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Chaussade E, Hanon O, Boully C, Labourée F, Caillard L, Gerotziafas G, Vidal JS, Elalamy I. Real-Life Peak and Trough Dabigatran Plasma Measurements over Time in Hospitalized Geriatric Patients with Atrial Fibrillation. J Nutr Health Aging 2018; 22:165-173. [PMID: 29300437 DOI: 10.1007/s12603-017-0982-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few geriatric patients were included in studies on direct oral anticoagulants and data on dabigatran concentration and safety are needed in this population. Our objectives were to evaluate peak and trough dabigatran plasma concentrations over time in a geriatric population and to identify factors associated with dabigatran plasma concentrations and to assess the relationship with bleeding events. METHODS Peak and trough dabigatran plasma concentration were performed 4,8,15,30,45 days after inception of dabigatran treatment in 68 consecutive patients ≥75 years old hospitalized in a geriatric hospital with atrial fibrillation. Bleeding events were monitored for 1 year. RESULTS Mean age was 85.8(5.1) years old and 76.5% were women. Overall, 541 dabigatran plasma measurements (270 peak, 271 trough) were performed. Mean dabigatran concentrations of the 5 sequential measurements ranged 106-146ng/mL for peak and 66-84ng/mL for trough. Renal failure was associated with high peak and trough dabigatran concentration. Inter- and intra-individual coefficients of variation were 59.5% and 44.7% for peak and 74.5% and 44.6% for trough. Participants in the lower two tertiles of dabigatran concentration at day 8 (D8) remained below the 90th percentile (243.9ng/ml) on the next measurements. Bleeding events were associated with high trough dabigatran concentrations. Trough dabigatran concentration at D8>243.9ng/mL significantly predicted bleeding. CONCLUSION In this geriatric population, renal function and low albumin were associated with dabigatran concentrations. Despite large variability, participants in the lower two tertiles of dabigatran concentration at D8 remained below the 90th percentile on the following measurements. D8 dabigatran trough concentration≥243.9ng/mL identified patients at risk of bleeding.
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Affiliation(s)
- E Chaussade
- Prof. Olivier Hanon, Hôpital Broca, 54-56 Pascal, 75013 Paris, France, Tel: +33 1 44 08 30 00, Fax: +33 1 44 08 36 18,
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Philippi N, Noblet V, Duron E, Cretin B, Boully C, Wisniewski I, Seux ML, Martin-Hunyadi C, Chaussade E, Demuynck C, Kremer S, Lehéricy S, Gounot D, Armspach JP, Hanon O, Blanc F. Exploring anterograde memory: a volumetric MRI study in patients with mild cognitive impairment. Alzheimers Res Ther 2016; 8:26. [PMID: 27473839 PMCID: PMC4967326 DOI: 10.1186/s13195-016-0190-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this volumetric study was to explore the neuroanatomical correlates of the Free and Cued Selective Reminding Test (FCSRT) and the Delayed Matching-to-Sample-48 items (DMS-48), two tests widely used in France to assess verbal and visual anterograde memory. We wanted to determine to what extent the two tests rely on the medial temporal lobe, and could therefore be predictive of Alzheimer's disease, in which pathological changes typically start in this region. METHODS We analysed data from a cohort of 138 patients with mild cognitive impairment participating in a longitudinal multicentre clinical research study. Verbal memory was assessed using the FCSRT and visual recognition memory was evaluated using the DMS-48. Performances on these two tests were correlated to local grey matter atrophy via structural MRI using voxel-based morphometry. RESULTS Our results confirm the existence of a positive correlation between the volume of the medial temporal lobe and the performance on the FCSRT, prominently on the left, and the performance on the DMS-48, on the right, for the whole group of patients (family-wise error, P < 0.05). Interestingly, this region remained implicated only in the subgroup of patients who had deficient scores on the cued recall of the FCSRT, whereas the free recall was associated with prefrontal aspects. For the DMS-48, it was only implicated for the group of patients whose performances declined between the immediate and delayed trial. Conversely, temporo-parietal cortices were implicated when no decline was observed. Within the medial temporal lobe, the parahippocampal gyrus was prominently involved for the FCSRT and the immediate trial of the DMS-48, whereas the hippocampus was solely involved for the delayed trial of the DMS-48. CONCLUSIONS The two tests are able to detect an amnestic profile of the medial temporal type, under the condition that the scores remain deficient after the cued recall of the FCSRT or decline on the delayed recognition trial of the DMS-48. Strategic retrieval as well as perceptual/attentional processes, supported by prefrontal and temporo-parietal cortices, were also found to have an impact on the performances. Finally, the implication of the hippocampus appears time dependent, triggered by a longer delay than the parahippocampus, rather than determined by the sense of recollection or the encoding strength associated with the memory trace.
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Affiliation(s)
- N Philippi
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France. .,University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France. .,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France. .,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France.
| | - V Noblet
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - E Duron
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Cretin
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France.,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France
| | - C Boully
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - I Wisniewski
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - M L Seux
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Martin-Hunyadi
- University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
| | - E Chaussade
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Demuynck
- University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
| | - S Kremer
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France.,Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - S Lehéricy
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Paris 6-Inserm U1127, CNRS 7225, Institut du Cerveau et de la Moelle (ICM), Centre de NeuroImagerie de Recherche (CENIR), Paris, France
| | - D Gounot
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - J P Armspach
- University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France
| | - O Hanon
- Department of Geriatrics, Broca Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, EA4468, Paris, France
| | - F Blanc
- Department of Neurology, University Hospital of Strasbourg, Neuropsychology Unit, Strasbourg, France.,University of Strasbourg, CNRS, ICube laboratory, FMTS, Strasbourg, France.,University Hospital of Strasbourg, Centre Mémoire Ressources et Recherche, Strasbourg, France.,Department of Geriatrics, University Hospital of Strasbourg, Strasbourg, France
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Hanon O, Boully C, Caillard L, Labourée F, Cochiello S, Chaussade E. Treatment of Hypertensive Patients With Diabetes and Microalbuminuria With Combination Indapamide SR/Amlodipine: Retrospective Analysis of NESTOR. Am J Hypertens 2015; 28:1064-71. [PMID: 25628416 DOI: 10.1093/ajh/hpu297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/09/2014] [Accepted: 12/10/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Combination treatments for hypertension most often include a renin-angiotensin-aldosterone system (RAAS) inhibitor. However, systolic blood pressure (SBP) remains difficult to control. Non-RAAS-inhibiting strategies such as calcium channel blocker/thiazide-like diuretic combinations may offer effective alternatives. METHODS Hypertensive diabetic patients with microalbuminuria were included in this retrospective, post-hoc analysis of the Natrilix SR Versus Enalapril Study in Hypertensive Type 2 Diabetics With MicrOalbuminuRia (NESTOR) trial if they were uncontrolled on monotherapy (indapamide slow release (SR) 1.5 mg or enalapril 10mg) and had been given add-on amlodipine 5 mg. Patients uncontrolled with monotherapy/amlodipine 5mg were uptitrated to 10 mg. RESULTS After 52 weeks, supine SBP/diastolic BP (DBP) decreased from baseline by 26±13/14±9 mm Hg in the indapamide SR/amlodipine group (n = 135) and by 21±14/11±9 mm Hg in the enalapril/amlodipine group (n = 156) (P = 0.006 for ΔSBP). In the amlodipine 10mg subgroup, SBP/DBP decreased from baseline by 26±13/13±9 mm Hg in the indapamide SR/amlodipine group (n = 62) and by 20±13/12±8 mm Hg in the enalapril/amlodipine group (n = 77) (P = 0.02 for ΔSBP). Treatment with indapamide SR/amlodipine was well tolerated. Few patients experienced edema, with no between-group differences. As expected with diuretics, slight changes in kalemia and in uricemia were observed in the indapamide SR/amlodipine group. Changes in fasting glucose, lipids, natremia, and creatinine clearance were similar between groups. CONCLUSIONS Indapamide SR/amlodipine results in superior SBP reduction with a safety profile in line with that of its components and tolerability equivalent to that of an angiotensin-converting enzyme inhibitor/amlodipine strategy.
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Affiliation(s)
- Olivier Hanon
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
| | - Clemence Boully
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France
| | - Laure Caillard
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France
| | - Florian Labourée
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France
| | - Sophie Cochiello
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France
| | - Edouard Chaussade
- Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France
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