Recommandations de bonne pratique : prévention et traitement de la maladie thrombo-embolique veineuse en médecine

Mismetti, Patrick; Baud, J. M.; Becker, F.; Belmahdi, F.; Blanchard, P.; Constans, J.; Couturaud, Francis; Debourdeau, Philippe; Drouet, L.; Dumarcet, Nathalie; Ferrari, Enrico; Galanaud, Jean‐Philippe; Girard, Pascal; Hay, Birgit; Laporte, Silvy; Laroche, J.-P.; Leizorovicz, Alain; Liard, François; Mahé, Isabelle; Meyer, Guy; Oger, Emmanuel; Parent, Florence; Quéré, I.; Samama, M.

doi:10.1016/j.jmv.2009.12.002

Cited by 77 publications

(22 citation statements)

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“…Les facteurs de risque de TVP et EP sont les mêmes et sont présentés dans le Tableau 1. On distingue ainsi des facteurs de risque transitoires et des facteurs de risque persistants, qui conditionnent la durée du traitement de la MTEV [4].…”

Section: Incidenceunclassified

“…Cependant, la récidive des patients ayant initialement présenté une EP est plus grave : ils présentent trois fois plus de risque de récidiver sous forme d'EP que les patients avec TVP [5]. En termes de mortalité, deux facteurs influencent ce risque : la gravité initiale de l'EP et le terrain de survenue, notamment la présence d'un cancer [4]. En France, la mortalité hospitalière de l'EP estimée à partir du PMSI était de 9,6 % [6].…”

Section: Pronosticunclassified

“…• chez les patients dont le contexte psychosocial et l'environnement géographique et médical ne permettent pas une prise en charge optimale à domicile ; • en cas de TVP proximales avec syndrome obstructif sévère ou de localisation ilio-cave [4].…”

Section: Algorithmes Diagnostiquesunclassified

“…Les anticoagulants à dose curative constituent la base du traitement de la MTEV dont ils ont bouleversé le pronostic [4,11,14,16]. En cas de suspicion de MTEV, la confirmation -impérative -du diagnostic ne doit pas retarder l'initiation du traitement anticoagulant.…”

Section: Modalités Du Traitement Anticoagulantunclassified

“…Aussi, lorsque le risque annuel de récidive excède 5 % par an, la question de la prolongation du traitement anticoagulant peut se poser. Actuellement, l'estimation du risque de récidive à l'arrêt du traitement repose principalement sur l'évaluation des circonstances de survenues de la MTEV (Tableau 1) [4].…”

Section: Durée Du Traitement Anticoagulantunclassified

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Prise en charge de la maladie thromboembolique veineuse en 2015

Galanaud

Messas

Blanchet-Deverly³

et al. 2015

La Revue de Médecine Interne

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Section: Incidenceunclassified

Section: Pronosticunclassified

Section: Algorithmes Diagnostiquesunclassified

Section: Modalités Du Traitement Anticoagulantunclassified

Section: Durée Du Traitement Anticoagulantunclassified

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Prise en charge de la maladie thromboembolique veineuse en 2015

Galanaud

Messas

Blanchet-Deverly³

et al. 2015

La Revue de Médecine Interne

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Six Months vs Extended Oral Anticoagulation After a First Episode of Pulmonary Embolism

Couturaud

Sanchez

Pernod

et al. 2015

JAMA

212

106

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IMPORTANCE The optimal duration of anticoagulation after a first episode of unprovoked pulmonary embolism is uncertain.OBJECTIVES To determine the benefits and harms of an additional 18-month treatment with warfarin vs placebo, after an initial 6-month nonrandomized treatment period on a vitamin K antagonist.DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind trial (treatment period, 18 months; median follow-up, 24 months); 371 adult patients who had experienced a first episode of symptomatic unprovoked pulmonary embolism (ie, with no major risk factor for thrombosis) and had been treated initially for 6 uninterrupted months with a vitamin K antagonist were randomized and followed up between July 2007 and September 2014 in 14 French centers.INTERVENTIONS Warfarin or placebo for 18 months. MAIN OUTCOMES AND MEASURESThe primary outcome was the composite of recurrent venous thromboembolism or major bleeding at 18 months after randomization. Secondary outcomes were the composite at 42 months (treatment period plus 24-month follow-up), as well as each component of the composite, and death unrelated to pulmonary embolism or major bleeding, at 18 and 42 months.RESULTS After randomization, 4 patients were lost to follow-up, all after month 18, and 1 withdrew due to an adverse event. During the 18-month treatment period, the primary outcome occurred in 6 of 184 patients (3.3%) in the warfarin group and in 25 of 187 (13.5%) in the placebo group (hazard ratio [HR], 0.22; 95% CI, 0.09-0.55; P = .001). Recurrent venous thromboembolism occurred in 3 patients in the warfarin group and 25 patients in the placebo group (HR, 0.15; 95% CI, 0.05-0.43); major bleeding occurred in 4 patients in the warfarin group and in 1 patient in the placebo group (HR, 3.96; 95% CI, 0.44 to 35.89). During the 42-month entire study period (including the study treatment and follow-up periods), the composite outcome occurred in 33 patients (20.8%) in the warfarin group and in 42 (24.0%) in the placebo group (HR, 0.75; 95% CI, 0.47-1.18). Rates of recurrent venous thromboembolism, major bleeding, and unrelated death did not differ between groups.CONCLUSIONS AND RELEVANCE Among patients with a first episode of unprovoked pulmonary embolism who received 6 months of anticoagulant treatment, an additional 18 months of treatment with warfarin reduced the composite outcome of recurrent venous thrombosis and major bleeding compared with placebo. However, benefit was not maintained after discontinuation of anticoagulation therapy.

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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 : prévention et traitement de la maladie thrombo-embolique veineuse en médecine

Cited by 77 publications

References 0 publications

Prise en charge de la maladie thromboembolique veineuse en 2015

Prise en charge de la maladie thromboembolique veineuse en 2015

Six Months vs Extended Oral Anticoagulation After a First Episode of Pulmonary Embolism

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

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