysterectomy without delay if the haemorrhage is intense. On an organisational level, a "vital emergency maternity care" plan, specific to each establishment could be proposed.
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Affiliation(s)
- E Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, place du Pr. Robert-Debré, 30029 Nîmes, France.
| | - J C Ducloy
- Anesthésie-réanimation, hôpital privé Villeneuve d'Ascq, 20, avenue de la Reconnaissance, 59491 Villeneuve d'Ascq, France
| | - A Proust
- Département de gynécologie obstétrique, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France
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6
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Consoli A, Coskun O, Perier M, Di Maria F, Gratieux J, Dean P, Pizzuto S, Badat N, Condette-Auliac S, Boulin A, Rodesch G. [Therapeutic and endovascular management of cerebral mycotic aneurysms]. Ann Cardiol Angeiol (Paris) 2020; 69:411-414. [PMID: 33131724 DOI: 10.1016/j.ancard.2020.10.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/15/2022]
Abstract
Infective endocardites are associated with both ischemic and hemorrhagic neurological complications and also with cerebral abscesses and the development of "mycotic" aneurysms, which are detected in about 5 % of patients in the acute and sub-acute phase of the infection. Data about their natural history and their hemorrhagic risk are scarce and fragmented. The therapeutic management is represented by the medical treatment of the infection with interventional abstention, the surgical treatment and the endovascular approach by selective embolization of the aneurysm. No evidence is provided concerning the superiority of a specific approach. Mycotic aneurysms remain a diagnostic and therapeutic challenge and their management is necessarily based on a multidiscplinary approach.
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Affiliation(s)
- A Consoli
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France.
| | - O Coskun
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - M Perier
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - F Di Maria
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - J Gratieux
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - P Dean
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - S Pizzuto
- Unité de neuroradiologie, ospedale Civile S.Agostino-Estense, CHU Modène, université de Modène et Reggio Emilia, Via Pietro Giardini 1355, Modène, Baggiovara, 41126, Italie
| | - N Badat
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - S Condette-Auliac
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - A Boulin
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - G Rodesch
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
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Lebas D, Preta LH, Leguern A, Modiano P, Wiart T. [Haemorrhagic complications following ibrutinib intake after dermatological surgery]. Ann Dermatol Venereol 2020; 147:775-779. [PMID: 32917401 DOI: 10.1016/j.annder.2020.06.023] [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: 12/16/2019] [Revised: 03/31/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Ibrutinib is a selective oral inhibitor of Bruton's tyrosine kinase. It is used in haematology to treat lymphoid B disorders. Haemorrhagic complications in dermatological surgery are occasionally associated with the use of anti-platelet and/or anticoagulant medication. Herein, we report a case of haemorrhage under ibrutinib following skin surgery. PATIENTS AND METHODS A 70-year-old male patient began treatment with ibrutinib for chronic lymphocytic leukaemia had 2 basal cell carcinomas of the face. The next day he had a persistent haemorrhage lasting more than 48h, with no effects on the final scarring result. DISCUSSION Ibrutinib is a tyrosine kinase inhibitor whose mechanism of action plays a role in platelet adhesion. It is known to cause haemorrhaging, either spontaneously or following invasive procedures, especially at the beginning of treatment. In the case of low-risk haemorrhagic procedures in which bleeding may be controlled by mechanical haemostasis, ibrutinib should be discontinued 3 days before and after surgery. In the event of recent initiation of ibrutinib and in the absence of urgent dermatological management, it is preferable to schedule any surgical procedures 3 months after the start of ibrutinib.
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Affiliation(s)
- D Lebas
- Service de dermatologie, université catholique de Lille, hôpital Saint-Vincent de Paul, Lille, France.
| | - L-H Preta
- Centre régional de pharmacovigilance, centre hospitalier régional universitaire de Lille, Lille, France
| | - A Leguern
- Service de dermatologie, université catholique de Lille, hôpital Saint-Vincent de Paul, Lille, France
| | - P Modiano
- Service de dermatologie, université catholique de Lille, hôpital Saint-Vincent de Paul, Lille, France
| | - T Wiart
- Service de dermatologie, université catholique de Lille, hôpital Saint-Vincent de Paul, Lille, France
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Noel G, Keller A, Antoni D. [Stereotactic radiotherapy of brain metastases in complex situations]. Cancer Radiother 2019; 23:708-715. [PMID: 31477442 DOI: 10.1016/j.canrad.2019.07.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
Stereotactic radiation therapy of brain metastases is a treatment recognized as effective, well tolerated, applicable for therapeutic indications codified and validated by national and international guidelines. However, the effectiveness of this irradiation, the evolution of patient care and the technical improvements enabling its implementation make it possible to consider it in more complex situations: proximity of brain metastases to organs at risk; large, cystic, haemorrhagic or multiple brain metastases, combination with targeted therapies and immunotherapy, stereotactic radiotherapy in patients with a pacemaker. This article aims to put forward the arguments available to date in the literature and those resulting from clinical practice to provide decision support for the radiation oncologists.
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Affiliation(s)
- G Noel
- Department of radiotherapy, comprehensive cancer center Paul-Strauss, UNICANCER, 3, rue de la porte de l'Hôpital, 67065 Strasbourg cedex, France; Strasbourg University, CNRS, IPHC UMR 7178, Centre Paul-Strauss, UNICANCER, 67000 Strasbourg, France.
| | - A Keller
- Department of radiotherapy, comprehensive cancer center Paul-Strauss, UNICANCER, 3, rue de la porte de l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- Department of radiotherapy, comprehensive cancer center Paul-Strauss, UNICANCER, 3, rue de la porte de l'Hôpital, 67065 Strasbourg cedex, France; Strasbourg University, CNRS, IPHC UMR 7178, Centre Paul-Strauss, UNICANCER, 67000 Strasbourg, France
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9
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Le Bon M, Lapeyre M, Moreau J, Bellière-Calandry A, Pezet D, Abergel A, Bellini R, Kwiatkowski F, Verrelle P, Martin F, Benoît C. [Tolerance of hypofractionated stereotactic radiotherapy for hepatic tumours]. Cancer Radiother 2019; 23:385-394. [PMID: 31300328 DOI: 10.1016/j.canrad.2019.02.004] [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] [Received: 09/20/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the outcomes of stereotactic radiation therapy for primary and secondary liver tumours in Jean-Perrin cancer centre (Clermont-Ferrand, France) in terms of efficacy and safety. MATERIALS AND METHODS Between December 2013 and June 2016, 25 patients were included. Treatment was performed on a linear accelerator Novalis TX®. The prescription dose was 42 to 60Gy in three to five fractions. Local control at 1 year was evaluated with modified Response Evaluation Criteria in Solid Tumours (mRECIST) and RECIST criteria. Acute and late toxicity were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) v4.0 criteria. RESULTS Median follow-up was 10.5 months. Treatment tolerance was good with few side effects grade 3 or above, no acute toxicity and only one late toxicity. We have highlighted that hepatic artery haemorrhage was associated with the presence of a biliary prosthesis in contact with the artery (P=0.006) and in the irradiation field. There was no correlation with the dose delivered to the artery and hepatic artery haemorrhage. CONCLUSION Stereotactic radiation therapy for liver tumours allows a good local control with few secondary effects. Caution should be exercised when treating patients with biliary prostheses in the vicinity of the target volume because there is a risk of haemorrhage of the hepatic artery in contact with the prosthesis.
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Affiliation(s)
- M Le Bon
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Département de radiothérapie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France.
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - A Bellière-Calandry
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - D Pezet
- Département de chirurgie digestive et hépatobiliaire, CHU de Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - A Abergel
- Département d'hépato-gastroentérologie, CHU de Clermont-Ferrand, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - R Bellini
- Département de radiologie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Kwiatkowski
- Département de physique médicale, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Verrelle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Martin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Benoît
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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Eberst G, Lakhzoum W, Tomasini P, Andreotti N, Abcaya J, Mascaux C, Barlesi F. [Autoimmune-related bleeding occurring during combined immunotherapy for lung cancer - Case report]. Rev Mal Respir 2018; 35:974-977. [PMID: 30318433 DOI: 10.1016/j.rmr.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/25/2017] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Specific immune-related adverse events in lung cancer treatment are rare and it is important that they are identified as they may have important adverse consequences. We report such a case here. CASE REPORT A Caucasian female diagnosed with KRAS mutant advanced adenocarcinoma of the lung was enrolled in a phase Ib trial assessing the combination of an anti cytotoxic T-lymphocyte- associated protein 4 antibody and a programmed death-Ligand 1 inhibitor. For several years, she had also been taking warfarin for recurrent pulmonary embolism. At day 15 of treatment, she presented with grade 1 haematomas and signs of grade 2 hyperthyroidism. Blood tests revealed a normal number of platelets but an INR increased to 6.5. Thyroid function tests and auto antibodies confirmed the presence of an autoimmune thyroitidis. The study treatment was then stopped and the patient received 1mg/kg of prednisone and 40mg of propranolol. At day 28, the thyroid function and symptoms were normalized. No direct interactions exist between immunotherapy and vitamin K antagonists (VKA) but hyperthyroidism, through pharmacokinetic and metabolic mechanisms, can boost VKA plasma levels and increase INR, leading to hemorrhagic complications. CONCLUSIONS This case emphasizes that special consideration should be given to patients with VKA treatment planned to receive immunotherapy.
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Affiliation(s)
- G Eberst
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - W Lakhzoum
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - P Tomasini
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France
| | - N Andreotti
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - J Abcaya
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - C Mascaux
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France
| | - F Barlesi
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France.
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11
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Abstract
Von Willebrand factor is involved in primary hemostasis (adhesion of platelets to subendothelium and platelet aggregation) and acts as the carrier of coagulation factor VIII. Von Willebrand disease, resulting from a quantitative or qualitative defect of this factor, is the most frequent inherited bleeding disorder. It is mainly responsible for symptoms such as mucocutaneous bleeding and excessive bleeding after trauma or invasive procedures, but can also cause gastro-intestinal bleeding or hemarthrosis in the most severe forms of the disease. There are numerous causes of physiological variation of von Willebrand factor plasma levels which can be responsible for diagnostic difficulty or changes in symptoms over time. Diagnosis relies primarily on clinical symptoms but requires the use of several laboratory analyses: von Willebrand factor activity and antigen testing and factor VIII activity. More specialized assays allow classification of the disease in various types and subtypes which imply different management strategies (types 1, 2A, 2B, 2M, 2N, and 3). Treatment is based on desmopressin, responsible for an increase in plasma concentration of von Willebrand factor, and plasma-derived von Willebrand factor concentrates which can be combined with factor VIII.
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Affiliation(s)
- L Calmette
- Laboratoire d'hématologie-immunologie-transfusion, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles de Gaulle, 92104 Boulogne-Billancourt cedex, France.
| | - S Clauser
- Laboratoire d'hématologie-immunologie-transfusion, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles de Gaulle, 92104 Boulogne-Billancourt cedex, France; UFR des sciences de la santé Simone Veil, université de Versailles Saint-Quentin-en-Yvelines, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France
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12
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Fanny M, Fomba M, Aka E, Adjoussou S, Olou L, Koffi A, Konan P, Koné M. [Prevention of bleeding during laparotomic myomectomy in Sub-Saharan Africa: Contribution to the tourniquet on the uterine isthmus]. ACTA ACUST UNITED AC 2018; 46:681-5. [PMID: 30262162 DOI: 10.1016/j.gofs.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To appreciate the decrease of bleeding by myomectomy by the use of a tourniquet on the uterine isthmus. METHODS We conducted a case-control retrospective study from March 2014 to February 2016 in the Gynecology and obstetrics Department of the university hospital of Yopougon (Abidjan, Ivory Coast). It interested 100 patients of which 50 had a myomectomy with the tourniquet on the uterine isthmus and 50 without the tourniquet. None of the patients received pre-operative preventive treatment. The criteria for comparison were the blood loss per operative and the pre-and post-operative hemoglobin levels. RESULTS The average age of patients was 33 years. Nulliparous women were the group most affected (68% of our patients) with 32% infertile women in the group with the tourniquet and 18% in the group without the tourniquet. Patients without tourniquet presented more bleeding than patients with tourniquet (X2=13.61) with a higher proportion of anemic patients in the group without the tourniquet. The differences were significant. The tourniquet has made it possible to realize the resection of a larger number of myoma. The duration of hospital stay was 4 days on average in both groups and no complications were observed. CONCLUSIONS The application of a tourniquet on the uterine isthmus during laparotomic myomectomy has a benefit in reducing intraoperative blood loss.
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13
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Eddou H, Zinebi A, Khalloufi A, Mahtat EM, El Khadir SE, Moudden MK, Doghmi K, Mikdame M, El Baaj M. [Thrombo-haemorrhagic disease-related hypoprothrombinemia-lupus anticoagulant syndrome revealing a light chains multiple myeloma]. J Med Vasc 2018; 43:325-328. [PMID: 30217348 DOI: 10.1016/j.jdmv.2018.07.008] [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] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
Thrombosis and hemorrhage are two opposing manifestations of multiple myeloma. These hemostatic disorders are present in less than 12% of patients at diagnosis and involve various pathophysiological mechanisms. We report the case of a 39-year-old patient with multiple myeloma revealed by the association of a hemorrhagic syndrome and deep vein thrombosis related to a hypoprothrombinemia-anticoagulant lupus syndrome.
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Affiliation(s)
- H Eddou
- Service de médecine A, hôpital Militaire Moulay Ismail Meknès, Maroc; Faculté de médecine et de pharmacie de Fès, Maroc.
| | - A Zinebi
- Service de médecine A, hôpital Militaire Moulay Ismail Meknès, Maroc
| | - A Khalloufi
- Service d'hématologie biologique, hôpital Militaire Moulay Ismail Meknès, Maroc
| | - E M Mahtat
- Service d'hématologie clinique, hôpital Militaire d'instruction Mohammed V Rabat, Maroc
| | - S E El Khadir
- Service de médecine A, hôpital Militaire Moulay Ismail Meknès, Maroc
| | - M K Moudden
- Service de médecine A, hôpital Militaire Moulay Ismail Meknès, Maroc
| | - K Doghmi
- Service d'hématologie clinique, hôpital Militaire d'instruction Mohammed V Rabat, Maroc
| | - M Mikdame
- Service d'hématologie clinique, hôpital Militaire d'instruction Mohammed V Rabat, Maroc
| | - M El Baaj
- Service de médecine A, hôpital Militaire Moulay Ismail Meknès, Maroc
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14
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Cuilleron J, Mas P, Kiakouama L, Gaillot-Durand L, Seve P, Devouassoux G. [Acquired hemophilia A revealing lung cancer]. Rev Mal Respir 2018; 35:727-730. [PMID: 30098880 DOI: 10.1016/j.rmr.2017.08.005] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 08/24/2017] [Indexed: 11/17/2022]
Abstract
Acquired hemophilia A (AHA) is a rare disease, defined by the production of anti-factor VIII antibodies causing disordered hemostasis. It is idiopathic in 50% of cases, but sometimes associated with solid tumors. We report a case where AHA led to the diagnosis of lung cancer. CASE REPORT An 82-year-old man with spontaneous hematomas on his trunk and extremities, and isolated prolongation of activated partial thromboplastin time was admitted to the emergency room. A severely reduced factor VIII level and a high factor VIII inhibitor title confirmed the diagnosis of AHA. Thoracic computed tomography scan found a suspect lung nodule and biopsy was consistent with a primary lung adenocarcinoma. The patient received recombinant factor VIII, immunosuppressive therapies, and finally lung stereotactic radiotherapy. Thirty months after diagnosis, the patient is in complete remission both from AHA and from his lung cancer. CONCLUSIONS Acquired hemophilia A is a rare but potentially severe disease, which may be idiopathic or linked to a solid tumor. The severity of AHA depends on both the volume of hemorrhage and the presence of associated diseases.
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Affiliation(s)
- J Cuilleron
- Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Mas
- Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France
| | - L Kiakouama
- Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France
| | - L Gaillot-Durand
- Service d'anatomopathologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - P Seve
- Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Université Claude-Bernard, Lyon 1, 69004 Lyon France
| | - G Devouassoux
- Service de pneumologie, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69004 Lyon, France; Université Charles-Mérieux, 69004 Oullins, France.
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15
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Abstract
Plasma for direct therapeutic use is a fast-evolving blood component in terms of its production and presentation. More than a dozen forms are available worldwide, which is often overlooked since most countries apply policies making only one or very few forms available for treating patients in need. It is most often reserved for the same three clinical indications, i.e. overall clotting-factor deficiency, reversal of vitamin K antagonists in the context of active bleeding or prior to urgent surgery, and therapeutic plasma exchange. The level of evidence is often less robust than generally acknowledged for such major indications while novel indications are tending to emerge in medical and trauma settings. This short review explores classical views and new prospects opened up by novel presentations and statuses for therapeutic plasma.
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Affiliation(s)
- O Garraud
- EA3064, university of Lyon, faculty of medicine, 42023 Saint-Étienne cedex 2, France; Institut national de la transfusion sanguine, 75039 Paris cedex 15, France.
| | - C Aubron
- Medical intensive care unit, centre hospitalier et universitaire de Brest, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France; Université de Bretagne Occidentale, 29009 Brest, France
| | - Y Ozier
- Medical intensive care unit, centre hospitalier et universitaire de Brest, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France; Université de Bretagne Occidentale, 29009 Brest, France
| | - P Coppo
- CNR-MAT, groupe hospitalier Cochin, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex, France; Université Paris Pierre-et-Marie-Curie, 75006 Paris, France; Faculté de médecine de Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Inserm_U1009, Institut Gustave Roussy, rue Edouard Vaillant, 94800 Villejuif, France
| | - J-D Tissot
- Faculté de Biologie et de Médecine de Lausanne, 1011 Lausanne, Switzerland
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16
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Ben Saad S, Abdenadher M, Attia M, Daghfous H, Tritar F. [White hemithorax in a young women carrying coffee and milk spots]. Rev Pneumol Clin 2018; 74:100-103. [PMID: 29580726 DOI: 10.1016/j.pneumo.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) or Von Recklinghausen disease is an autosomal dominant genetic disorder with multivisceral manifestations. We report the case of a spontaneous haemothorax in a young lady wearing this genetic pathology. CASE REPORT A 31-year-old woman with kyphoscoliosis developed acute chest pain and dyspnea. The physical examination revealed a right pleuritic syndrome, coffee and milk spots and neurofibromas of the trunk. Biological assessment showed anemia at 6.4g/dl. Chest x-ray revealed a right side opacification. The pleural puncture showed an incoagulable hemorrhagic fluid. The chest CT scan showed no vascular abnormalities. The diagnosis of spontaneous haemothorax, revealing NF1, was retained. Transfusion and thoracic drainage were performed followed by haemostasis surgery. Pleural exploration showed pleural hematoma with regard to the 5th intercostal space. Electrocoagulation and declogging were performed. The evolution of the patient was favorable. CONCLUSION Haemothorax is a rare and serious complication which may reveal NF1. It must be suspected when sudden and spontaneous white haemithorax occurs in NF1.
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Affiliation(s)
- S Ben Saad
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie.
| | - M Abdenadher
- Université El-Manar, Tunisie; Service de chirurgie thoracique, hôpital Abderahmen-Mami, Ariana, Tunisie
| | - M Attia
- Université El-Manar, Tunisie; Service de radiologie, hôpital Abderahmen-Mami, Ariana, Tunisie
| | - H Daghfous
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie
| | - F Tritar
- Université El-Manar, Tunisie; Service de pneumologie (C), hôpital Abderahmen-Mami, 1, rue de l'hôpital, Pavillon C, 2080 Ariana, Tunisie
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17
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Godier A, Fontana P, Motte S, Steib A, Bonhomme F, Schlumberger S, Lecompte T, Rosencher N, Susen S, Vincentelli A, Gruel Y, Albaladejo P, Collet JP; French Working Group on perioperative hemostasis (GIHP). Management of antiplatelet therapy in patients undergoing elective invasive procedures: Proposals from the French Working Group on perioperative hemostasis (GIHP) and the French Study Group on thrombosis and hemostasis (GFHT). In collaboration with the French Society for Anesthesia and Intensive Care (SFAR). Arch Cardiovasc Dis 2018; 111:210-23. [PMID: 29402671 DOI: 10.1016/j.acvd.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 01/02/2023]
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18
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Lafon T, Vallejo C, Hadj M, Laroche ML, Geniaux H. [Misuse and adverse effects of new direct oral anticoagulants: A prospective observational study in patients admitted to an emergency unit of a French university hospital]. Therapie 2017; 73:209-215. [PMID: 28822583 DOI: 10.1016/j.therap.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/16/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of direct oral anticoagulants (NOAC) is complex: indications, dosage adjustments and precautions. Emergency departments (ED) are increasingly faced with patients receiving NOAC. The aim of this study was to evaluate the misuse and the adverse effects (AE) of NOAC. METHODS All subjects with NOAC admitted to the Limoges University Hospital ED from 1/8/2013 to 1/4/2014 were included in a prospective observational study. Misuse was identified from the NOAC summary of product characteristics and from the 2014 ANSM guideline (indication, dose, co-medications, age, hepatic and renal function); adverse effects were recorded. RESULTS A total of 198 subjects were included receiving rivaroxaban (68.7 %), dabigatran (30.8 %) or apixaban (0.5 %). Main indications were embolic prevention in patients with non-valvular atrial fibrillation (78.7 %) and curative treatment of venous thromboembolism (17.2 %). In 16.2 % of the cases, the treatment was not in according to the guidelines: 78 % for prescribing errors (incorrect dosage according to age, renal function, co-medications) and 22 % for wrong initial indication. AE related to NOAC were encountered in 25.8 % patients. Hemorrhagic events were diagnosed in 36 patients with no according to the guidelines in 11.1 % of them. Hemorrhagic events resulted in 3 deaths (8.3 %). Thrombotic events occurred in 15 patients, all these patients were issued with appropriate guidelines. CONCLUSION Through the view of an ED, this study confirms a part of misuse and highlights the risk of spontaneous bleeding of NOAC despite appropriate use.
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Affiliation(s)
- Thomas Lafon
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France; Inserm CIC 1435, 87042 Limoges, France.
| | - Christine Vallejo
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France; Inserm CIC 1435, 87042 Limoges, France
| | - Mathilde Hadj
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042 Limoges cedex, France
| | - Marie-Laure Laroche
- Centre régional de pharmacovigilance, de pharmaco-épidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges cedex, France; Service de pharmacologie, toxicologie et pharmacovigilance, CHU de Limoges, 87042 Limoges cedex, France; Faculté de médecine, université de Limoges, 87042 Limoges, France
| | - Hélène Geniaux
- Centre régional de pharmacovigilance, de pharmaco-épidémiologie et d'information sur les médicaments, CHU de Limoges, 87042 Limoges cedex, France; Service de pharmacologie, toxicologie et pharmacovigilance, CHU de Limoges, 87042 Limoges cedex, France
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19
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Martin AC, Godier A, Smadja DM, Mauge L, Fischer AM. [State of the art: Direct oral anticoagulants and transfusion]. Transfus Clin Biol 2017; 24:154-159. [PMID: 28673500 DOI: 10.1016/j.tracli.2017.05.019] [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: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Abstract
Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.
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Affiliation(s)
- A-C Martin
- Service de cardiologie, service de santé des armées, hôpital d'instruction des armées Percy, 92025 Clamart, France; Inserm UMR-S 1140, faculté de pharmacie, université Paris-Descartes, 75006 Paris, France
| | - A Godier
- Inserm UMR-S 1140, faculté de pharmacie, université Paris-Descartes, 75006 Paris, France; Service d'anesthésie réanimation, fondation Adolphe-de-Rothschild, 75019 Paris, France
| | - D M Smadja
- Inserm UMR-S 1140, faculté de pharmacie, université Paris-Descartes, 75006 Paris, France; Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, inserm UMR-S1140, 20, rue Leblanc, 75015 Paris, France.
| | - L Mauge
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, inserm UMR-S1140, 20, rue Leblanc, 75015 Paris, France; Inserm U970, PARCC (Paris cardiovascular research center), université Paris-Descartes, Sorbonne Paris-cité, 75019 Paris, France
| | - A-M Fischer
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, inserm UMR-S1140, 20, rue Leblanc, 75015 Paris, France; Inserm U970, PARCC (Paris cardiovascular research center), université Paris-Descartes, Sorbonne Paris-cité, 75019 Paris, France
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20
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Martin AC, Houssany-Pissot S, Zlotnik D, Taylor G, Godier A. [Management of the bleeding risk associated with antiplatelet agents]. Rev Med Interne 2017; 38:467-473. [PMID: 28528236 DOI: 10.1016/j.revmed.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/09/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 10/19/2022]
Abstract
Like all antithrombotic drugs, antiplatelet agents expose to a risk of bleeding complications. Clinical research has extensively focused on the efficacy of these drugs to reduce ischemic events. The bleeding risk associated with them was solely considered as an inevitable and acceptable complication. When two new potent P2Y12-receptor inhibitors, prasugrel and ticagrelor, were marketed, the risk of major bleeding increased. These new agents have modified the balance between the absolute risk reduction in ischemic events and the absolute risk increase in bleeding events. This paper is an update on the bleeding risk assessment associated with antiplatelet agents. It discusses the place of platelet function monitoring, and the optimal management of bleeding complications. It addresses the challenging issue of reversal of antiplatelet therapy, focusing especially on ticagrelor, which pharmacodynamics complicate bleeding management.
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Affiliation(s)
- A-C Martin
- Service de cardiologie, hôpital d'instruction des armées Percy, 92140 Clamart, France; Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, 75006 Paris, France.
| | - S Houssany-Pissot
- Service de cardiologie, hôpital d'instruction des armées Percy, 92140 Clamart, France
| | - D Zlotnik
- Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, 75006 Paris, France
| | - G Taylor
- Service d'anesthésie réanimation, fondation Adolphe-de-Rothschild, 75019 Paris, France
| | - A Godier
- Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, 75006 Paris, France; Service d'anesthésie réanimation, fondation Adolphe-de-Rothschild, 75019 Paris, France
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21
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Howlett J, Prudent C, De Maistre E, Fagnoni P, Lazzarotti A. [Hemorrhage treatment: Evaluation of the proper use of fibrinogen concentrate]. Therapie 2017; 72:517-524. [PMID: 28336161 DOI: 10.1016/j.therap.2017.01.009] [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: 12/13/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
An increase in fibrinogen concentrate prescriptions was noticed in 2015 after several guidelines regarding their use were published. We tried to evaluate if they were used appropriately. To evaluate the conformity of the prescriptions to these guidelines, we searched for each prescription if a dosage of blood fibrinogen was made, if its result was below the limit recommended to prescribe fibrinogen concentrate, and if the posology was in line with the recommendations. Effect and security of the treatment was also evaluated. We analyzed 202 prescriptions for 117 patients. The indications are respected except for one prescription for which we could not find it. The blood fibrinogen is measured for 76% of the prescriptions, 59% of the results are below the limit recommended to prescribe. The posology is conforming to the guidelines for 73% of the prescriptions, it is below the dose recommended for 20%. Patients who were prescribed low doses seemed less at risk than the others which questions the necessity of the prescriptions. The guidelines respect depends on the emergency of the prescription situation. It would be interesting to conduct a prospective study to better explain why doses below those recommended are prescribed.
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Affiliation(s)
- Jennifer Howlett
- Service pharmacie, hôpital François-Mitterrand, 14, rue Gaffarel, 21000 Dijon, France.
| | - Christelle Prudent
- Service pharmacie, hôpital François-Mitterrand, 14, rue Gaffarel, 21000 Dijon, France
| | - Emmanuel De Maistre
- Service hémostase, plateau technique de biologie, hôpital François-Mitterrand, 21000 Dijon, France
| | - Philippe Fagnoni
- Service pharmacie, hôpital François-Mitterrand, 14, rue Gaffarel, 21000 Dijon, France
| | - Aline Lazzarotti
- Service pharmacie, hôpital François-Mitterrand, 14, rue Gaffarel, 21000 Dijon, France
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22
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Nasri A, Mansour M, Brahem Z, Kacem A, Hassan AA, Derbali H, Messelmani M, Zaouali J, Mrissa R. Stroke disclosing primary aldosteronism: Report on three cases and review of the literature. Ann Endocrinol (Paris) 2017; 78:9-13. [PMID: 28168953 DOI: 10.1016/j.ando.2016.07.993] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas. MATERIALS AND METHODS We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke. The diagnosis of primary aldosteronism was established according to the Endocrine Society Clinical Practice Guideline, with a review of the literature on the spectrum of neurologic manifestations in PA. RESULTS We report on three cases, two women and a man, presenting with ischemic or hemorrhagic stroke, of early onset in two of them. All of the reported patients had hypertension and hypokaliemia. This association prompted the assessment of renin angiotensin aldosterone system (RAAS) disclosing PA, which was due to bilateral adenomas in the first one or bilateral adrenal hyperplasia in the two others. All patients refused the surgical option and received spironolactone with recurrence of stroke in one of them due to treatment incompliance. CONCLUSION Although cerebrovascular events are quite common in PA, their occurrence as initial feature can be misleading. The association of hypokaliemia and refractory hypertension in ischemic or hemorrhagic strokes should prompt an assessment of the RAAS to rule out PA and initiate adequate management as soon as possible in order to avoid further complications.
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Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
| | - Malek Mansour
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Zeineb Brahem
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Amel Kacem
- Department of Medicine, Regional Hospital of Jendouba, Tunisia
| | - Ahmed Abou Hassan
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Hager Derbali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Meriem Messelmani
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Jamel Zaouali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
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Godier A, Martin AC, Rosencher N, Susen S. [Direct oral anticoagulant associated bleeding]. J Mal Vasc 2016; 41:272-8. [PMID: 27297642 DOI: 10.1016/j.jmv.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/23/2016] [Indexed: 11/21/2022]
Abstract
Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements.
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Benoist D'azy C, Bonnin N, Maurin C, Farguette F, Chiambaretta F. [Vitreous hemorrhage as the initial manifestation of familial exudative vitreoretinopathy in an eight-year-old child]. J Fr Ophtalmol 2016; 39:549-53. [PMID: 27230891 DOI: 10.1016/j.jfo.2015.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/20/2015] [Revised: 08/13/2015] [Accepted: 08/28/2015] [Indexed: 10/21/2022]
Abstract
PURPOSE To report vitreous hemorrhage as the initial manifestation of familial exudative vitreoretinopathy (FEVR). METHODS Case report. RESULTS An 8-year-old child presented with vitreous hemorrhage leading to the discovery of large neovascularization. Fundus examination and fluorescein angiography showed the typical appearance of FEVR. A genetic study confirmed the diagnosis. Treatment by laser photocoagulation was performed with good recovery of visual acuity. CONCLUSION Ophthalmologists should be aware of familial exudative vitreoretinopathy (FEVR) so as not to misdiagnose this sight-threatening disease.
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Affiliation(s)
- C Benoist D'azy
- RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - N Bonnin
- RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; EA 7281 R2D2, Biochemistery Laboratory, Medicine Faculty, Auvergne University, 63000 Clermont-Ferrand, France; Centre d'ophtalmologie du Zénith, bâtiment Trident E, 46, rue de Sarliève , 63800 Cournon D'Auvergne, France.
| | - C Maurin
- RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Farguette
- RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Centre d'ophtalmologie du Zénith, bâtiment Trident E, 46, rue de Sarliève , 63800 Cournon D'Auvergne, France
| | - F Chiambaretta
- RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; EA 7281 R2D2, Biochemistery Laboratory, Medicine Faculty, Auvergne University, 63000 Clermont-Ferrand, France
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Deffieux X, de Rochambeau B, Chêne G, Gauthier T, Huet S, Lamblin G, Agostini A, Marcelli M, Golfier F. [Hysterectomy for benign pathology: Guidelines for clinical practice]. ACTA ACUST UNITED AC 2015; 44:1219-27. [PMID: 26530174 DOI: 10.1016/j.jgyn.2015.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology. METHODS Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method). RESULTS Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B). CONCLUSION The application of these recommendations should minimize risks associated with hysterectomy.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France.
| | - B de Rochambeau
- Service de gynécologie-obstétrique, hôpital Privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France
| | - G Chêne
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - S Huet
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - G Lamblin
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France
| | - M Marcelli
- Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France
| | - F Golfier
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite cedex, France
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Godier A, Gouin-Thibault I, Rosencher N, Albaladejo P. [Management of direct oral anticoagulants for invasive procedures]. ACTA ACUST UNITED AC 2015; 40:173-81. [PMID: 25778841 DOI: 10.1016/j.jmv.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/17/2014] [Accepted: 01/08/2015] [Indexed: 12/16/2022]
Abstract
Three new Direct Oral Anticoagulants (DOACs), rivaroxaban, apixaban and dabigatran etexilate are available on the French market. Management of DOAC-induced bleeding risk remains challenging. For elective procedures with high hemorrhagic risk, a last DOAC intake five days before procedure ensures complete elimination in all patients. Heparin bridging therapy should be proposed only to patients at high thrombotic risk. For elective procedures with low hemorrhagic risk, the DOAC intake of the night before procedure should be omitted. For urgent procedures with high bleeding risk, DOAC plasmatic concentration can be helpful: concentration lower than 30 ng/mL should enable performing the procedure; a high concentration is associated with a higher bleeding risk, especially if higher than 400 ng/mL. In case of massive bleeding, no antidote is approved yet; activated prothrombin concentrates or non-activated 4-factors prothrombin concentrates could be considered.
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Affiliation(s)
- A Godier
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France; Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France.
| | - I Gouin-Thibault
- Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France; Laboratoire d'hématologie, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France
| | - N Rosencher
- Service d'anesthésie-réanimation, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France
| | - P Albaladejo
- Pôle d'anesthésie-réanimation, CHU de Grenoble, 38000 Grenoble, France
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Sui J, Devoize L, Gonnu-Levallois S, Mulliez A, Baudet-Pommel M, Barthélémy I, Dang NP. [Retrospective study on bleeding and thromboembolic complications related to tooth extraction, in 93 patients usually treated by antithrombotic therapy]. ACTA ACUST UNITED AC 2015; 116:5-11. [PMID: 25458596 DOI: 10.1016/j.revsto.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/03/2014] [Accepted: 10/06/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Tooth extraction for patients treated by AVK and/or platelet aggregation inhibitor is performed according to local habits rather than to a consensus. We had for objective to assess hemorrhagic and thromboembolic risks for patients for whom treatment with AVK and/or platelet aggregation inhibitor was modified before tooth extraction. MATERIALS AND METHODS Ninety-three patient files were examined retrospectively. The following data was collected: epidemiological data, ASA score, nature and changes of antithrombotic therapy, preoperative INR, number teeth extracted, postoperative complications (bleeding and thromboembolic events). RESULTS Thirty-seven patients were treated with oral anticoagulants, 41 by a platelet aggregation inhibitor, 10 by double platelet aggregation inhibitor therapy, and 5 by an AVK-platelet aggregation inhibitor combination. At D0, the mean INR was decreased to 1.4, 4 patients with high thromboembolic risk had received heparin relay treatment; the treatment was stopped for 9 of the 56 patients on monotherapy with antiplatelet therapy, 4 were switched from clopidogrel to lysine acetylate; clopidogrel was stopped for 7 patients under combination therapy. Seven hundred and twenty-six avulsions (mean 8.1 per patient) were performed, 41 patients presented with mild/moderate bleeding, easily resolved. A patient presented with delayed hemorrhage at D6 (AVK overdose). No thromboembolic complication was reported. DISCUSSION The modification of antithrombotic treatment, as for surgery at high risk of bleeding, seems to limit the risk of bleeding without increasing thromboembolic risk.
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Vardon F, Bounes V, Ducassé JL, Minville V, Lapostolle F. [Out-of-hospital equipment of emergency medical services for hemorrhagic shock management: can do better!]. ACTA ACUST UNITED AC 2014; 33:621-5. [PMID: 25443039 DOI: 10.1016/j.annfar.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 09/08/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations. METHODS Multicenter descriptive observational study by email then phone with all the 370 French SMUR leaders. The questionnaire was created by investigators of the project through a Delphi method, and was about service protocols concerning hemorrhagic patient care, hemorrhagic parameters measure equipment available, intravenous solutes and drugs as well as various medical devices useful or perceived to be useful to support prehospital hemorrhagic shock. The results are expressed in numbers and percentages. RESULTS The overall response rate was 48% (n=178). Protocols were established in between 43% (n=76) and 47% (n=83) according to etiology, measuring devices were available in 5% (n=9) of the Smur for hemostasis up to 89% (n=158) for hemoglobin measurement. Available intravenous solutes were mainly isotonic salty serum (95%, n=169), hydroxylethylstarch (83%, n=148) and Ringer lactate (73%, n=130). Tranexamic acid was available in 84 (47%) Smur. The teams had access to erythrocytes concentrates, fresh frozen plasma and platelets in 84% (n=150), 44% (n=79) and 23% (n=41) respectively. Eighty-one (46%) Smur had tourniquets and 127 (71%) anti-shock trousers. Finally, 57 (32%) had a pelvic restraint belt. CONCLUSION There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts.
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Sauguet P, Aguilar-Martinez P, Boulot P, Escudié JB, Schved JF, Biron-Andréani C. [Carriers of haemophilia: Experience of a French university hospital]. ACTA ACUST UNITED AC 2015; 44:565-76. [PMID: 25263159 DOI: 10.1016/j.jgyn.2014.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/23/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To report the management of carriers of haemophilia in a French university hospital and assess different issues of these patients. PATIENTS AND METHODS Retrospective study of the carriers of haemophilia who consulted at the university hospital of Montpellier, France, between 1995 and 2011. Information were obtained from medical records and from a questionnaire sent to carriers. We recorded data about biological characteristics, bleeding tendency and management of pregnancies. RESULTS Sixty-four carriers of haemophilia A or B were included. Their median FVIII or FIX level was 52 % (range, 15-137 %). Menstrual bleeding lasted more than 7 days in 31 % of carriers. A total of 142 pregnancies started in 54 carriers, and 101 resulted in live births with 26 boys with haemophilia. Sixty-two prenatal diagnoses carried out, 15 have terminated their pregnancy because of a hemophiliac male fetus. Seventy-six percent of deliveries were vaginal delivery and 49 % took place in a level-3 maternity. There were 10.8 % and 8.5 % primary and secondary post-partum hemorrhage, respectively. CONCLUSION The risk of bleeding among carriers of haemophilia is associated with their antihemophilic factor level. To improve the management of carriers, a multidisciplinary and standardized medical record, with a specific questionnaire to evaluate bleedings, could be considered. A regional register that lists all carriers, regardless of their antihemophilic factor level, would also be useful.
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Di Roio C. [Perioperative intracranial hemorrhage from cerebral arteriovenous malformation]. ACTA ACUST UNITED AC 2014; 33:552. [PMID: 25148715 DOI: 10.1016/j.annfar.2014.06.003] [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: 05/27/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
Affiliation(s)
- C Di Roio
- Réanimation neurologique, GHE, 59, boulevard Pinel, 69677 Bron cedex, France.
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Bouvet C, Lehousse T, Sentilhes L, Branger B, Granry JC. [Declarative survey about postpartum haemorrhage management by anaesthesiologists in Pays de la Loire area (France): what's the adherence to clinical practice guidelines?]. ACTA ACUST UNITED AC 2014; 33:310-7. [PMID: 24836116 DOI: 10.1016/j.annfar.2014.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 03/14/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the management of postpartum hemorrhage (PPH) by anaesthesiologists in Pays de la Loire area. METHODS A declarative survey was conducted from November 2011 to January 2012 with an online questionnaire to assess prevention and PPH specific care and to clarify the PPH transfusion practices and interest of new therapies. Nine indicators of adherence to clinical practice guidelines were selected to distinguish two groups: one group "adhering to the RCP" and another "not adhering to the RCP". RESULTS Response rate 53%. One hundred and one responses were analyzed. Use of a collection bag graded blood receipt pockets 93%, start time of PPH noted: 76%, leaf specific monitoring: 67%, management of the third part of the work: 78%. The evacuation of the placenta is performed within 30minutes in 75% of cases. The transfusion strategy happens early (92% before the biological assessment results) and "aggressive" (ratio RCB/FFP is 1/1 for 72%). The use of tranexamic acid is not systematic (53%). Seventy-nine percent of respondents adhere to the RCP. Practitioners in maternity level 1 (with few deliveries) don't follow these RCP as much. CONCLUSION Some inappropriate practices remain in structures not used to support them. The use of new therapies remain controversial. The priority at this time is the implementation and enforcement of the current RCP, not their modifications.
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Abstract
OBJECTIVES The purpose of this literature review is, after a history and a point about current situation, to present the military use and precautions of use of tourniquet for civil and military medicine. DATA SOURCES A review of the Anglo-Saxon and French literature was performed in PUBMED database, from 1962 to 2012. The research was conducted using the following keywords: "tourniquet", "complications", "haemorrhage", "emergency", "military medicine", used alone or in combination. DATA EXTRACTION The extracted data concerned the history, the epidemiology, the interest of tourniquet during peacetime and wartime, adverse effects and the ratio benefit/risk. DATA SYNTHESIS The tourniquet is "a device which is tightened, in case of haemorrhage, around a limb in order to slow or stop the venous or arterial circulation before surgery…". This item is thus used in surgery to reduce intraoperative bleeding and in emergency medicine as a rescue technique for bleeding places non accessible to compression or to other technical hemostasis. It is also used for treating bleeding of mass casualties. However, its use is too poorly managed by health professionals and it remains risky. Recent armed conflicts have yet revived its day use. CONCLUSION The tourniquet has utility in times of war and in peacetime. In each case, indications and complications must be known.
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Affiliation(s)
- S Paul
- Département d'anesthésie et réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France.
| | - B Debien
- Département d'anesthésie et réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France
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Bachellerie B, Ruiz S, Conil JM, Crognier L, Seguin T, Georges B, Fourcade O. [Patient with acute renal injury presenting dabigatran overdose: Hemodialysis for surgery]. ACTA ACUST UNITED AC 2014; 33:44-6. [PMID: 24378048 DOI: 10.1016/j.annfar.2013.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/12/2013] [Indexed: 11/20/2022]
Abstract
Dabigatran is a direct thrombin inhibitor indicated for stroke and systemic embolism prevention in patients with non-valvular atrial fibrillation. No reversal agent exists, but hemodialysis has been proposed as dabigatran removal method. We report a case of an 80-year-old man presenting hemorrhage with dabigatran overdose caused by obstructive acute renal failure. Before nephrostomy, several hemodialysis sessions were necessary to remove dabigatran probably because of its large volume of distribution.
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Mais L, Galoo E, Nibaud A, Barba T, Pasquet F, Pavic M. [Complicated course of eosinophilic gastroenteritis: a case report and literature review]. Rev Med Interne 2013; 35:683-5. [PMID: 24315473 DOI: 10.1016/j.revmed.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/06/2012] [Accepted: 08/12/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Eosinophilic gastroenteritis is an unusual disease characterized by an eosinophilic infiltration of the gastrointestinal tract. The esophageal location of this disorder is uncommon and is usually revealed by dysphagia. Diagnosis is obtained by histology during endoscopy after exclusion of differential diagnosis. Treatment is based on systemic corticosteroids, which improve dramatically symptoms and endoscopic lesions. CASE REPORT We report an 88-year-old man who presented eosinophilic gastroenteritis with esophageal injury complicated by gastrointestinal haemorrhage and fistule. CONCLUSION Eosinophilic gastroenteritis may have a potentially unfavourable outcome. The treatment of complicated forms is not codified and often empirical.
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Affiliation(s)
- L Mais
- Service de pathologies digestives, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France.
| | - E Galoo
- Service de pathologies digestives, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France
| | - A Nibaud
- Service de médecine interne oncologie, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France
| | - T Barba
- Service de médecine interne oncologie, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France
| | - F Pasquet
- Service de médecine interne oncologie, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France
| | - M Pavic
- Service de médecine interne oncologie, HIA Desgenettes, 108, boulevard Pinel, 69175 Lyon cedex 03, France
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Kluger N, Cribier B. [Stigmata: From Saint-Francis of Assisi to idiopathic haematidrosis]. Ann Dermatol Venereol 2013; 140:771-7. [PMID: 24315222 DOI: 10.1016/j.annder.2013.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/13/2013] [Revised: 04/24/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Abstract
"Religious" stigmata describe body marks and sores that reflect the crucifixion wounds of Christ (hands and wrists, feet, flank, back, shoulders, forehead) and which are transferred to an individual through fervent prayer. "Non-religious" stigmata usually describe spontaneous episodes of bleeding with no identifiable cause outside any religious context. Irrespective of the setting in which they occur, such lesions are extremely striking. This review intends to summarize what is currently known about stigmata in the light of current medical knowledge, while stressing that the "spontaneous" nature of these lesions does not rule out a genuine medical cause.
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Affiliation(s)
- N Kluger
- Departments of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Helsinki University Central Hospital, Skin and Allergies Hospital, Helsinki, 2, PO Box 160, 00029 Hus, Finlande.
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Deffieux X, Gauthier T, Ménager N, Legendre G, Agostini A, Pierre F. [Prevention of the complications related to hysteroscopy: guidelines for clinical practice]. ACTA ACUST UNITED AC 2013; 42:1032-49. [PMID: 24210234 DOI: 10.1016/j.jgyn.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide clinical practice guidelines (CPGs) from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning the adverse events related to hysteroscopy. MATERIALS AND METHODS Review of literature using following Keywords: hysteroscopy; vaginoscopy; infection; perforation; intrauterine adhesions RESULTS Vaginoscopy should be the standard technique for outpatient hysteroscopy (grade A) using a miniature (≤ 3.5mm sheath) (grade A) rigid hysteroscope (grade C), using normal saline solution distension medium (grade C), without any anesthesia (conscious sedation should not be routinely used), without cervical preparation (grade B), without vaginal disinfection and without antibiotic prophylaxy (grade B). Misoprostol (grade A), vaginal estrogens (grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120 mmHg. The maximum fluid deficit of 2000 mL is suggested when using normal saline solution and 1000 mL is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (grade B). CONCLUSION Implementation of this guideline should decrease the prevalence of complications related to office and operative hysteroscopy.
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Vanhuyse F, Frotscher B, Lecompte T, Maureira P, Villemot JP, Folliguet T, Toussaint-Hacquard M. [Use of rFVIIa in intractable hemorrhage in patients on central veno-arterial ECMO]. ACTA ACUST UNITED AC 2013; 32:665-9. [PMID: 23993217 DOI: 10.1016/j.annfar.2013.07.794] [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: 03/26/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of our study is to describe the use of recombinant factor VIIa (rFVIIa) in patients on central veno-arterial ECMO with a particular attention on associated thrombotic complications. STUDY DESIGN Monocentric retrospective study. PATIENTS AND METHODS We examined 91 files of patients on ECMO between 2005 and 2010. During this period, eight patients presented refractory bleeding and benefited from rFVIIa treatment. RESULTS In six of the eight patients, the bleeding stopped. A decrease of the bleeding was noticed after the treatment of rFVIIa (before rFVIIa: 40.1±33.1mL/kg per 3 hours after rFVIIa: 5.4±3.2mL/kg per 3 hours (P=0.01). The transfusional needs were decreased after administration of rFVIIa. No thrombotic event was detected. Fibrinogen, d-dimers, platelet count and lactate were not modified by the treatment. Two patients were weaned from ECMO. One patient died 17 days after the weaning. The other patient survived without neurological damages. CONCLUSION The rFVIIa is a treatment of exception for patients on central veno-arterial ECMO and could be a last-resort treatment in the presence of a not curable massive bleeding.
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Affiliation(s)
- F Vanhuyse
- Département de chirurgie cardiovasculaire et transplantation, université de Lorraine, institut Louis-Mathieu du cœur et des vaisseaux, CHU de Nancy, 54511 Nancy, France.
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Bardon J, Fink J, de Montblanc J, Bergmann JF, Sarrut B, Benhamou D. [Off-label use of recombinant factor VII (rFVIIa) in teaching hospitals in Paris in 2010]. ACTA ACUST UNITED AC 2013; 32:659-64. [PMID: 23953834 DOI: 10.1016/j.annfar.2013.05.007] [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: 02/03/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Recombinant activated factor VII (rFVIIa) (Novoseven(®)) was initially developed as a substitutive treatment in haemophiliacs but has then been used in situations of major haemorrhage in non-haemophiliacs (off-label use). The goal of the present study was to assess the practice patterns when rFVIIa is used in off-label indications in major teaching hospitals of Paris in 2010. METHODS We retrospectively identified files of patients in whom rFVIIa had been used. Physicians in charge of these patients (or the most proxy physician available) were contacted and files analysed with one of the authors. Quality of rFVIIa used in these off-label situations was determined based on either French or European guidelines or the available literature when no guidelines could be found. Three categories were defined for indication, dosage, timing, associated biological factors and overall use: adequate, acceptable (mainly adequate but lacking some characteristics of an "ideal" prescription) and inadequate (lacking most of the necessary characteristics of an "ideal" prescription). RESULTS Among 59 patients who had an off-label prescription of rFVIIa, 49 prescriptions could be analysed. Indication for use and timing of administration were adequate in 100% of multiple trauma cases and 83% of obstetrical cases. Biological criteria associated with an improved efficacy were found in two thirds of prescriptions analysed. Overall, prescriptions were adequate or acceptable in 82% of cases. CONCLUSION In the vast majority of patients who received rFVIIa for off-label indications in teaching hospitals of the Paris area in 2010, prescriptions were in line with recommendations.
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Affiliation(s)
- J Bardon
- Service d'anesthésie-réanimation, hôpitaux universitaires Paris-Sud, France; Hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
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Mertes PM, Sirieix D. [New oral anticoagulants and emergency procedures]. ACTA ACUST UNITED AC 2013; 32:648-9. [PMID: 23958180 DOI: 10.1016/j.annfar.2013.07.795] [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: 11/28/2022]
Affiliation(s)
- P M Mertes
- Service d'anesthésie-réanimation chirurgicale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France; Groupe des anesthésistes-réanimateurs de l'hôpital privé d'Antony (GARHPA), 1, rue Velpeau, 92160 Antony, France.
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Tourtier JP, Palmier B, Tazarourte K, Raux M, Meaudre E, Ausset S, Sailliol A, Vivien B, Domanski L, Carli P. The concept of damage control: extending the paradigm in the prehospital setting. ACTA ACUST UNITED AC 2013; 32:520-6. [PMID: 23916519 DOI: 10.1016/j.annfar.2013.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this review is to present the progressive extension of the concept of damage control resuscitation, focusing on the prehospital phase. ARTICLE TYPE Review of the literature in Medline database over the past 10 years. DATA SOURCE Medline database looking for articles published in English or in French between April 2002 and March 2013. Keywords used were: damage control resuscitation, trauma damage control, prehospital trauma, damage control surgery. Original articles were firstly selected. Editorials and reviews were secondly studied. DATA SYNTHESIS The importance of early management of life-threatening injuries and rapid transport to trauma centers has been widely promulgated. Technical progress appears for external methods of hemostasis, with the development of handy tourniquets and hemostatic dressings, making the crucial control of external bleeding more simple, rapid and effective. Hypothermia is independently associated with increased risk of mortality, and appeared accessible to improvement of prehospital care. The impact of excessive fluid resuscitation appears negative. The interest of hypertonic saline is denied. The place of vasopressor such as norepinephrine in the early resuscitation is still under debate. The early use of tranexamic acid is promoted. Specific transfusion strategies are developed in the prehospital setting. CONCLUSION It is critical that both civilian and military practitioners involved in trauma continue to share experiences and constructive feedback. And it is mandatory now to perform well-designed prospective clinical trials in order to advance the topic.
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Affiliation(s)
- J-P Tourtier
- Emergency Department, Fire Brigade of Paris, 1, place Jules-Renard, 75017 Paris, France.
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Abstract
Hemorrhage is the leading cause of death in trauma patients who arrive alive at hospital. This type of hemorrhage has a "coagulopathic" component, specific to major trauma and associated with poor outcomes. Over the last decade, a better understanding of this trauma-induced coagulopathy lead to a new therapeutic approach requiring earlier and more aggressive management. This hemostatic resuscitation includes early activation of massive transfusion protocols with: 1) immediate delivery of blood packs with high ratios for RBC units: fresh frozen plasma: platelet-concentrates; 2) antifibrinolytics; 3) substitution of coagulation factors. However, early identification of coagulopathic patients requiring aggressive hemostatic resuscitation remains challenging, with an increasing role of point of care devices for hemostatic diagnosis and monitoring. Efforts have to be focused on the early diagnosis of coagulopathy for immediate delivery of blood products and coagulation factors to the right, accurately screened patients through pre-established protocols within the golden hour.
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Affiliation(s)
- A Godier
- Service d'anesthésie-réanimation chirurgicale, université Paris-Descartes, hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Abstract
The management of a patient in post-traumatic haemorrhagic shock will meet different logics that will apply from the prehospital setting. This implies that the patient has beneficiated from a "Play and Run" prehospital strategy and was sent to a centre adapted to his clinical condition capable of treating all haemorrhagic lesions. The therapeutic goals will be to control the bleeding by early use of tourniquet, pelvic girdle, haemostatic dressing, and after admission to the hospital, the implementation of surgical and/or radiological techniques, but also to address all the factors that will exacerbate bleeding. These factors include hypothermia, acidosis and coagulopathy. The treatment of these contributing factors will be associated to concepts of low-volume resuscitation and permissive hypotension into a strategy called "Damage Control Resuscitation". Thus, the objective in situation of haemorrhagic shock will be to not exceed a systolic blood pressure of 90 mmHg (in the absence of severe head trauma) until haemostasis is achieved.
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Affiliation(s)
- J-S David
- Department of Anaesthesia and Intensive Care, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France.
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Pernod G, Albaladejo P, Godier A, Samama CM, Susen S, Gruel Y, Blais N, Fontana P, Cohen A, Llau JV, Rosencher N, Schved JF, de Maistre E, Samama MM, Mismetti P, Sié P. Management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors: proposals of the working group on perioperative haemostasis (GIHP) - March 2013. Arch Cardiovasc Dis 2013; 106:382-93. [PMID: 23810130 DOI: 10.1016/j.acvd.2013.04.009] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [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: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 12/29/2022]
Abstract
Direct new oral anticoagulants (NOACs) - inhibitors of thrombin or factor Xa - are intended to be used largely in the treatment of venous thromboembolic disease or the prevention of systematic embolism in atrial fibrillation, instead of vitamin K antagonists. Like any anticoagulant treatment, they are associated with spontaneous or provoked haemorrhagic risk. Furthermore, a significant proportion of treated patients are likely to be exposed to emergency surgery or invasive procedures. Given the absence of a specific antidote, the action to be taken in these situations must be defined. The lack of data means that it is only possible to issue proposals rather than recommendations, which will evolve according to accumulated experience. The proposals presented here apply to dabigatran (Pradaxa(®)) and rivaroxaban (Xarelto(®)); data for apixaban and edoxaban are still scarce. For urgent surgery with haemorrhagic risk, the drug plasma concentration should be less or equal to 30ng/mL for dabigatran and rivaroxaban should enable surgery associated with a high bleeding risk. Beyond that, if possible, the intervention should be postponed by monitoring the drug concentration. The course to follow is then defined according to the NOAC and its concentration. If the anticoagulant dosage is not immediately available, worse propositions, based on the usual tests (prothrombin time and activated partial thromboplastin time), are presented. However, these tests do not really assess drug concentration or the risk of bleeding that depends on it. In case of serious bleeding in a critical organ, the effect of anticoagulant therapy should be reduced using a non-specific procoagulant drug as a first-line approach: activated prothrombin complex concentrate (aPCC) (FEIBA(®) 30-50U/kg) or non-activated PCC (50U/kg). In addition, for any other type of severe haemorrhage, the administration of a procoagulant drug, which is potentially thrombogenic in these patients, is discussed according to the NOAC concentration and the possibilities of mechanical haemostasis.
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Affiliation(s)
- Gilles Pernod
- Vascular Medicine Department, University Hospital, UJF-Grenoble 1/CNRS TIMC-IMAG UMR 5525/Themas, France.
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