34 results on '"Virginie Barbay"'
Search Results
2. Management and follow-up of pregnancy-onset thrombotic thrombocytopenic purpura: the French experience
- Author
-
Jean-François, Augusto, Elie, Azoulay, Virginie, Barbay, Ygal, Benhamou, Jaccard, Arnaud, Anne, Charvet-Rumpler, Dominique, Chauveau, Gabriel, Choukroun, Jean-Philippe, Coindre, Paul, Coppo, Yahsou, Delmas, Salanoubat, Celia, Antoine, Dossier, Ville, Simon, Véronique, Frémeaux-Bacchi, Lionel, Galicier, Steven, Grangé, Bertrand, Guidet, Jean-Michel, Halimi, Neel, Antoine, Miguel, Hié, Frédéric, Jacobs, Bérangère, Joly, Tarik, Kanouni, Gilles, Kaplanski, Rieu, Virginie, Véronique, Le Guern, Bruno, Moulin, Jean-Michel, Rebibou, Mario, Ojeda Uribe, Nathalie, Parquet, Frédéric, Pène, Pierre, Perez, Pascale, Poullin, Claire, Pouteil-Noble, Claire, Presne, François, Provôt, Mesnard, Laurent, Samir, Saheb, Amélie, Seguin, Aude, Servais, Alain, Stépanian, Agnès, Veyradier, Cécile, Vigneau, Alain, Wynckel, Patricia, Zunic, Thierry, Krummel, Marc, Ulrich, Alexandre, Hertig, Suzon, Benoît, Gilardin, Laurent, Moglie, Le Quintrec, Theresa, Kwon, Valérie, Chatelet, Damien, Ducheyron, Nihal, Martis, Manon, Marie, David, Ribes, Anne-Marie, Ronchetti, Béranger, Nicolas, Coppo, Paul, Tsatsaris, Vassilis, Boisseau, Pierre, Provôt, François, Delmas, Yahsou, Poullin, Pascale, Vanhoorelbeke, Karen, Veyradier, Agnès, and Joly, Bérangère S. more...
- Published
- 2024
- Full Text
- View/download PDF
Catalog
3. Severe acquired Factor VII deficiency complicating an aplastic anemia, successfully treated with corticosteroids
- Author
-
Batton, Romain, Pierre, Chamouni, Marion, Carrette, Gaëtan, Sauvêtre, and Virginie, Barbay
- Published
- 2024
- Full Text
- View/download PDF
4. Point-of-Care Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Comparison of Thromboelastography 6S, Thromboelastometry Sigma, and Quantra
- Author
-
Zoe Demailly, Veronique Wurtz, Virginie Barbay, Elisabeth Surlemont, Vincent Scherrer, Vincent Compère, Paul Billoir, Thomas Clavier, and Emmanuel Besnier
- Subjects
Anesthesiology and Pain Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
- Full Text
- View/download PDF
5. Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience
- Author
-
Cécile, Landart, Virginie, Barbay, Pierre, Chamouni, and Olivier, Trost
- Subjects
Otorhinolaryngology ,Oral Surgical Procedures ,Humans ,Surgery ,Oral Surgery ,Hemophilia A ,Surgery, Oral - Abstract
The management of patients with inherited bleeding disorders in oral surgery requires the systematic evaluation of bleeding risk and the setting up of an adequate treatment protocol by the referring haematologist, defining a replacement therapy and a recommended length of hospital stay. The purpose of this study was to determine the bleeding risk associated with oral surgery for each type of inherited bleeding disorder and to evaluate the efficacy of the treatment protocols set up in our tertiary care center.We included all patients with an inherited bleeding disorder, managed in our oral and maxillofacial surgery department with a treatment protocol set up by our local Haemophilia Treatment Centre for an oral surgical procedure.Between January 2006 and December 2018, 295 treatment protocols were set up for the management of patients with haemorrhagic risk in oral surgical procedures. Of these, 203 were scheduled to take place in our department. A total of 180 oral surgical procedures for 147 patients were included. The incidence of bleeding complications in our study was 4.44% (8 out of 180) with a significantly higher risk in patients with haemophilia, the mean time to onset of bleeding was 11 days.The use of a treatment protocol for the management of patients with inherited bleeding disorders in oral surgery seems effective. Our rate of bleeding complications was comparable to data in the literature, and often lower. more...
- Published
- 2022
- Full Text
- View/download PDF
6. Cardiac troponin‐I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center
- Author
-
Benhamou, Y., Boelle, P.‐Y., Baudin, B., Ederhy, S., Gras, J., Galicier, L., Azoulay, E., Provôt, F., Maury, E., Pène, F., Mira, J.‐P., Wynckel, A., Presne, C., Poullin, P., Halimi, J.‐M., Delmas, Y., Kanouni, T., Seguin, A., Mousson, C., Servais, A., Bordessoule, D., Perez, P., Hamidou, M., Cohen, A., Veyradier, A., Coppo, P., Elie, Azoulay, Virginie, Barbay, Guy, Bonmarchand, Dominique, Bordessoule, Christophe, Charasse, Dominique, Chauveau, Gabriel, Choukroun, Jean‐Philippe, Coindre, Paul, Coppo, Elise, Corre, Yahsou, Delmas, Georges, Deschenes, Alain, Devidas, Olivier, Fain, Véronique, Frémeaux‐Bacchi, Lionel, Galicier, Bertrand, Guidet, Jean‐Michel, Halimi, Mohamed, Hamidou, Raoul, Herbrecht, Frédéric, Jacobs, Bérangère, Joly, Tarik, Kanouni, Alexandre, Lautrette, Véronique, Le Guern, Chantal, Loirat, Jean‐Paul, Mira, Bruno, Moulin, Christiane, Mousson, Mario, Ojeda Uribe, Abdelkader, Ouchenir, Nathalie, Parquet, Julie, Peltier, Pierre, Perez, Pascale, Poullin, Claire, Pouteil‐Noble, Claire, Presne, François, Provôt, Jean‐Antoine, Ribeil, Eric, Rondeau, Samir, Saheb, Benoît, Schlemmer, Amélie, Seguin, Alain, Stépanian, Jean‐Paul, Vernant, Agnès, Veyradier, Cécile, Vigneau, François, Vrtovsnick, Alain, Wynckel, Martine, Wolf, and Patricia, Zunic more...
- Published
- 2015
- Full Text
- View/download PDF
7. Evaluation of thrombin generation assay in factor XI deficiency
- Author
-
Sabine Brunel, Guillaume Feugray, Marielle Fresel, Virginie Barbay, Véronique Le Cam Duchez, Pierre Chamouni, Paul Billoir, Marie Hélène Chrétien, and Fiston Kasonga
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Factor XI Deficiency ,Clinical Biochemistry ,Biochemistry ,Thrombin generation ,Young Adult ,Pregnancy ,Internal medicine ,medicine ,Humans ,Child ,Blood Coagulation ,Factor XI ,Aged ,Plasma samples ,business.industry ,Biochemistry (medical) ,Thrombin ,General Medicine ,Plasma levels ,Middle Aged ,medicine.disease ,Endocrinology ,Coagulation ,Female ,Blood Coagulation Tests ,business - Abstract
Factor XI (FXI) deficiency is characterized by a lack of correlation between FXI plasma levels and the occurrence of hemorrhagic events. The main objective of our study was to determine whether thrombin generation assay (TGA) could be used to assess the hemorrhagic phenotype of patients with FXI deficiency.All patients had confirmed laboratory measurement of FXI 50% in two plasma samples. Relevant bleeding history was evaluated by a senior physician. TGA was performed with Calibrated Automated Thrombography, in platelet poor plasma, from patients and healthy controls. The assay was performed with PPP low reagent (1 pM of human tissue factor).Seventy-six patients with FXI deficiency were included between 2011 and 2020. Among them, eight patients had severe deficiency (FXI 15%). Mean age was 34 years [range: 9-77]. Endogenous thrombin potential (ETP) was significantly lower in patients with FXI deficiency and bleeding (573 nM·min [225-1214]) or no bleeding (732 nM·min [222-1435]), compared to healthy controls (1184 nM·min [933-1518]). No difference was observed for ETP and peak between patients with FXI deficiency and bleeding and patients with FXI deficiency and no bleeding. No difference was observed for ETP (923 nM·min [377-1497] vs 1063 nM·min [252-2529]), peak (82 nM [28-154] vs 131 nM [20-330]) or velocity (13.7 nM/min [3.6-29.6] vs 26.5 nM/min [2.5-90]) in women with (n = 4) and without history (n = 17) of post-partum bleeding. No difference of thrombin generation was observed in pregnant women with FXI deficiency (ETP: 1395 nM·min [351-2529]; peak: 154 nM [26-330]; velocity: 29.6 nM/min [4.1-90.0]), compared to healthy controls and a control group of healthy pregnant women.In conclusion, under our experimental condition, a non-significant decrease of thrombin generation was observed in plasma samples of patients with FXI deficiency and bleeding. Our results suggest an increase of coagulation parameters during pregnancy in women with FXI deficiency. A larger sample size or other experimental conditions are required to evaluate the use of TGA in FXI deficiency. more...
- Published
- 2021
- Full Text
- View/download PDF
8. Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest Study
- Author
-
Justine Hugon-Rodin, Camille Carrière, Ségolène Claeyssens, Nathalie Trillot, Nicolas Drillaud, Christine Biron-Andreani, Cécile Lavenu-Bombled, Anna Wieland, Claire Flaujac, Natalie Stieltjes, Aurélien Lebreton, Thomas Brungs, Andrea Hegglin, Mathieu Fiore, Céline Desconclois, Valérie Gay, Brigitte Tardy-Poncet, Philippe Beurrier, Virginie Barbay, Pierre Chamouni, Emmanuel De Maistre, Tomas Simurda, and Alessandro Casini more...
- Subjects
Hematology ,610 Medicine & health - Abstract
BACKGROUND Women with hereditary fibrinogen disorders (HFDs) seem to be at increased risk of adverse obstetrical outcomes, but epidemiologic data are limited Patients/methods: We conducted a retrospective and prospective international study to determine the prevalence of pregnancy complications, the modalities and management of delivery, and the postpartum events. RESULTS A total of 425 pregnancies were investigated from 159 women (49 hypofibrinogenemia, 95 dysfibrinogenemia, 15 hypodysfibrinogenemia). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) in a late miscarriage and 4 (0.9%) in an intrauterine fetal death. Prevalence of live birth was similar among the types of HFD (p=0.31). Obstetrical complications were observed in 54 (17.3%) of live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most 56deliveries were spontaneous (218, 74.1%) with a vaginal non-instrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, while 71 (16.6%) and 129 (44.9%) were under general or no anesthesia, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) of pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were more at risk of bleeding during the pregnancy (p=0.04). CONCLUSIONS Compared to European epidemiologic data, we did not observe a greater frequency of miscarriage while retroplacental hematoma, postpartum hemorrhage and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on management of pregnancy in HFDs. more...
- Published
- 2023
- Full Text
- View/download PDF
9. Management and follow-up of pregnancy-onset thrombotic thrombocytopenic purpura: the French experience
- Author
-
Béranger, Nicolas, Coppo, Paul, Tsatsaris, Vassilis, Boisseau, Pierre, Provôt, François, Delmas, Yahsou, Poullin, Pascale, Vanhoorelbeke, Karen, Veyradier, Agnès, Joly, Bérangère S., Jean-François, Augusto, Elie, Azoulay, Virginie, Barbay, Ygal, Benhamou, Jaccard, Arnaud, Anne, Charvet-Rumpler, Dominique, Chauveau, Gabriel, Choukroun, Jean-Philippe, Coindre, Paul, Coppo, Yahsou, Delmas, Salanoubat, Celia, Antoine, Dossier, Ville, Simon, Véronique, Frémeaux-Bacchi, Lionel, Galicier, Steven, Grangé, Bertrand, Guidet, Jean-Michel, Halimi, Neel, Antoine, Miguel, Hié, Frédéric, Jacobs, Bérangère, Joly, Tarik, Kanouni, Gilles, Kaplanski, Rieu, Virginie, Véronique, Le Guern, Bruno, Moulin, Jean-Michel, Rebibou, Mario, Ojeda Uribe, Nathalie, Parquet, Frédéric, Pène, Pierre, Perez, Pascale, Poullin, Claire, Pouteil-Noble, Claire, Presne, François, Provôt, Mesnard, Laurent, Samir, Saheb, Amélie, Seguin, Aude, Servais, Alain, Stépanian, Agnès, Veyradier, Cécile, Vigneau, Alain, Wynckel, Patricia, Zunic, Thierry, Krummel, Marc, Ulrich, Alexandre, Hertig, Suzon, Benoît, Gilardin, Laurent, Moglie, Le Quintrec, Theresa, Kwon, Valérie, Chatelet, Damien, Ducheyron, Nihal, Martis, Manon, Marie, David, Ribes, and Anne-Marie, Ronchetti more...
- Abstract
•Three distinct entities of pregnancy-onset TTP are singled out: iTTP, uTTP, and cTTP, with fetal outcome closely linked to gestational age.•In the context of pregnancy, most iTTP and uTTP are shown to have an open ADAMTS13 conformation at acute phase. more...
- Published
- 2024
- Full Text
- View/download PDF
10. Theophylline adenosine dipyridamole (CTAD) and citrate evaluation to survey unfractionated heparin treatment: a delayed centrifugation validation for anti-Xa measurement?
- Author
-
Véronique Le Cam Duchez, Arnaud Guilbert, Thomas Clavier, Paul Billoir, Marielle Fresel, Caroline Abriou, Virginie Barbay, Christophe Girault, and Marie Hélène Chrétien
- Subjects
Adenosine ,Time Factors ,medicine.drug_class ,Thrombin Time ,Centrifugation ,Chemical Fractionation ,Pharmacology ,Thrombin time ,Citric Acid ,Theophylline ,medicine ,Humans ,Blood Specimen Collection ,medicine.diagnostic_test ,Heparin ,Chemistry ,Anticoagulant ,Anticoagulants ,Dipyridamole ,General Medicine ,Blood Preservation ,Factor Xa ,Partial Thromboplastin Time ,Blood Coagulation Tests ,Drug Monitoring ,Platelet factor 4 ,Factor Xa Inhibitors ,circulatory and respiratory physiology ,medicine.drug - Abstract
Unfractionated heparin (UFH) is the main anticoagulante used in intensive care unit. The anticoagulant effect is monitored by activated partial thrombin time (aPTT) and anti-Xa activity (anti-Xa) measurement. However, delayed centrifugation induces platelet factor 4 (PF4) release and anti-Xa decrease. Several studies have concluded that aPTT and anti-Xa measurement should be performed within 2 hours in citrated anticoagulant but may be delayed longer in citrate theophylline adenosine and dypiridamol (CTAD) anticoagulant. The objective of this study was to compare the stability of both aPTT and anti-Xa in citrate and CTAD samples, and to determine the effect of delayed centrifugation on both aPTT, anti-Xa results, and PF4 release in citrate samples only. Methods aPTT and anti-Xa were measured in citrate and CTAD anticoagulant samples from 93 patients. Delayed centrifugation was performed in citrate samples from 31 additional patients, with hourly aPTT and anti-Xa measurement from 1 to 6 hours. In 14 of these last patients, PF4 release was also evaluated with Human CXCL4/PF4 Quantikine ELISA Kit. Results We observed a significant correlation between citrate and CTAD anticoagulant for aPTT (r2=0.94) and anti-Xa (r2=0.95). With Bland-Altman correlation, a minor bias was observed for anti-Xa (-0.025±0.041). Delayed centrifugation in citrated anticoagulant showed an excellent concordance from 1 to 4 hours for aPTT (-4.0±5.3 s) and anti-Xa (1.10-9±0.058 UI/mL) measurements. Moreover, PF4 release was not different between 1 hour (31.5±14.7 ng/mL) and 4 hours (33.8±11.8 ng/mL). Conclusion We have demonstrated that anti-Xa measurement for unfractionated heparin should be done 4 hours in citrated plasma and that CTAD was not better than citrate. However, these initial findings require confirmation using other aPTT and calibrated anti-Xa assays. more...
- Published
- 2020
- Full Text
- View/download PDF
11. Is citrate theophylline adenosine dipyridamole (CTAD) better than citrate to survey unfractionated heparin treatment? Has delayed centrifugation a real impact on this survey?
- Author
-
Marie Hélène Chrétien, Paul Billoir, Virginie Barbay, Thomas Clavier, Véronique Le Cam Duchez, Arnaud Guilbert, Marielle Fresel, Christophe Girault, and Caroline Abriou
- Subjects
Time Factors ,Phosphodiesterase Inhibitors ,medicine.drug_class ,Centrifugation ,030204 cardiovascular system & hematology ,Pharmacology ,Thrombin time ,03 medical and health sciences ,0302 clinical medicine ,Theophylline ,Humans ,Medicine ,Citrates ,030212 general & internal medicine ,medicine.diagnostic_test ,Heparin ,business.industry ,Anticoagulant ,Anticoagulants ,Dipyridamole ,Hematology ,Adenosine ,Blood Preservation ,Blood Coagulation Tests ,Drug Monitoring ,Cardiology and Cardiovascular Medicine ,business ,Platelet factor 4 ,circulatory and respiratory physiology ,medicine.drug - Abstract
Unfractionated heparin (UFH) is the main anticoagulant used in intensive care unit. The anticoagulant effect is monitored by activated partial thrombin time (aPTT) and anti-Xa activity (anti-Xa) measurement. However, delayed centrifugation induces platelet factor 4 (PF4) release and anti-Xa decrease. Several studies have concluded that aPTT and anti-Xa measurement should be performed within 2 h in citrated anticoagulant but may be delayed longer in Citrate Theophylline Adenosine and Dypiridamol (CTAD) anticoagulant. The objective of this study was to compare the stability of both aPTT and anti-Xa in citrate and CTAD samples, and to determine the effect of delayed centrifugation on both aPTT, anti-Xa results, and PF4 release in citrate samples only. aPTT and anti-Xa were measured in citrate and CTAD anticoagulant samples from 93 patients. Delayed centrifugation was performed in citrate samples from 31 additional patients, with hourly aPTT and anti-Xa measurement from 1 to 6 h. In 14 of these last patients, PF4 release was also evaluated with Human CXCL4/PF4 Quantikine ELISA Kit. We observed a significant correlation between citrate and CTAD anticoagulant for aPTT (r2 = 0.94) and anti-Xa (r2 = 0.95). With Bland–Altman correlation, a minor bias was observed for anti-Xa (− 0.025 ± 0.041). Delayed centrifugation in citrated anticoagulant showed an excellent concordance from 1 to 4 h for aPTT (− 4.0 ± 5.3 s) and anti-Xa (1.10−9 ± 0.058 UI/ml) measurements. Moreover, PF4 release was not different between 1 h (31.5 ± 14.7 ng/ml) and 4 h (33.8 ± 11.8 ng/ml). We have demonstrated that anti-Xa measurement for unfractionated heparin should be done 4 h in citrated plasma and that CTAD was not better than citrate. However, these initial findings require confirmation using other aPTT and calibrated anti-Xa assays. more...
- Published
- 2019
- Full Text
- View/download PDF
12. Factor XII deficiency evaluated by thrombin generation assay
- Author
-
Marie Hélène Chrétien, Pierre Chamouni, Paul Billoir, Fiston Kasonga, Virginie Barbay, Sabine Brunel, Marielle Fresel, Guillaume Feugray, and Véronique Le Cam Duchez
- Subjects
Adult ,Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Factor XII Deficiency ,medicine.medical_treatment ,Clinical Biochemistry ,Inflammation ,Coagulation Factor XII ,Tissue factor ,Internal medicine ,Fibrinolysis ,medicine ,Humans ,Platelet-poor plasma ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Thrombin ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Endocrinology ,Coagulation ,Female ,Partial Thromboplastin Time ,medicine.symptom ,business ,Partial thromboplastin time - Abstract
INTRODUCTION Coagulation factor XII (FXII) plays a role in thrombin generation, fibrinolysis, inflammation, angiogenesis, chemotaxis and diapedesis. FXII deficiency is not associated with bleeding risk unlike other coagulation factors. MATERIALS/METHODS We investigated thrombin generation assay (TGA) profile modification in FXII deficiency and the correlation with TGA and deficiency severity. TGA was performed in platelet poor plasma (PPP) with tissue factor (1 pmol/L) and phospholipid (4 µmol/L) standardized concentration. Thrombin generation profiles were compared in 54 patients with FXII deficiency, 25 healthy controls and 23 patients with hemophilia A (factor VIII (FVIII) deficiency. Patients with FXII deficiency were classified in three groups based on FXII activity (30-50%, 10-29% more...
- Published
- 2021
13. Afibrinogenemia with two compound heterozygous mutations in FGA gene
- Author
-
Alessandro Casini, Paul Billoir, Guillaume Feugray, Marguerite Neerman-Arbez, Pascale Schneider, Véronique Le Cam Duchez, Pierre Chamouni, and Virginie Barbay
- Subjects
Genetics ,ddc:616 ,Cephalhaematoma ,Afibrinogenemia ,business.industry ,Hereditary afibrinogenemia ,Bleeding ,Fibrinogen ,Hematology ,General Medicine ,Compound heterozygosity ,Mutation ,Medicine ,Humans ,ddc:576.5 ,business ,Gene ,Genetics (clinical) - Published
- 2021
14. Imaging of Oxford/AstraZeneca COVID-19 vaccine-induced immune thrombotic thrombocytopenia
- Author
-
Paul Billoir, Jean-Nicolas Dacher, Matthieu Demeyere, Adelya Curado, Virginie Barbay, Matthieu Garnier, Nouvelles Cibles Pharmacologiques de la Protection Endothéliale et de l'Insuffisance Cardiaque (EnVI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), CHU Rouen, Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and DACHER, Jean Nicolas more...
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Middle cerebral artery ,Infarction, middle cerebral artery ,Article ,030218 nuclear medicine & medical imaging ,Covid-19 Vaccines ,Imaging ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,[SDV.IMM.VAC] Life Sciences [q-bio]/Immunology/Vaccinology ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,ComputingMilieux_MISCELLANEOUS ,[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Radiological and Ultrasound Technology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Thrombosis ,General Medicine ,Virology ,Thrombocytopenia ,3. Good health ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,VITT, Vaccine-induced immune thrombotic thrombocytopenia ,Infarction ,030220 oncology & carcinogenesis ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,CT, Computed tomography ,[SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology ,business - Abstract
Diagnostic and Interventional Imaging - In corso di stampa. Prove corrette dall'autore. Disponibile online dal mercredi 5 mai 2021
- Published
- 2021
- Full Text
- View/download PDF
15. Abnormal bleeding phenotype for mild haemophilia B patients with the p.Ile112Thr variation on the gene for factor IX
- Author
-
Anne Lienhart, Julien Bovet, Sandrine Meunier, Céline Row, Vincent Dalibard, Hervé Chambost, Pierre Chamouni, Virginie Barbay, Mathilde Fretigny, Marie Viprey, Claire Berger, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire d'hématologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Hospices Civils de Lyon, Departement de Neurologie (HCL), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), CHU Lille, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), WILEY, Lucas, Nelly, and Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne) more...
- Subjects
[SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Hemophilia A ,Hemophilia B ,Gastroenterology ,Factor IX ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Haemophilia B ,Gene ,Genetics (clinical) ,ComputingMilieux_MISCELLANEOUS ,030304 developmental biology ,0303 health sciences ,Factor VIII ,business.industry ,Abnormal bleeding ,[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology ,Hematology ,General Medicine ,medicine.disease ,Phenotype ,business ,medicine.drug - Abstract
International audience
- Published
- 2021
- Full Text
- View/download PDF
16. Age at diagnosis is delayed in women/girls with haemophilia compared to men/boys: a FranceCoag report
- Author
-
Marie, Viprey, Fabienne, Volot, Céline, Falaise, Guillaume, Mourey, Benjamin, Gillet, Yoann, Huguenin, Sandrine, Meunier, Noémie De, Gunzburg, Virginie, Barbay, Sophie, Bayart, Cécile, Bally, Marc, Trossaert, Ségolène, Claeyssens, Valérie, Gay, Anne-Lise, Voyer, Placide, Nyombe, Yves, Gruel, Aurélien, Lebreton, Yohan, Demay, Vanessa, Milien, Mohamed, Boucekine, Yannick, Collé, Hervé, Chambost, Roseline, d'Oiron, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Assistance Publique - Hôpitaux de Marseille (APHM), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de chirurgie pédiatrique [CHU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Bordeaux [Bordeaux], Hospices Civils de Lyon (HCL), Service d’Hématologie et d’Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France, CHU Rouen, Normandie Université (NU), Service de Pathologie [Rennes] = Pathology [Rennes], CHU Pontchaillou [Rennes], Centre Référence des Maladies Héréditaires du Métabolisme de l'Enfant et de l'Adulte [CHU Necker] (MaMEA Necker), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Métropole Savoie [Chambéry], CHU Amiens-Picardie, Hôpital de Saint-Denis, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Clermont-Ferrand, Association française des hémophiles (AFH), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Université Paris-Saclay, World Federation of Hemophilia, CHU Toulouse [Toulouse], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Lucas, Nelly more...
- Subjects
[SDV] Life Sciences [q-bio] ,[SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology ,[SDV]Life Sciences [q-bio] ,[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2020
- Full Text
- View/download PDF
17. Prednisolone treatment induced temporary factor IX normalization in mild hemophilia B who required an epidural infiltration: A case report
- Author
-
Paul Billoir, Guillaume Feugray, Virginie Barbay, V. Le Cam Duchez, M. Fretigny, M. Carrette, Pierre Chamouni, Service d'Hémostase Vasculaire [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Normandie Université (NU), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM) more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Prednisolone ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,Thrombin time ,Hemophilia B ,Factor IX ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Back pain ,Humans ,medicine.diagnostic_test ,business.industry ,Hematology ,medicine.disease ,3. Good health ,Surgery ,Hemostasis ,Hemorrhagic complication ,Partial Thromboplastin Time ,Fresh frozen plasma ,medicine.symptom ,business ,Infiltration (medical) ,Intervertebral Disc Displacement ,030215 immunology ,medicine.drug - Abstract
A 31-year-old man with mild hemophilia B developed a herniated disc treated with prednisolone for back pain. Surprisingly, hemostasis result tests performed before epidural infiltration were a normal activated partial thrombin time at 36.1 s. (normal range 27.9–37.7 s.) and factor IX (FIX) level 76% (normal range>70%), 13 days after prednisolone introduction. After a second control with a normal FIX level and a second genetic confirmation of hemophilia, no FIX concentrates was administered to perform the infiltration, which occurred without hemorrhagic complication. This new case of FIX normalization showed the necessity to have a perfect knowledge of patient’s treatment to avoid misdiagnosis and a temporary normal hemostasis permit to perform epidural infiltration without replacement therapy. more...
- Published
- 2019
- Full Text
- View/download PDF
18. First observation of inhibitor development against efmoroctocog alfa in France
- Author
-
Christoph Königs, Paul Billoir, Pierre Chamouni, Virginie Barbay, Céline Malassigne, Nathalie Massy, and Véronique Le Cam-Duchez
- Subjects
Male ,Drug ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Recombinant Fusion Proteins ,media_common.quotation_subject ,Haemophilia A ,030204 cardiovascular system & hematology ,Antibodies, Monoclonal, Humanized ,Hemophilia A ,Haemophilia ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,Efmoroctocog alfa ,Antibodies, Bispecific ,Humans ,Medicine ,Mucosal bleeding ,media_common ,Emicizumab ,Clotting factor ,Factor VIII ,Blood Coagulation Factor Inhibitors ,business.industry ,Hematology ,Middle Aged ,medicine.disease ,France ,Anamnestic response ,business ,030215 immunology - Abstract
In patients with severe haemophilia receiving clotting factor concentrates, the risk of immunisation against their usual treatment is still patent and feared. New haemophilia drug treatments with an extended half-life have become available over the past few years. The risk of inhibitor development to these new treatments is unclear. We report the case of a 51-year-old man with severe haemophilia A, who was previously treated with no history of inhibitor development. Soon after a switch in his treatment to efmoroctocog alfa he developed an inhibitor against this recombinant Fc fusion extended half-life FVIII (rFc-FVIII) product. The patient was on an on-demand treatment regimen and was treated for mucosal bleeding. The inhibitor was characterised as type I, with classical epitope mapping. The spontaneous evolution of this inhibitor was favourable, but an anamnestic response led to a switch in his treatment to emicizumab. more...
- Published
- 2021
- Full Text
- View/download PDF
19. Thrombotic thrombocytopenic purpura misdiagnosed as autoimmune cytopenia: Causes of diagnostic errors and consequence on outcome. Experience of the French thrombotic microangiopathies reference centre
- Author
-
Lionel Galicier, Jean-Michel Halimi, Amélie Seguin, Pierre Perez, Agnès Veyradier, Virginie Barbay, Frédéric Pène, Claire Presne, Alain Wynckel, Stephane Girault, Dominique Chauveau, Alexandre Lautrette, Mario Ojeda-Uribe, François Provôt, Steven Grangé, Tarik Kanouni, Pascale Poullin, Maximilien Grall, Paul Coppo, Yahsou Delmas, Ygal Benhamou, Mohamed Hamidou, Christiane Mousson, and Elie Azoulay more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Thrombotic microangiopathy ,Exacerbation ,Thrombotic thrombocytopenic purpura ,ADAMTS13 Protein ,030204 cardiovascular system & hematology ,Gastroenterology ,Autoimmune thrombocytopenia ,Diagnosis, Differential ,Hemoglobins ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Diagnostic Errors ,Purpura, Thrombocytopenic, Idiopathic ,Purpura, Thrombotic Thrombocytopenic ,business.industry ,Autoimmune Cytopenia ,Hematology ,Middle Aged ,Prognosis ,medicine.disease ,ADAMTS13 ,Schistocyte ,Coombs Test ,Antibodies, Antinuclear ,Female ,Anemia, Hemolytic, Autoimmune ,Autoimmune hemolytic anemia ,business ,030215 immunology - Abstract
Thrombotic thrombocytopenic purpura (TTP) has a devastating prognosis without adapted management. Sources of misdiagnosis need to be identified to avoid delayed treatment. We studied 84 patients with a final diagnosis of severe ( more...
- Published
- 2017
- Full Text
- View/download PDF
20. Thrombin generation profile in non-thrombotic factor V Leiden carriers
- Author
-
Paul Billoir, Véronique Le Cam Duchez, Thomas Duflot, Marie Hélène Chrétien, Virginie Barbay, and Marielle Fresel
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heterozygote ,Deep vein ,030204 cardiovascular system & hematology ,Gastroenterology ,Risk Assessment ,03 medical and health sciences ,Tissue factor ,0302 clinical medicine ,Thrombin ,Predictive Value of Tests ,Internal medicine ,medicine ,Factor V Leiden ,Humans ,Thrombophilia ,030212 general & internal medicine ,Medical History Taking ,Platelet-poor plasma ,Aged ,Retrospective Studies ,business.industry ,Factor V ,Thrombosis ,Hematology ,Middle Aged ,medicine.disease ,Pulmonary embolism ,medicine.anatomical_structure ,Mutation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Asymptomatic carrier ,medicine.drug - Abstract
Factor V Leiden (FVL) mutation is the most common genetic risk factor for venous thromboembolism. In families with a history of thrombosis, FVL can be present in 18%. Thrombin generation test is commonly used as an evaluation tool of thrombotic risk. The objective of this study was to evaluate the thrombogenic potential of FVL in asymptomatic carriers and in patients with personal or familial history of thrombosis. This was a retrospective single center study including 160 patients. Among them, 43 had personal history of thrombosis and 117 had familial history of thrombosis. Thrombin generation (TG) was realized in frozen platelet poor plasma with 1 pM of tissue factor and 4 µM of phospholipid. FVL mutation was associated with a global increase of TG. No difference was observed between patients with provoked thrombosis and patients with first-degree familial history of thrombosis (endogenous thrombin potential (ETP): 1501.0 ± 316.4 nM min and thrombin peak: 253.4 ± 71.5 nM vs. 1520.4 ± 283.8 nM min and 268.6 ± 68.0 nM). An increase of TG was observed in patients with unprovoked thrombosis (n = 23) and in patients with provoked thrombosis (n = 20) (ETP: 1819.5 ± 319.8 nM min and peak: 332.3 ± 55.8 nM). In the unprovoked thrombosis group, patients with a pulmonary embolism had a higher ETP than patients with deep vein thrombosis (DVT) (2036 ± 343 nM min vs. 1707 ± 261 nM min). With a predictive score formula (s = 0.1315 × Age + 0.0105 × ETP) with a threshold of 22.1 as risk to develop an unprovoked thrombosis among patients with second-degree familial history. The results of our analysis suggest that measurement of thrombin generation in patients with FVL mutation may identify subjects with an increased risk of unprovoked thrombosis. Further studies are needed to examine the usefulness of predicting thrombotic presentation in asymptomatic carriers. more...
- Published
- 2019
21. Anti-Xa Oral Anticoagulant Plasma Concentration Assay in Real Life: Rivaroxaban and Apixaban Quantification in Emergency With LMWH Calibrator
- Author
-
Paul Billoir, Luc Marie Joly, Véronique Le Cam Duchez, Virginie Barbay, Marie Hélène Chrétien, and Marielle Fresel
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_mechanism_of_action ,Pyridones ,Factor Xa Inhibitor ,Hemorrhage ,030204 cardiovascular system & hematology ,030226 pharmacology & pharmacy ,Gastroenterology ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Predictive Value of Tests ,Internal medicine ,Atrial Fibrillation ,medicine ,In real life ,Humans ,Pharmacology (medical) ,Stroke ,Blood Coagulation ,Aged ,Retrospective Studies ,business.industry ,Atrial fibrillation ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,medicine.disease ,Plasma concentration ,Calibration ,Oral anticoagulant ,Pyrazoles ,Apixaban ,Female ,Blood Coagulation Tests ,business ,medicine.drug ,Factor Xa Inhibitors - Abstract
Background: Oral anti-Xa inhibitors have demonstrated noninferiority to vitamin K antagonists (VKAs) for the prevention of stroke in patients with atrial fibrillation and recurrent venous thromboembolism. They are associated with a decrease in major bleeding. In contrast with VKA, no coagulation monitoring is required. However, in clinical practice, determination of drug concentration is sometimes necessary. Objective: The objective of this study was to evaluate a low-molecular-weight heparin (LMWH) calibrated anti-Xa assay for the quantification of rivaroxaban and apixaban plasma concentration in emergency. Methods: The anti-Xa plasma concentration of rivaroxaban and apixaban were measured in emergency in 210 patients using STA anti-Xa liquid assay. For each plasma concentration 2 = 0.947) or apixaban ( R2 = 0.959) concentration and a significant correlation between rivaroxaban and apixaban plasma concentration ( R2 = 0.972). A LMWH anti-Xa activity 30 ng/mL and indicate the feasibility of invasive procedure. Conclusion and Relevance: In the absence of a specific test, LMWH-calibrated anti-Xa assay could be used to determine the presence and evaluate the plasma concentration of oral anti-Xa inhibitors. However, these initial findings require confirmation using other chromogenic calibrated oral anti-Xa assays. more...
- Published
- 2018
22. Management of dabigatran after overdosage: two case reports and suggestions for monitoring
- Author
-
Virginie Barbay, Steven Grangé, Véronique Le Cam Duchez, Déborah Boyer, Paul Billoir, Marielle Fresel, Christophe Girault, and Marie Hélène Chrétien
- Subjects
medicine.drug_class ,Hemorrhage ,macromolecular substances ,030204 cardiovascular system & hematology ,Antibodies, Monoclonal, Humanized ,Antithrombins ,Dabigatran ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Emergency Treatment ,business.industry ,Anticoagulant ,Warfarin ,Atrial fibrillation ,Idarucizumab ,Hematology ,General Medicine ,medicine.disease ,Prothrombin complex concentrate ,Blood Coagulation Factors ,Embolism ,Anesthesia ,Drug Monitoring ,Drug Overdose ,business ,medicine.drug - Abstract
Bleeding is the main complication of anticoagulant treatments as dabigatran etexilate. In patients with atrial fibrillation, dabigatran, at certain doses, has been associated with similar rates of stroke and embolism, and a lower rate of major hemorrhage compared to warfarin. Before the recent possibility of reversing the anticoagulant effect of dabigatran with idarucizumab, prothrombin complex concentrate (PCC) was the main available treatment in cases of severe bleeding or emergency surgery . We describe two different cases with very high overdosage in which PCC or idarucizumab was used to reverse the effect of dabigatran etexilate. more...
- Published
- 2018
23. A difficult decision: what should we do when malignant tumours are diagnosed in patients supported by left ventricular assist devices?
- Author
-
Hassiba Smail, Christian Pfister, Jean-Marc Baste, Catherine Nafeh-Bizet, Arnaud Gay, Virginie Barbay, Jean-Paul Bessou, Christophe Peillon, and Pierre-Yves Litzler
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Breast Neoplasms ,Breast cancer ,Neoplasms ,Preoperative Care ,medicine ,Humans ,Heart Failure ,Postoperative Care ,Heart transplantation ,business.industry ,Sleeve Lobectomy ,Cancer ,General Medicine ,Perioperative ,Antibiotic Prophylaxis ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Nephrectomy ,Surgery ,Transplantation ,Echocardiography ,Female ,Lymphadenectomy ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Left ventricular assist devices (LVADs) are used as a bridge to heart transplantation. During the preimplantation or pretransplantation screening, malignant tumours can be discovered. Owing to the lack of guidelines, the management is difficult. We describe our perioperative approach and the patients' outcomes. Methods Between 2006 and 2014, 55 patients underwent implantation of HeartMate II LVAD. Five were diagnosed with malignant tumours: 2 renal, 2 lung and 1 breast tumours. The renal tumours were diagnosed during the preimplantation screening. An LVAD was implanted in both followed by partial nephrectomies 8 and 9 months later. The lung cancers were diagnosed after device implantation, a left pulmonary segmentectomy and a right upper sleeve lobectomy were performed. The breast cancer was diagnosed few months after support and a tumourectomy with lymphadenectomy was performed. Results Tumour resection was performed successfully in all patients. Prior to surgery haemostasis, device and heart function were evaluated. During surgery, haemodynamics and anticoagulation were monitored. Reoperations were necessary to evacuate haemothorax after lobectomy and an abdominal haematoma post-nephrectomy. After discussion with oncologists, 3 patients were relisted for heart transplantation. Two were successfully transplanted 2 and 3 years after partial nephrectomy with an actual survival of 56 and 59 months after the cancer diagnosis. The follow-up revealed no cancer recurrences. Conclusions Malignant tumours during support with LVAD can be successfully resected. A multidisciplinary evaluation in these high-risk patients is mandatory. After careful evaluation, regaining the patient's heart transplant candidacy is possible. more...
- Published
- 2015
- Full Text
- View/download PDF
24. Thrombin generation test as a marker for high risk venous thrombosis pregnancies
- Author
-
Véronique Le Cam Duchez, Bénédicte Sudrié-Arnaud, Virginie Barbay, Bérangère S. Joly, and Jeanne-Yvonne Borg
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Pregnancy, High-Risk ,030204 cardiovascular system & hematology ,Thrombophilia ,Fibrinogen ,Gastroenterology ,Sensitivity and Specificity ,03 medical and health sciences ,Tissue factor ,Young Adult ,0302 clinical medicine ,Pregnancy ,Internal medicine ,medicine ,Humans ,Risk factor ,Retrospective Studies ,Venous Thrombosis ,business.industry ,Pregnancy Complications, Hematologic ,Thrombin ,Hematology ,medicine.disease ,Thrombosis ,Venous thrombosis ,Coagulation ,030220 oncology & carcinogenesis ,Case-Control Studies ,Immunology ,Female ,Blood Coagulation Tests ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Pregnancy is a well-established risk factor for venous thromboembolism and is associated with a state of hypercoagulability. The use of sensitive and specific biological markers to predict risk factors for thrombosis is essential during pregnancy. Our objective was to investigate the usefulness of thrombin generation test (TGT) as a marker to predict the risk of thrombosis in high risk venous thrombosis (HRVT) pregnancies compared to normal pregnancies. This retrospective study enrolled 134 women with HRVT pregnancies, 78 of whom had monozygotic, spontaneous and untreated pregnancies and formed the study group. The control group comprised 106 women with normal pregnancies. Routine assessment of coagulation activation markers: fibrinogen, d-dimer, prothrombin fragments 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and fibrin monomer complexes (FMC) was performed every 5 weeks in the study group to detect a possible pathological state of hypercoagulability. TGT was performed using platelet-free plasma, 1 and 5 pM tissue factor (TF), supplemented by phospholipids (PL) ± thrombomodulin. Fibrinogen, d-dimer, F1 + 2, and TAT, but not FMC, increased significantly throughout pregnancy in both groups but no difference was shown between the groups. TGT showed an early increase in thrombin generation in both groups, which stabilized during the second month of pregnancy. No correlation was demonstrated between thrombin generation parameters and coagulation activation markers. Based on our results, TGT did not prove conclusive as a marker to predict the risk of thrombosis in HRVT pregnancies. Finding a sensitive and specific biological marker to predict thrombosis risk requires further investigation. more...
- Published
- 2017
25. Comparison of markers of coagulation activation and thrombin generation test in uncomplicated pregnancies
- Author
-
Virginie Barbay, Véronique Le Cam-Duchez, Bérangère S. Joly, and Jeanne-Yvonne Borg
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Population ,Fibrinogen ,Thrombomodulin ,Tissue plasminogen activator ,Young Adult ,Tissue factor ,Pregnancy ,Internal medicine ,medicine ,Humans ,education ,Blood Coagulation ,Platelet-poor plasma ,Hemostasis ,education.field_of_study ,business.industry ,Thrombin ,Hematology ,medicine.disease ,Endocrinology ,Coagulation ,Calibration ,Immunology ,Female ,Blood Coagulation Tests ,business ,Biomarkers ,medicine.drug - Abstract
Introduction Pregnancy is a well-established risk factor for venous thromboembolism, and is associated with a state of hypercoagulability or parameters of thrombin generation. Currently, there is a lack of consensual data on thrombin generation during pregnancy. This study aimed to find a sensitive and specific biological marker of coagulation activation and to identify parameters of thrombin generation. Patients and methods The population included 101 women with uncomplicated pregnancies. The objective of this study was to correlate thrombin generation test (measured at 5pM tissue factor, 4 μM lipids and without thrombomodulin), with fibrinogen and markers of blood coagulation activation: D-dimer, prothrombin fragments 1+2 (F1+2), thrombin-antithrombin complexes (TAT) and fibrin monomer complexes (FMC) in these women. Internal quality control was performed in each set of experiments. Results Fibrinogen, D-dimer, F1+2, and TAT concentrations increased significantly throughout pregnancy, and were correlated with term of pregnancy. In our study, thrombin generation seemed to increase early on, and then remained stable throughout normal pregnancy, in contrast with other markers of blood coagulation activation, excepting FMC. The latter are subject to large inter-individual variations, especially during second trimester. No correlation was demonstrated between thrombin generation parameters and other activation markers. Conclusion While markers of coagulation activation significantly increased during pregnancy, thrombin generation increased only early on and remains stable during pregnancy. Finding a sensitive and specific biological marker for vascular pregnancy complications, such as FMC and thrombin generation levels, requires further investigation. more...
- Published
- 2013
- Full Text
- View/download PDF
26. Adjusted value of thromboprophylaxis in hospitalized obese patients: A comparative study of two regimens of enoxaparin: The ITOHENOX study
- Author
-
Hervé Levesque, Virginie Barbay, Nathalie Donnadieu, Maelle Le Besnerais, Véronique Le Cam-Duchez, Jacques Benichou, G. Armengol, Antoine Cuvelier, François-Xavier Delmas, Sébastien Miranda, and Ygal Benhamou more...
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,Low molecular weight heparin ,Subgroup analysis ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Enoxaparin ,Adverse effect ,Aged ,Aged, 80 and over ,Dose-Response Relationship, Drug ,business.industry ,Incidence (epidemiology) ,Thrombosis ,Hematology ,Thromboembolism Prophylaxis ,Middle Aged ,medicine.disease ,Surgery ,Hospitalization ,Regimen ,Treatment Outcome ,Factor Xa ,Female ,business ,Factor Xa Inhibitors - Abstract
Thromboprophylaxis is a mainstay of hospital care in patients at high risk of thrombosis. Fixed doses of low-molecular-weight heparin (LMWH) are recommended for thromboprophylaxis in patients admitted to hospital for an acute medical condition. However, the distribution of LMWH is weight-based, and the efficacy of standard doses in obese patients may be decreased. Data for obese patients are mainly available in bariatric surgery with extremely obese patients who are at greater risk of venous thromboembolism than those hospitalized for a medical condition. We conducted a randomized control trial in medically obese inpatients (BMI≥30kg/m2) assessing two regimens of enoxaparin (40mg and 60mg SQ daily) in order to determine whether a stronger dosage would achieve higher anti-Xa level suitable for thromboprophylaxis. Between September 2013 and April 2015, 91 patients were included in the study (mean (±standard deviation) age was 70.4±10.7years, average BMI 37.8±6.4kg/m2). Main indications of thromboprophylaxis were mainly acute infection (50%), acute respiratory failure (10%), acute congestive heart failure (9%) and acute rheumatic disorders (18%). Average anti-Xa activity, measured 4h after the third administration of enoxaparin was 0.25±0.09IU/mL in group 1 (enoxaparin 40mg) and 0.35±0.13IU/mL in group 2 (enoxaparin 60mg) (P more...
- Published
- 2016
27. Évaluation du risque de récidive de la maladie thromboembolique veineuse par les dosages de D-dimères et du fragment F1 + 2 de la prothrombine : analyse d’une cohorte de 125 patients
- Author
-
Nicole Cailleux, A. Dhamy, G. Armengol, Sébastien Miranda, Ygal Benhamou, V. Le Cam Duchez, Virginie Barbay, and H. Levesque
- Subjects
Gastroenterology ,Internal Medicine - Abstract
Introduction La maladie thromboembolique veineuse (MTEV) est une pathologie frequemment recidivante pour laquelle la duree du traitement anticoagulant reste problematique. Le dosage des D-Dimeres est un outil d’evaluation du risque de recidive mais sujet a de nombreux faux positifs. La mesure des fragments F1 + 2 de la prothrombine semble etre plus specifique de l’activation de la coagulation. L’objectif du travail etait de comparer les dosages des D-dimeres seuls et associe aux fragments F1 + 2 de la prothrombine afin d’evaluer le risque de recidive de MTEV. Patients et methodes Il s’agit d’une etude retrospective monocentrique menee a l’institut de biologie clinique du CHU de Rouen. Les patients ont eu un dosage des D-dimeres et des fragments F1 + 2 a l’arret du traitement. Resultats Un total de 125 patients (suivi moyen 28 mois) a ete inclus dans l’etude. L’âge moyen est de 52 ans + 15 (69,6 % d’hommes). Une MTEV non provoquee etait presente dans 44,8 % des cas. Les principaux resultats sont un faible taux de recidive (4,8 % soit 1,9 pour 100 patients-annee), un taux de D-dimeres eleves et de fragments F1 + 2 de la prothrombine eleves chez respectivement 58 % et 32 % des cas. La VPN des D-dimeres etait de 100 % par contre sa specificite seulement de 43,2 %. A l’inverse, les fragments F1 + 2 de la prothrombine avaient une specificite de 94,8 % et une VPP de 57 %. L’utilisation des seuls D-dimeres comme facteur de reprise d’une anticoagulation entrainerait le retraitement de 13 patients pour eviter 1 recidive. Par contre, en presence d’un dosage des F1 + 2 normal, une recidive apparaissait dans seulement 2,3 % des cas. Conclusion Cette etude compare pour la premiere fois les dosages des D-dimeres aux fragments F1 + 2 de la prothrombine. Ce travail insiste sur l’importance d’interpreter les resultats des D-dimeres comme un parametre d’exclusion de la recidive et qu’en presence d’un dosage anormal, le recours aux F1 + 2 de la prothrombine pourrait limiter un exces de retraitement. more...
- Published
- 2017
- Full Text
- View/download PDF
28. Protéine Z, polymorphismes du gène de la protéine Z et thromboses
- Author
-
Jeanne-Yvonne Borg, Claudine Soria, Virginie Barbay, and V. Le Cam-Duchez
- Subjects
Chemistry ,Haplotype ,Gastroenterology ,Protein Z ,Single-nucleotide polymorphism ,Thrombophilia ,medicine.disease ,Molecular biology ,In vitro ,Genetic variation ,Internal Medicine ,medicine ,Allele ,Gene - Abstract
Protein Z (PZ) is a vitamin K dependent protein acting as the cofactor of the protein Z dependent inhibitor (ZPI), in the inhibition of activated factor X bound on the phospholipids. Normal plasma protein Z concentrations have wide variations among individuals, partly explained by a genetic control. Several protein Z gene polymorphisms influence plasma concentration, separately and in combination. The role of PZ in blood coagulation regulation has been demonstrated in vitro. The responsibility of low PZ level in the occurrence of thrombosis has been questioned. However, the roles of PZ plasma level and PZ gene polymorphisms remain debated with conflicting results in arterial, venous, or placental thrombosis. These discrepancies can be explained by the heterogeneity of populations chosen as control, by the PZ interindividual variability, by the small size of the cohorts in mainly retrospective studies and perhaps by the lack of real important influence of this protein on coagulation. PZ measurement is not actually considered as a biological marker of thrombophilia. Large prospective studies remain to be done to investigate its possible role in thrombosis. more...
- Published
- 2010
- Full Text
- View/download PDF
29. The G79A polymorphism of protein Z gene is an independent risk factor for cerebral venous thrombosis
- Author
-
Jeanne-Yvonne Borg, Virginie Barbay, Bruno Mihout, A. Bagan-Triquenot, and V. Le Cam-Duchez
- Subjects
Adult ,Male ,Vitamin ,medicine.medical_specialty ,Neurology ,DNA Mutational Analysis ,Central nervous system ,Protein Z ,Polymorphism (biology) ,Biology ,Gastroenterology ,Cohort Studies ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,medicine ,Humans ,Genetic Predisposition to Disease ,Gene ,Venous Thrombosis ,Polymorphism, Genetic ,Blood Proteins ,Middle Aged ,medicine.disease ,Cerebral Veins ,Venous thrombosis ,medicine.anatomical_structure ,chemistry ,Immunology ,Cohort ,Female ,Neurology (clinical) ,Intracranial Thrombosis - Abstract
Protein Z (PZ), a vitamin Kdependent protein, plays a role in inhibiting coagulation. Its plasma level or PZ gene polymorphisms have been discussed as risk factors for stroke with conflicting results reported between various studies. Only one of these polymorphisms was studied in a cohort of patients suffering from cerebral venous thrombosis (CVT).We performed a retrospective genetic study comparing 100 healthy controls to 54 patients referred to our hemostasis unit after CVT occurrence. We compared the distribution of three PZ gene polymorphisms that may influence PZ plasma levels: A-13G in the promoter and G79A in intron F were tested using previously described techniques, and we developed a technique to evaluate the G-103A in intron A.The G79A polymorphism was significantly more frequent in patients than in controls (p = 0.012): the presence of at least one A allele led to an odds ratio of 2.57 with a 95 % confidence interval of 1.23-5.34. The A-13G polymorphism also showed a nonsignificant trend towards a higher prevalence in patients.The G79A polymorphism of the PZ gene was shown to be a new independent risk factor for cerebral venous thrombosis. Nevertheless, these results have to be confirmed by a prospective study including plasma PZ evaluation. more...
- Published
- 2008
- Full Text
- View/download PDF
30. Role of M2-like macrophage recruitment during angiogenic growth factor therapy
- Author
-
Malik Mekki, Mahmoud Houssari, Sahil Adriouch, Vincent Richard, Sébastien Banquet, Ebba Brakenhielm, Jean-Paul Henry, Christian Thuillez, Virginie Barbay, Florence Edwards-Levy, Anaïs Dumesnil, Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'hématologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Institut de Chimie Moléculaire de Reims - UMR 7312 (ICMR), SFR Condorcet, Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre National de la Recherche Scientifique (CNRS)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre National de la Recherche Scientifique (CNRS)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie et biothérapies des maladies inflammatoires et autoimmunes, Aliments Bioprocédés Toxicologie Environnements (ABTE), Université de Caen Normandie (UNICAEN), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Centre National de la Recherche Scientifique (CNRS), Pharmacologie des Dysfonctionnements Endotheliaux et Myocardiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Reims Champagne-Ardenne (URCA)-Institut de Chimie du CNRS (INC)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre National de la Recherche Scientifique (CNRS)-SFR Condorcet, Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre National de la Recherche Scientifique (CNRS)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre National de la Recherche Scientifique (CNRS), and Brakenhielm, Ebba more...
- Subjects
Male ,Cancer Research ,Therapeutic revascularization ,[SDV.BIO]Life Sciences [q-bio]/Biotechnology ,[SDV.IMM] Life Sciences [q-bio]/Immunology ,Combination therapy ,[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Physiology ,Angiogenesis ,medicine.medical_treatment ,Clinical Biochemistry ,Ischemia ,Mice ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Blocking antibody ,medicine ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Animals ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,Therapeutic angiogenesis ,Rats, Wistar ,Matrigel ,Monocyte recruitment ,business.industry ,Hepatocyte Growth Factor ,Growth factor ,Macrophages ,[SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy ,[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences ,medicine.disease ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.BIO] Life Sciences [q-bio]/Biotechnology ,Rats ,[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences ,[SDV.IMM.IA]Life Sciences [q-bio]/Immunology/Adaptive immunology ,Immunology ,Cancer research ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Fibroblast Growth Factor 2 ,[SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology ,business ,Infiltration (medical) - Abstract
International audience; Therapeutic angiogenesis has yet to fulfill its promise for the clinical treatment of ischemic diseases. Given the impact of macrophages during pathophysiological angiogenesis, we asked whether macrophages may similarly modulate vascular responses to targeted angiogenic therapies. Mouse matrigel plug assay and rat myocardial infarction (MI) model were used to assess angiogenic therapy with either VEGF-A or FGF-2 with HGF (F+H) delivered locally via albumin-alginate microcapsules. The infiltration of classical M1-type and alternative M2-like macrophages was assessed. Clodronate was used to prevent macrophage recruitment, and the VEGFR2 blocking antibody, DC101, to prevent VEGF-A signaling. At 3 weeks after matrigel implantation, the combination therapy (F+H) led to increased total, and specifically M2-like, macrophage infiltration versus control and VEGF-A plugs, correlating with the angiogenic response. In contrast, VEGF-A preferential recruited M1-type macrophages. In agreement with a direct role of M2-like macrophages in F+H-induced vessel growth, clodronate radically decreased angiogenesis. Further, DC101 reduced F+H-induced angiogenesis, without altering macrophage infiltration, revealing macrophage-derived VEGF-A as a crucial determinant of tissue responsiveness. Similarly, increased cardiac M2-like macrophage infiltration was found following F+H therapy post-MI, with strong correlation between macrophage levels and angiogenic and arteriogenic responses. In conclusion, M2-like macrophages play a decisive role, linked to VEGF-A production, in regulation of tissue responsiveness to angiogenic therapies including the combination of F+H. Our data suggest that future attempts at therapeutic revascularization in ischemic patients might benefit from coupling targeted growth factor delivery with either direct or indirect approaches to recruit pro-angiogenic macrophages in order to maximize therapeutic angiogenic/arteriogenic responses. more...
- Published
- 2015
- Full Text
- View/download PDF
31. Haplotypic or genotypic combinations of three protein Z polymorphisms influence protein Z plasma level
- Author
-
Virginie Barbay, Ludovic Drouet, Claire Bal dit Sollier, Jeanne-Yvonne Borg, Véronique Le Cam-Duchez, Mathieu Coudert, and Claudine Soria
- Subjects
Adult ,Male ,Genetics ,Polymorphism, Genetic ,business.industry ,Protein Z ,Vascular biology ,Blood Proteins ,Hematology ,Plasma levels ,Middle Aged ,Linkage Disequilibrium ,Phenotype ,Gene Frequency ,Haplotypes ,Immunology ,Genotype ,Humans ,Medicine ,Female ,France ,business ,Blood Coagulation ,Biomarkers - Abstract
Haplotypic or genotypic combinations of three protein Z polymorphisms influence protein Z plasma level
- Published
- 2009
- Full Text
- View/download PDF
32. Is anti-platelet therapy needed in continuous flow left ventricular assist device patients? A single-centre experience
- Author
-
F. Bouchart, Jean-Paul Bessou, Caroline Abriou, Catherine Nafeh-Bizet, Hassiba Smail, Pierre-Yves Litzler, Virginie Barbay, and Jean-Marc Baste
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Objective (goal) ,Kaplan-Meier Estimate ,Postoperative Hemorrhage ,Internal medicine ,Thromboembolism ,medicine ,Humans ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Aspirin ,Continuous flow ,business.industry ,General Medicine ,Blood Coagulation Disorders ,Middle Aged ,equipment and supplies ,medicine.disease ,Thrombosis ,Anti platelet ,Surgery ,Transplantation ,Single centre ,Treatment Outcome ,Ventricular assist device ,Cardiology ,Platelet aggregation inhibitor ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
We report our 5-year experience of continuous flow left ventricular assist device (LVAD) implantation without the use of anti-platelet therapy.Between February 2006 and September 2011, 27 patients (26 men; 1 woman) were implanted with a continuous flow LVAD (HeartMate II, Thoratec Corporation, Pleasanton, CA, USA). The mean age was 55.7 ± 9.9 years. The mean duration of support was 479 ± 436 (1-1555) days with 35.4 patient-years on support. Twenty-one patients were implanted as a bridge to transplantation and 6 for destination therapy. The anticoagulation regimen was fluindione for all patients, with aspirin for only 4 patients. At the beginning of our experience, aspirin was administered to 4 patients for 6, 15, 60 and 460 days. Due to gastrointestinal (GI) bleeding and epistaxis, aspirin was discontinued, and since August 2006, no patients have received anti-platelet therapy.At 3 years, the survival rate during support was 76%. The most common postoperative adverse event was GI bleeding (19%) and epistaxis (30%) (median time: 26 days) for patients receiving fluindione and aspirin. The mean International Normalized Ratio (INR) was 2.58 ± 0.74 during support. Fifteen patients have been tested for acquired Von Willebrand disease. A diminished ratio of collagen-binding capacity and ristocetin cofactor activity to Von Willebrand factor antigen was observed in 7 patients. In the postoperative period, 2 patients presented with ischaemic stroke at 1 and 8 months. One of these 2 patients had a previous history of carotid stenosis with ischaemic stroke. There were no patients with haemorrhagic stroke, transient ischaemic attack or pump thrombosis. The event rate of stroke (ischaemic and haemorrhagic) per patient-year was 0.059 among the patients without aspirin with fluindione regimen only.A fluindione regimen without aspirin in long-duration LVAD support appears to not increase thromboembolic events and could lead to a diminished risk of haemorrhagic stroke. more...
- Published
- 2013
33. Thrombotic Thrombocytopenic Purpura Misdiagnosed As Autoimmune Cytopenia: Causes of Diagnostic Errors and Consequence on Outcome. Experience of the French Thrombotic Microangiopathies Reference Centre
- Author
-
Steven Grangé, Paul Coppo, Lionel Galicier, Ygal Benhamou, Virginie Barbay, Eric Mariotte, Dominique Bordessoule, Elie Azoulay, Maximilien Grall, and Agnès Veyradier
- Subjects
medicine.medical_specialty ,Cytopenia ,Evans syndrome ,Anemia ,business.industry ,Fulminant ,Immunology ,Thrombotic thrombocytopenic purpura ,Context (language use) ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Gastroenterology ,ADAMTS13 ,Internal medicine ,medicine ,Thrombopenic purpura ,business - Abstract
Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life threatening disease defined by the association of a hemolytic mechanical anemia, a profound thrombopenia and organ failure with a severe ADAMTS13 deficiency. A rapid diagnosis represents a major goal and sources of misdiagnosis need to be identified to avoid diagnostic wandering and delayed adapted treatment that may translate in increased morbi-mortality. The main objective of this study is to describe the characteristics of TTP initially misdiagnosed and analyse the impact of a late diagnosis on patient's outcomes. Methods: From May 2000 to May 2014, all patients with acquired TTP and severe ADAMTS13 deficiency enrolled prospectively in the French TMA Reference Centre registry were included. A misdiagnosis was retained if initial diagnosis was not TTP and if patients did not receive TPE as initial treatment. Results: Among the 423 studied patients, 84 (20%) were initially misdiagnosed and not received plasma exchange. Main diagnostic errors were attributed to an Evans syndrome and an auto-immune thrombopenic purpura in 51% and 37% of cases respectively. Median time to diagnosis was longer in the misdiagnosed group than in the accurately diagnosed (5 [IQR, 2-8] vs. 1 [IQR, 0-3] days, P=.008). At admission, compared to the accurately diagnosed patients, misdiagnosed patients had a higher rate of low or undetectable schizocytosis (57.5% vs. 32%, P=.001), higher hemoglobin level (8.4 [IQR, 6.7-9.7] g/dl vs. 7.7 [IQR, 6.5-9.1] g/dl, P=.008) and rate of positive DAT (18% vs. 4%, P=.008). Anti-nuclear antibodies (65% vs. 51%, P=.045) and an associated auto-immune disease (24% vs. 13%, P=.017) were also more frequent. In multivariate analysis, a positive DAT and hemoglobin level were retained as risk factor (OR= 8.71, 95% CI [1.759-43.181], P=.008 and OR= 1.27, 95% CI [1.002-1.602], P=.048), respectively. Platelet count recovery over time was significantly longer in the misdiagnosed group (log-rank test: P=.041) without any consequence on overall mortality, exacerbation and relapse. However, specific causes of death probably differed between groups: in the accurately diagnosed group, patients died more frequently on early stage from a fulminant form of TTP within the first week, whereas in the misdiagnosed group patients died later (13 [IQR, 3-20] vs. 6 [IQR, 2-9] days; P=.023), had less organ involvement at early diagnosis (49% vs.64%, P=.019) and received more salvage therapies (80% vs. 35%, P=.009), suggesting that prognosis could have been improved with an earlier treatment. Conclusion: TTP is frequently misdiagnosed with auto-immune cytopenias and usual biological parameters may be initially absent. In a context of hemolysis and thrombocytopenia, a low or undetectable rate of schizocytosis at admission, and a positive DAT should not rule out the diagnosis of TTP, especially when associated with organ failure. A rapid accurate diagnosis of TTP may result in a shorter time to platelet recovery and could improve prognosis. Disclosures No relevant conflicts of interest to declare. more...
- Published
- 2016
- Full Text
- View/download PDF
34. Intérêt d’une thromboprophylaxie adaptée au poids chez le patient obèse hospitalisé : étude comparative de 2 schémas posologiques d’énoxaparine (étude Itohenox)
- Author
-
G. Armengol, Antoine Cuvelier, Sébastien Miranda, Ygal Benhamou, Jacques Benichou, H. Levesque, Virginie Barbay, N. Donnadieu, F.X. Delmas, M. Le Besnerais, and V. Le Cam-Duchez
- Subjects
Gastroenterology ,Internal Medicine - Abstract
Introduction La prescription d’une thromboprophylaxie est actuellement recommandee lors de l’hospitalisation de patients a haut risque de thrombose. Dans ces recommandations, la posologie d’heparine de bas poids moleculaire (HBPM) est fixe, quel que soit le poids du patient. Toutefois, plusieurs donnees pharmacologiques montrent que l’efficacite des HBPM utilisees a la posologie usuelle pourrait etre diminuee chez les patients obeses. Les principales donnees concernant ces patients proviennent de chirurgie bariatrique, ou les patients ont un niveau d’obesite bien superieur a ceux rencontres classiquement dans les services de medecine des hopitaux de France. Nous avons effectue un essai randomise-controle chez les patients obeses hospitalises (IMC ≥ 30 kg/m2) qui a compare deux schemas posologiques d’enoxaparine (40 mg et 60 mg par jour) afin de determiner si une posologie renforcee permettrait d’obtenir une meilleure activite anti-Xa, au regard de l’objectif de thromboprophylaxie. Resultats Entre septembre 2013 et avril 2015, 91 patients ont ete inclus dans l’etude. La moyenne d’âge etait de 70,4 ± 10,7 ans et l’IMC moyen de 37,8 ± 6,4 kg/m2. Les principales indications de thromboprophylaxie etaient les causes infectieuses (50 %), l’insuffisance respiratoire aigue (10 %), la decompensation cardiaque (9 %) et les maladies rhumatologiques aigues (18 %). L’activite anti-Xa moyenne, mesuree 4 h apres la 3e injection d’enoxaparine etait de 0,25 ± 0,09 UI/mL dans le groupe 1 (enoxaparine 40 mg) et 0,35 ± 0,13 UI/mL dans le groupe 2 (enoxaparine 60 mg) (p Conclusion En conclusion, l’etude Itohenox montre que chez les patients obeses hospitalises en medecine, l’utilisation d’enoxaparine 60 mg permet un meilleur controle de l’activite anti-Xa qu’avec l’enoxaparine a 40 mg, sans plus de complications hemorragiques. L’utilisation de cette posologie chez l’obese devrait etre envisagee en dehors du contexte de chirurgie bariatrique ou de chirurgie orthopedique. more...
- Published
- 2016
- Full Text
- View/download PDF
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.