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187 results on '"Roullet, Stéphanie"'

5. A nanobody against the VWF A3 domain detects ADAMTS13-induced proteolysis in congenital and acquired VWD

Author

Kizlik-Masson, Claire, Peyron, Ivan, Gangnard, Stéphane, Le Goff, Gaelle, Lenoir, Solen M, Damodaran, Sandra, Clavel, Marie, Roullet, Stéphanie, Regnault, Véronique, Rauch, Antoine, Vincent, Flavien, Jeanpierre, Emmanuelle, Dupont, Annabelle, Ternisien, Catherine, Donnet, Thibault, Christophe, Olivier D., van Belle, Eric, Denis, Cécile V., Casari, Caterina, Susen, Sophie, and Lenting, Peter J.

Published
2023
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6. Day-case robotic-assisted partial nephrectomy: feasibility and preliminary results of a prospective evaluation (UroCCR-25 AMBU-REIN study)

Author

Bernhard, Jean-Christophe, Robert, Grégoire, Ricard, Solène, Michiels, Clément, Capon, Grégoire, Boulenger de Hautecloque, Astrid, Bensadoun, Henri, Gay, Joséphine, Rogier, Julien, Tauzin-Fin, Patrick, Gross-Goupil, Marine, Benard, Antoine, Nouette, Karine, Roullet, Stéphanie, and Ferrière, Jean-Marie

Published
2022
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11. Diagnosis and management of heparin-induced thrombocytopenia

Author

Albaladejo, P., Belisle, S., Blais, N., Bonhomme, F., Borel-Derlon, A., Borg, J.Y., Bosson, J.-L., Cohen, A., Collet, J.-P., de Maistre, E., Faraoni, D., Fontana, P., Huet, D. Garrigue, Godier, A., Gruel, Y., Guay, J., Hardy, J.F., Huet, Y., Ickx, B., Laporte, S., Lasne, D., Levy, J.H., Llau, J., Le Gal, G., Lecompte, T., Lessire, S., Longrois, D., Madi-Jebara, S., Marret, E., Mas, J.L., Mazighi, M., Meyer, G., Mismetti, P., Morange, P.E., Motte, S., Mullier, F., Nathan, N., Nguyen, P., Ozier, Y., Pernod, G., Rosencher, N., Roullet, S., Roy, P.M., Samama, C.M., Schlumberger, S., Schved, J.F., Sié, P., Steib, A., Susen, S., Testa, S., van Belle, E., van Der Linden, P., Vincentelli, A., Zufferey, P., Gruel, Yves, De Maistre, Emmanuel, Pouplard, Claire, Mullier, François, Susen, Sophie, Roullet, Stéphanie, Blais, Normand, Le Gal, Grégoire, Vincentelli, André, Lasne, Dominique, Lecompte, Thomas, Albaladejo, Pierre, and Godier, Anne

Published
2020
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14. Position du GIHP sur les tests viscoélastiques : quelle place pour quelle indication en situation hémorragique ?

Author

Albaladejo, Pierre, Belisle, Sylvain, Blais, Normand, Bonhomme, Fanny, Borel-Derlon, Annie, Borg, Jeanne-Yvonne, Bosson, Jean-Luc, Cohen, Ariel, Collet, Jean-Philippe, de Maistre, Emmanuel, Faraoni, David, Fontana, Pierre, Garrigue Huet, Delphine, Godier, Anne, Gruel, Yves, Guay, Joanne, Hardy, Jean-François, Huet, Yann, Ickx, Brigitte, Laporte, Silvy, Lasne, Dominique, Levy, Jerrold H., Llau, Juan, Le Gal, Grégoire, Lecompte, Thomas, Lessire, Sarah, Longrois, Dan, Madi-Jebara, Samia, Marret, Emmanuel, Mas, Jean-Louis, Mazighi, Mikael, Mismetti, Patrick, Morange, Pierre-Emmanuel, Motte, Serge, Mullier, François, Nathan, Nathalie, Nguyen, Philippe, Ozier, Yves, Pernod, Gilles, Rosencher, Nadia, Roullet, Stéphanie, Roy, Pierre-Marie, Samama, Charles Marc, Schlumberger, Sylvie, Schved, Jean-François, Sié, Pierre, Steib, Annick, Susen, Sophie, van Belle, Eric, Van der Linden, Philippe, Vincentelli, André, Zufferey, Paul, and Garrigue, Delphine

Published
2018
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15. Management of bleeding and emergency invasive procedures in patients on dabigatran: Updated guidelines from the French Working Group on Perioperative Haemostasis (GIHP) – September 2016

Author

Albaladejo, Pierre, Pernod, Gilles, Godier, Anne, de Maistre, Emmanuel, Rosencher, Nadia, Mas, Jean Louis, Fontana, Pierre, Samama, Charles Marc, Steib, Annick, Schlumberger, Sylvie, Marret, Emmanuel, Roullet, Stéphanie, Susen, Sophie, Madi-Jebara, Samia, Nguyen, Philippe, Schved, Jean François, Bonhomme, Fanny, and Sié, Pierre

Published
2018
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17. Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) – September 2015

Author

Albaladejo, Pierre, Bonhomme, Fanny, Blais, Normand, Collet, Jean-Philippe, Faraoni, David, Fontana, Pierre, Godier, Anne, Llau, Juan, Longrois, Dan, Marret, Emmanuel, Mismetti, Patrick, Rosencher, Nadia, Roullet, Stéphanie, Samama, Charles-Marc, Schved, Jean-François, Sié, Pierre, Steib, Annick, and Susen, Sophie

Published
2017
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18. Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study.

Author

Soucy-Proulx, Maxim, Kato, Hiromi, Coeckelenbergh, Sean, Naili Kortaia, Salima, Herboulier, Laurence, Pittau, Gabriella, Pham, Patrick, Lemoine, Antoinette, Duranteau, Jacques, and Roullet, Stéphanie

Subjects
LIVER transplantation, HEMATOPOIESIS, BLOOD coagulation factors, PLATELET count, THROMBOSIS, SURGICAL site
Abstract

Background: Liver transplantation (LT) remains a potentially haemorrhagic procedure whose perioperative bleeding and transfusion could be better monitored using point-of-care devices. Quantra® is a device based on sonorheometry to assess whole blood clot formation. Our aims were to describe Quantra® parameters during LT and to study their correlations with standard laboratory parameters, and to determine Quantra® cut-off values for thrombocytopenia, hypofibrinogenemia and coagulation factors' deficit. Methods: In 34 patients undergoing LT, blood samples were collected before surgical incision, 15 min after the beginning of the anhepatic phase, and 15 min after arterial revascularization of the graft. Results: Clotting time (CT) was well correlated with prothrombin (PT) ratio and activated partial thromboplastin time (aPTT) ratio. Platelet contribution to clot stiffness (PCS) was correlated with platelets (ρ = 0.82, p < 0.001) and fibrinogen contribution clot stiffness (FCS) with fibrinogen (Fg) (ρ = 0.74, p < 0.001). CT predicted a PT ratio < 30% with an area under the curve (AUC) of 0.93 (95% CI 0.87–0.98; p < 0.001). PCS predicted a platelet count < 50 G/L with an AUC of 0.87 (95% CI 0.76–0.98, p < 0.001). FCS predicted a Fg < 1.0, 1.2 or 1.5 g/L, with an AUC of 0.86 (95% CI 0.77–094, p < 0.001), 0.82 (95% CI 0.74–0.91, p < 0.001) and 0.88 (95% CI 0.82–0.95, p < 0.001), respectively. Conclusion: Quantra® provides a rapid assessment of haemostasis during LT. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. 2022, , 860.

Author

UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Laboratoire de biologie clinique, Bareille, Marion, Lecompte, Thomas, Mullier, François, Roullet, Stéphanie, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Laboratoire de biologie clinique, Bareille, Marion, Lecompte, Thomas, Mullier, François, and Roullet, Stéphanie

Abstract

With the advent of new viscoelastometric hemostatic assay (VHA) devices, with ready-to-use cartridge reagents allowing for their use by people without special laboratory skills, the appreciation of the actual clinical value of VHAs in settings such as severe trauma, post-partum hemorrhage, cardiac surgery and liver transplantation still needs to be fully validated. While two of the newest versions remain based on a 'cup and pin' system (ROTEM sigma, ClotPro), two other new devices (TEG 6s, Quantra) rely on very different technologies: clotting blood is no longer in contact with the probe and challenged by oscillation of one of the components but explored with ultrasound exposure. A systematic literature search (including Sonoclot) retrieved 20 observational studies (19 prospective). Most studies pointed to imperfect agreements, highlighting the non-interchangeability of devices. Only a few studies, often with a limited number of patients enrolled, used a clinical outcome. No study compared VHA results with conventional laboratory assays obtained through a rapid tests panel. Clinical evidence of the utility of the new VHAs largely remains to be proven through randomized clinical trials, with clinically relevant outcomes, and compared to rapid panel hemostasis testing. The availability of new, improved VHA devices provides an impetus and an opportunity to do so.

Published
2023

21. Gestion des anticoagulants oraux directs pour la chirurgie et les actes invasifs programmés : propositions réactualisées du Groupe d’intérêt en hémostase périopératoire (GIHP) – septembre 2015

Author

Albaladejo, Pierre, Bonhomme, Fanny, Blais, Normand, Collet, Jean Philippe, Faraoni, David, Fontana, Pierre, Godier, Anne, Llau, Juan V., Longrois, Dan, Marret, Emmanuel, Mismetti, Patrick, Rosencher, Nadia, Roullet, Stéphanie, Samama, Charles Marc, Schved, Jean-François, Sie, Pierre, Steib, Annick, and Susen, Sophie

Published
2016
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23. Modèles murins en hémostase.

Author

Denis, Cécile V., Roullet, Stéphanie, and Casari, Caterina

Subjects
*VON Willebrand disease, *VON Willebrand factor, *HEMOSTASIS, *HEMORRHAGE, *MICE
Abstract

Since the advent of transgenesis techniques, the mouse model has become the model par excellence in research laboratories, making it possible to model various pathologies or better understand the functions of numerous proteins, in a controlled genetic environment. The resulting challenge has been to develop methods for assessing various phenotypes in a small model such as the mouse. Hemostasis is no exception, and procedures adapted to the measurement of bleeding have emerged. Some of these procedures, and in particular the most frequently used, will be detailed in this review. These experimental models have proliferated in response to the phenotypic heterogeneity of transgenic mice developed in the field of coagulation. We have endeavored to present an example of this heterogeneity, focusing on the mouse models of Willebrand disease that exist today. Indeed, a large number of Willebrand disease models are currently available, attempting as best they can to reproduce the most varied aspects of this extremely polymorphic pathology. These models will be discussed, taking stock of their respective contributions either to improving our knowledge of pathophysiological mechanisms, or as pre-clinical models for the evaluation of new therapies. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. 2022, , 860

Author

Bareille, Marion, Lecompte, Thomas, Mullier, François, Roullet, Stéphanie, UCL - SSS/IREC/MONT - Pôle Mont Godinne, and UCL - (MGD) Laboratoire de biologie clinique

Subjects
viscoelastometry, trauma, liver transplantation, postpartum hemorrhage, COVID-19, thromboelastography, fibrinogen, rotational thromboelastometry, viscoelastic testing, cardiac surgery, coagulopathy
Abstract

With the advent of new viscoelastometric hemostatic assay (VHA) devices, with ready-to-use cartridge reagents allowing for their use by people without special laboratory skills, the appreciation of the actual clinical value of VHAs in settings such as severe trauma, post-partum hemorrhage, cardiac surgery and liver transplantation still needs to be fully validated. While two of the newest versions remain based on a 'cup and pin' system (ROTEM sigma, ClotPro), two other new devices (TEG 6s, Quantra) rely on very different technologies: clotting blood is no longer in contact with the probe and challenged by oscillation of one of the components but explored with ultrasound exposure. A systematic literature search (including Sonoclot) retrieved 20 observational studies (19 prospective). Most studies pointed to imperfect agreements, highlighting the non-interchangeability of devices. Only a few studies, often with a limited number of patients enrolled, used a clinical outcome. No study compared VHA results with conventional laboratory assays obtained through a rapid tests panel. Clinical evidence of the utility of the new VHAs largely remains to be proven through randomized clinical trials, with clinically relevant outcomes, and compared to rapid panel hemostasis testing. The availability of new, improved VHA devices provides an impetus and an opportunity to do so.

Published
2023

27. A nanobody against the von Willebrand factor A3-domain detects ADAMTS13-induced proteolysis in congenital & acquired VWD

Author

Kizlik-Masson, Claire, primary, Peyron, Ivan, additional, Gangnard, Stéphane, additional, Le Goff, Gaelle Claire, additional, Lenoir, Solen, additional, Damodaran, Sandra, additional, Clavel, Marie, additional, Roullet, Stéphanie, additional, Regnault, Veronique, additional, Rauch, Antoine, additional, Vincent, Flavien, additional, Jeanpierre, Emmanuelle, additional, Dupont, Annabelle, additional, Ternisien, Catherine, additional, Donnet, Thibault, additional, Christophe, Olivier D., additional, Van Belle, Eric, additional, Denis, Cecile V, additional, Casari, Caterina, additional, Susen, Sophie, additional, and Lenting, Peter J, additional

Published
2022
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30. Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis

Author

Godon, Alexandre, primary, Gabin, Manon, additional, Levy, Jerrold H., additional, Huet, Olivier, additional, Chapalain, Xavier, additional, David, Jean-Stéphane, additional, Tacquard, Charles, additional, Sattler, Laurent, additional, Minville, Vincent, additional, Mémier, Vincent, additional, Blanié, Antonia, additional, Godet, Thomas, additional, Leone, Marc, additional, De Maistre, Emmanuel, additional, Gruel, Yves, additional, Roullet, Stéphanie, additional, Vermorel, Céline, additional, Samama, Charles Marc, additional, Bosson, Jean-Luc, additional, and Albaladejo, Pierre, additional

Published
2022
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31. Intraoperative measurement of the respiratory exchange ratio predicts postoperative complications after liver transplantation

Author

Coeckelenbergh, Sean, Desebbe, Olivier, Carrier, Francois Martin, Thepault, Francois, De Oliveira, Cécile, Pellerin, Florian, Le Canne, Cyril, Herboulier, Laurence, Laukaityte, Edita, Moussa, Maya, Toubal, Leila, Kato, Hiromi, Pham, Hung, Roullet, Stéphanie, Lanteri Minet, Marc, Amara, Youcef, Naili, Salima, Ciacio, Oriana, Cherqui, Daniel, Duranteau, Jacques, Vincent, Jean Louis, Van Der Linden, Philippe, Joosten, Alexandre, Coeckelenbergh, Sean, Desebbe, Olivier, Carrier, Francois Martin, Thepault, Francois, De Oliveira, Cécile, Pellerin, Florian, Le Canne, Cyril, Herboulier, Laurence, Laukaityte, Edita, Moussa, Maya, Toubal, Leila, Kato, Hiromi, Pham, Hung, Roullet, Stéphanie, Lanteri Minet, Marc, Amara, Youcef, Naili, Salima, Ciacio, Oriana, Cherqui, Daniel, Duranteau, Jacques, Vincent, Jean Louis, Van Der Linden, Philippe, and Joosten, Alexandre

Abstract

Background: During surgery, any mismatch between oxygen delivery (DO2) and consumption (VO2) can promote the development of postoperative complications. The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production (VCO2) to VO2, may be a useful noninvasive tool for detecting inadequate DO2. The primary objective of this study was to test the hypothesis that RER measured during liver transplantation may predict postoperative morbidity. Secondary objectives were to assess the ability of other variables used to assess the DO2/VO2 relationship, including arterial lactate, mixed venous oxygen saturation, and veno-arterial difference in the partial pressure of carbon dioxide (VAPCO2gap), to predict postoperative complications. Methods: This retrospective study included consecutive adult patients who underwent liver transplantation for end stage liver disease from June 27th, 2020, to September 5th, 2021. Patients with acute liver failure were excluded. All patients were routinely equipped with a pulmonary artery catheter. The primary analysis was a receiver operating characteristic (ROC) curve constructed to investigate the discriminative ability of the mean RER measured during surgery to predict postoperative complications. RER was calculated at five standardized time points during the surgery, at the same time as measurement of blood lactate levels and arterial and mixed venous blood gases, which were compared as a secondary analysis. Results: Of the 115 patients included, 57 developed at least one postoperative complication. The mean RER (median [25–75] percentiles) during surgery was significantly higher in patients with complications than in those without (1.04[0.96–1.12] vs 0.88[0.84–0.94]; p < 0.001). The area under the ROC curve was 0.87 (95%CI: 0.80–0.93; p < 0.001) with a RER value (Youden index) of 0.92 giving a sensitivity of 91% and a specificity of 74% for predicting the occurrence of postoperative complications. The RER outpe, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2022

34. Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors

Author

Angles, Emeline, primary, Robin, Florian, additional, Moal, Bertrand, additional, Roy, Maxim, additional, Sesay, Musa, additional, Ouattara, Alexandre, additional, Biais, Matthieu, additional, Roullet, Stéphanie, additional, Saillour-Glénisson, Florence, additional, and Nouette-Gaulain, Karine, additional

Published
2021
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38. Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review.

Author

UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Laboratoire de biologie clinique, UCL - (MGD) Service d'anesthésiologie, Bareille, Marion, Hardy, Michaël, Douxfils, Jonathan, Roullet, Stéphanie, Lasne, Dominique, Levy, Jerrold H, Stépanian, Alain, Susen, Sophie, Frère, Corinne, Lecompte, Thomas, Mullier, François, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Laboratoire de biologie clinique, UCL - (MGD) Service d'anesthésiologie, Bareille, Marion, Hardy, Michaël, Douxfils, Jonathan, Roullet, Stéphanie, Lasne, Dominique, Levy, Jerrold H, Stépanian, Alain, Susen, Sophie, Frère, Corinne, Lecompte, Thomas, and Mullier, François

Abstract

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until 31st December 2020. VET methods and parameters, and patients' features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

Published
2021

44. Impact of Preexisting Inflammatory Bowel Disease on the Outcome of Liver Transplantation for Primary Sclerosing Cholangitis

Author

Irlès‐Depé, Marie, primary, Roullet, Stéphanie, additional, Neau‐Cransac, Martine, additional, Dumortier, Jérôme, additional, Dharancy, Sébastien, additional, Houssel‐Debry, Pauline, additional, Boillot, Olivier, additional, Chiche, Laurence, additional, Laurent, Christophe, additional, Laharie, David, additional, and De Lédinghen, Victor, additional

Published
2020
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45. Day-case robotic-assisted partial nephrectomy: feasibility and preliminary results of a prospective evaluation (UroCCR-25 AMBU-REIN study)

Author

Bernhard, Jean-Christophe, primary, Robert, Grégoire, additional, Ricard, Solène, additional, Michiels, Clément, additional, Capon, Grégoire, additional, Boulenger de Hautecloque, Astrid, additional, Bensadoun, Henri, additional, Gay, Joséphine, additional, Rogier, Julien, additional, Tauzin-Fin, Patrick, additional, Gross-Goupil, Marine, additional, Benard, Antoine, additional, Nouette, Karine, additional, Roullet, Stéphanie, additional, and Ferrière, Jean-Marie, additional

Published
2020
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46. Diagnosis and management of heparin-induced thrombocytopenia

Author

Gruel, Yves, primary, De Maistre, Emmanuel, additional, Pouplard, Claire, additional, Mullier, François, additional, Susen, Sophie, additional, Roullet, Stéphanie, additional, Blais, Normand, additional, Le Gal, Grégoire, additional, Vincentelli, André, additional, Lasne, Dominique, additional, Lecompte, Thomas, additional, Albaladejo, Pierre, additional, Godier, Anne, additional, Albaladejo, P., additional, Belisle, S., additional, Blais, N., additional, Bonhomme, F., additional, Borel-Derlon, A., additional, Borg, J.Y., additional, Bosson, J.-L., additional, Cohen, A., additional, Collet, J.-P., additional, de Maistre, E., additional, Faraoni, D., additional, Fontana, P., additional, Huet, D. Garrigue, additional, Godier, A., additional, Gruel, Y., additional, Guay, J., additional, Hardy, J.F., additional, Huet, Y., additional, Ickx, B., additional, Laporte, S., additional, Lasne, D., additional, Levy, J.H., additional, Llau, J., additional, Le Gal, G., additional, Lecompte, T., additional, Lessire, S., additional, Longrois, D., additional, Madi-Jebara, S., additional, Marret, E., additional, Mas, J.L., additional, Mazighi, M., additional, Meyer, G., additional, Mismetti, P., additional, Morange, P.E., additional, Motte, S., additional, Mullier, F., additional, Nathan, N., additional, Nguyen, P., additional, Ozier, Y., additional, Pernod, G., additional, Rosencher, N., additional, Roullet, S., additional, Roy, P.M., additional, Samama, C.M., additional, Schlumberger, S., additional, Schved, J.F., additional, Sié, P., additional, Steib, A., additional, Susen, S., additional, Testa, S., additional, van Belle, E., additional, van Der Linden, P., additional, Vincentelli, A., additional, and Zufferey, P., additional

Published
2020
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48. Position du GIHP sur les tests viscoélastiques : quelle place pour quelle indication en situation hémorragique ?

Author

Roullet, Stéphanie, primary, de Maistre, Emmanuel, additional, Ickx, Brigitte, additional, Blais, Normand, additional, Susen, Sophie, additional, Faraoni, David, additional, Garrigue, Delphine, additional, Bonhomme, Fanny, additional, Godier, Anne, additional, Lasne, Dominique, additional, Albaladejo, Pierre, additional, Belisle, Sylvain, additional, Borel-Derlon, Annie, additional, Borg, Jeanne-Yvonne, additional, Bosson, Jean-Luc, additional, Cohen, Ariel, additional, Collet, Jean-Philippe, additional, Fontana, Pierre, additional, Garrigue Huet, Delphine, additional, Gruel, Yves, additional, Guay, Joanne, additional, Hardy, Jean-François, additional, Huet, Yann, additional, Laporte, Silvy, additional, Levy, Jerrold H., additional, Llau, Juan, additional, Le Gal, Grégoire, additional, Lecompte, Thomas, additional, Lessire, Sarah, additional, Longrois, Dan, additional, Madi-Jebara, Samia, additional, Marret, Emmanuel, additional, Mas, Jean-Louis, additional, Mazighi, Mikael, additional, Mismetti, Patrick, additional, Morange, Pierre-Emmanuel, additional, Motte, Serge, additional, Mullier, François, additional, Nathan, Nathalie, additional, Nguyen, Philippe, additional, Ozier, Yves, additional, Pernod, Gilles, additional, Rosencher, Nadia, additional, Roullet, Stéphanie, additional, Roy, Pierre-Marie, additional, Samama, Charles Marc, additional, Schlumberger, Sylvie, additional, Schved, Jean-François, additional, Sié, Pierre, additional, Steib, Annick, additional, van Belle, Eric, additional, Van der Linden, Philippe, additional, Vincentelli, André, additional, and Zufferey, Paul, additional

Published
2018
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49. Gestion de la coagulopathie et de la transfusion au cours de la transplantation hépatique : Facteurs de risque de saignement, place du monitorage délocalisé de l’hémostase, étude de la génération de thrombine et de l’hyperfibrinolyse

Author

Roullet, Stéphanie and STAR, ABES

Subjects
Thrombin generation, Liver transplantation, Hyperfibrinolyse, Thromboélastométrie, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Hyperfibrinolysis, Transfusion, Thromboelastometry, Génération de thrombine, Transplantation hépatique
Abstract

Liver transplantation (LT) is a bleeding procedure, in which all the haemostatic steps (primary haemostasis, secondary haemostasis, fibrinolysis) are impaired. We have first shown the predictive factors of bleeding and transfusion were difficult to determine and were of poor clinical relevance. Then, we showed that thromboelastometry (ROTEM®) could detect thrombocytopenia and hypofibrinogenemia during LT. However, the utilisation of an algorithm based on ROTEM® results did not led to less bleeding and transfusion when compared to an algorithm based on laboratory results. Moreover, ROTEM® lacked sensitivity to detect hyperfibrinolysis. Thrombin is the key-enzyme of coagulation cascade. The Calibrated Automated Thrombogram (CAT®) is the reference test for thrombin generation. We searched for rapid tools to evaluate thrombin generation, usable in routine and on individual plasma samples. The Thrombodynamics-4D® (TD4D) enabled in the same time study of fibrin clot formation and propagation in time and space and thrombin generation. Hyperfibrinolysis is encountered in 20 to 66% of LT procedures. It is associated with more bleeding and transfusion. Rapid diagnosis of hyperfibrinolysis would allow a quick and target treatment with antifibrinolytic drugs. Lysis Timer was more sensitive than ROTEM® to detect hyperfibrinolysis. TD4D also visualized clot lysis. Routine utilization of these new devices now requires validation of its results in fresh plasma, after acceleration of pre-analytic steps (rapid centrifugation) and clinical studies to find their place in transfusion algorithms., La transplantation hépatique (TH) est une intervention à risque hémorragique, au cours de laquelle toutes les étapes de la coagulation (hémostase primaire, hémostase secondaire, fibrinolyse) sont perturbées. Nous avons d’abord montré que les facteurs de risque de saignement et transfusion étaient difficiles à identifier et n’étaient pas cliniquement très pertinents. Puis nous avons montré que la thromboélastométrie (ROTEM®) pouvait diagnostiquer la thrombopénie et l’hypofibrinogénémie au cours de la TH, même si l’utilisation d’un algorithme basé sur le ROTEM® ne diminuait pas le saignement ni la transfusion par rapport à un algorithme basé sur les résultats du laboratoire. De plus le ROTEM® manquait de sensibilité pour détecter l’hyperfibrinolyse. La thrombine est l’enzyme-clé de la cascade de la coagulation. Le Calibrated Automated Thrombogram (CAT®) est la méthode de référence de génération de thrombine. Nous avons cherché des moyens rapides d’évaluation de la génération de thrombine, utilisable en routine et sur échantillons individuels. Le Thrombodynamics-4D® (TD4D) permettait à la fois l’étude de la formation et de la propagation du caillot de fibrine dans le temps et l’espace et de la génération de thrombine. Une hyperfibrinolyse survient au cours de 20 à 66% des TH. Elle majore le saignement et la transfusion. Le diagnostic rapide de l’hyperfibrinolyse permettrait un traitement rapide et ciblé par antifibrinolytique. Le Lysis Timer était plus sensible que le ROTEM® pour détecter les hyperfibrinolyses. Le TD4D permettait également de visualiser la lyse du caillot. L’utilisation en routine de ces nouveaux appareils nécessite la validation des résultats sur plasma frais, après accélération des étapes pré-analytiques (centrifugation rapide) et des études cliniques pour les positionner au sein d’algorithmes transfusionnels.

Published
2018

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