Recommandations de bonne pratique pour la prise en charge de la maladie veineuse thromboembolique chez l’adulte. Version courte

Sanchez, Olivier; Benhamou, Y.; Bertoletti, Laurent; Constant, Jacques; Couturaud, Francis; Delluc, Aurélien; Elias, Antoine; Fischer, Anne‐Marie; Frappé, Paul; Gendron, Nicolas; Girard, Philippe; Godier, Anne; Gut-Gobert, Christophe; Laporte, Silvy; Mahé, Isabelle; Mauge, Laëtitia; Méneveau, Nicolas; Meyer, Guy; Mismetti, Patrick; Parent, Florence; Pernod, Gilles; Quéré, Isabelle; Revel, Marie‐Pierre; Roy, Pierre‐Marie; Salaün, Pierre-Yves; Smadja, David M.; Sevestre, Marie‐Antoinette

doi:10.1016/j.rmr.2019.01.003

Cited by 105 publications

(48 citation statements)

References 2 publications

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“…We also tested D-Dimers serum level as an age-adjusted categorical variable according to National consensus (i.e. abnormal D-Dimers ≥ age x 10) [21]. Anticoagulation was classified as follows: curative, preventive or none.…”

Section: Covariatesmentioning

confidence: 99%

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

Bousquet

Falgarone

Deutsch

et al. 2020

Aging

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Background: To assess factors associated with one-month mortality among older inpatients with Covid-19. Results: The mean age was 78 ± 7.8 years, 55.5% were men, CT scan lung damage was observed in 76% of the patients (mild 23%, moderate 38%, extensive 22%, and severe 7%). The mortality rate was 26%. Dependency/Activities of Daily Living (ADL) score ≤ 5/6, D-Dimers, LDH, and no anticoagulation by reference for curative were independently associated with one-month mortality. A score derived from the multivariate model showed good calibration and very good discrimination (Harrell's C index [95%CI] = 0.83 [0.79-0.87]). Conclusion: ADL-dependency, high serum levels of D-Dimers and LDH and the absence of anticoagulation were independently associated with one-month mortality among older inpatients with Covid-19. Methods: 108 consecutive older inpatients aged 65 and over with Covid-19 confirmed by RT-PCR and/or typical CT chest scan were prospectively included in a French single-centre cohort study from March to April 2020. A systematic geriatric assessment was performed. Covariates were lymphocyte count, serum levels of albumin, C-Reactive Protein, D-Dimers and Lactate Dehydrogenase (LDH), anticoagulation level, and exposure to the hydroxychloroquine and azithromycin combined therapy. Cox uni-and multivariate proportional-hazard regressions were performed to identify predictors of one-month mortality.

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Section: Covariatesmentioning

confidence: 99%

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

Bousquet

Falgarone

Deutsch

et al. 2020

Aging

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“…At PE diagnosis, demographic and biological data were collected using a predefined case report form and three patient profiles were identified: (1) PE provoked by a major transient factor (surgery or trauma of lower limbs, prolonged immobilization, pregnancy or postpartum, estrogen-containing contraception, hormonal replacement therapy, or medically assisted procreation hormonal treatment in the past 3 months); (2) PE with active cancer; and (3) unprovoked PE if neither major transient risk factor nor cancer were present at diagnosis. 4…”

Section: Study Populationmentioning

confidence: 99%

“…1 Beyond the initial 3 to 6 months of anticoagulant therapy, the decision to prolong anticoagulation or not is mainly based on the presence of easily detectable clinical risk factors. [2][3][4] Hence, when PE is provoked by a major transient risk factor, the risk of recurrence is low and anticoagulation should be stopped. [2][3][4] Conversely, when PE is provoked by a major persistent risk factor, such as cancer, the risk of recurrence is high and anticoagulation is often prolonged indefinitely.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Hence, when PE is provoked by a major transient risk factor, the risk of recurrence is low and anticoagulation should be stopped. [2][3][4] Conversely, when PE is provoked by a major persistent risk factor, such as cancer, the risk of recurrence is high and anticoagulation is often prolonged indefinitely. [2][3][4] Lastly, when PE is not provoked by a major transient or persistent risk factor (termed unprovoked PE), the risk of recurrence is high and current guidelines recommend indefinite anticoagulation in case of low or moderate risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Conversely, when PE is provoked by a major persistent risk factor, such as cancer, the risk of recurrence is high and anticoagulation is often prolonged indefinitely. [2][3][4] Lastly, when PE is not provoked by a major transient or persistent risk factor (termed unprovoked PE), the risk of recurrence is high and current guidelines recommend indefinite anticoagulation in case of low or moderate risk of bleeding. [2][3][4][5][6][7] However, extending anticoagulation indefinitely in all patients with unprovoked PE will expose two-thirds of patients who will not experience recurrent VTE after stopping treatment to an unjustified high risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

et al. 2021

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Background We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). Study Design and Methods French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. Results A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2–6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20–2.62, p < 0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve = 0.64). Conclusion PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

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Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

Galanaud

Genty-Vermorel

Rolland

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%‐40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain. We present an overview of published studies assessing the efficacy of ECS to prevent PTS and present the protocol for the CELEST clinical trial. While previous open‐label randomized trials have reported a 50% risk reduction in PTS in patients treated with >30 mm Hg ankle pressure ECS, a large double‐blind trial reported no effect of ECS. We discuss the main potential limitations of these trials, including a placebo effect and suboptimal compliance to ECS. We present the protocol of the CELEST double‐blind randomized trial comparing 2 years of high strength (ankle pressure 35 mm Hg) versus lower strength (ankle pressure 25 mm Hg) ECS in the prevention of PTS after a first acute symptomatic, unilateral, proximal DVT. The use of lower‐strength ECS than that used in previous studies should favor compliance. CELEST may provide important evidence about the efficacy of ECS in the prevention of PTS after DVT. The results will be interpreted in the light of results from recent clinical trials assessing ECS for PTS prevention that reported that the duration of ECS use should be tailored to the individual, if ECS are efficacious in the prevention of PTS.

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Recommandations de bonne pratique pour la prise en charge de la maladie veineuse thromboembolique chez l’adulte. Version courte

Cited by 105 publications

References 2 publications

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial

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