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de Moreuil C, Dargaud Y, Pan-Petesch B. "Women with severe postpartum hemorrhage have a decreased endogenous thrombin potential before delivery": reply. J Thromb Haemost 2024; 22:879-880. [PMID: 38417984 DOI: 10.1016/j.jtha.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Department of Vascular Medicine and Pneumology, Internal Medicine, Brest University Hospital, Brest, France.
| | - Yesim Dargaud
- Department of Clinical Haemostasis, Lyon University Hospitals, Lyon, France
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Center for Haemophilia Treatment, Haematology, Brest University Hospital, Brest, France
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Horvais V, Beurrier P, Cussac V, Pan-Petesch B, Schirr-Bonnans S, Rose J, Bayart S, Ternisien C, Fouassier M, Sigaud M, Babuty A, Drillaud N, Guillet B, Trossaërt M. Key Drivers of Coagulation Factor Use in Von Willebrand Disease During Hospitalization: An Overview of the French BERHLINGO Cohort. Clin Drug Investig 2024; 44:35-49. [PMID: 38036930 DOI: 10.1007/s40261-023-01323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Von Willebrand disease (VWD) is the most common inherited bleeding disorder. However, studies of hospitalisation patterns with replacement treatment are scarce. OBJECTIVES The aim of this study was to investigate the current therapeutic management of VWD and determine the key drivers of coagulation factor uses in patients during hospitalisation. METHODS Hopscotch-WILL was a multi-centric retrospective study conducted over a 48-month period in any patients with VWD. The data were collected from the BERHLINGO Research Database and the French Hospital database. RESULTS A total of 988 patients were included; 153 patients (15%) were hospitalised during 293 stays requiring treatment with von Willebrand factor (VWF) concentrates-pure or in association with Factor VIII (FVIII). Their median basal concentrations of VWF and FVIII were significantly lower than in untreated patients: VWF antigen < 30 IU/dL, VWF activity < 20 IU/dL and FVIII:C < 40 IU/dL. The median (interquartile range) concentrate consumption was similar between highly purified VWF or VWF combined with FVIII (72 [110] vs 57 [89] IU/kg/stay, p = 0.154). The use of VWF was highly heterogeneous by VWD type; type 3 had a particularly high impact on VWF consumption in non-surgical situations. The main admissions were for ear/nose/throat, hepato-gastroenterology, and trauma/orthopaedic conditions, besides gynaecological-obstetric causes in women. CONCLUSIONS The use of VWF concentrates is mostly influenced by low basal levels of VWF and FVIII, but also by VWD type or the cause for hospitalisation. These results could inform future studies of newly released recombinant VWF.
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Affiliation(s)
- Valérie Horvais
- Nantes Université, CHU Nantes, Unité d'Investigation Clinique 17, 44000, Nantes, France.
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France.
| | - Philippe Beurrier
- CHU Angers, Centre de Traitement des Maladies Hémorragiques Constitutionnelles, 49000, Angers, France
| | - Vincent Cussac
- CH Le Mans, Centre de Traitement des Maladies Hémorragiques Constitutionnelles, 72000, Le Mans, France
| | | | - Solène Schirr-Bonnans
- Nantes Université, CHU Nantes, Service Evaluation Economique et Développement des Produits de Santé, 44000, Nantes, France
| | - Johann Rose
- CH Le Mans, Centre de Traitement des Maladies Hémorragiques Constitutionnelles, 72000, Le Mans, France
| | - Sophie Bayart
- Rennes Université, CHU Rennes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 35000, Rennes, France
| | - Catherine Ternisien
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
| | - Marc Fouassier
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
| | - Marianne Sigaud
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
| | - Antoine Babuty
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
| | - Nicolas Drillaud
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
| | - Benoît Guillet
- Rennes Université, CHU Rennes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 35000, Rennes, France
- Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000, Rennes, France
| | - Marc Trossaërt
- Nantes Université, CHU Nantes, Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, 44000, Nantes, France
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de Moreuil C, Dargaud Y, Nougier C, Dupré PF, Trémouilhac C, Le Joliff D, Rosec S, Lucier S, Pabinger I, Ay C, Couturaud F, Pan-Petesch B. Women with severe postpartum hemorrhage have a decreased endogenous thrombin potential before delivery. J Thromb Haemost 2023; 21:3099-3108. [PMID: 37541589 DOI: 10.1016/j.jtha.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/01/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Severe postpartum hemorrhage (PPH), defined as a blood loss ≥1000 mL, is associated with maternal morbidity and mortality. OBJECTIVES We aimed at characterizing coagulation properties of predelivery plasmas from pregnant women with thrombin generation assay and hemostatic biomarkers (plasminogen activator inhibitor-1, tissue factor [TF], and thrombomodulin). METHODS A nested case-control study was conducted within the "Study of Biological Determinants of Bleeding Postpartum," a French prospective cohort study, in order to compare women with severe PPH (cases) and controls matched for age, body mass index, term, and mode of delivery. Plasma was collected at entry in the delivery room, and blood loss was measured objectively. The predelivery endogenous thrombin generation potential (ETP) was measured in plasma using calibrated automated thrombinography and low TF concentration. Hemostatic biomarkers were measured using ELISA kits. RESULTS A total of 142 women (71 cases and 71 controls) were investigated. There was no difference in the median lag phase, thrombin peak, and time to peak between cases and controls. However, median predelivery ETP was lower in cases than in controls (2170 vs 2408 nM.min, P < .0001), independently of mode of delivery and PPH etiology. Median plasminogen activator inhibitor-1 and TF levels were higher in cases compared with controls (107.4 vs 68.1 ng/mL, P = .0003; 34.4 vs 27.4 pg/mL, P = .007), whereas thrombomodulin levels did not differ between the 2 groups. CONCLUSION Among thrombin generation assay parameters, predelivery ETP levels may have a predictive value for severe PPH.
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Affiliation(s)
- Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Internal Medicine, Vascular Medicine and Pneumology Department, Brest University Hospital, Brest, France.
| | - Yesim Dargaud
- Haemostasis Department, Lyon University Hospital, Lyon, France
| | | | | | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Gynecology and Obstetrics Department, Brest University Hospital, Brest, France
| | | | - Sylvain Rosec
- CIC-RB Ressources Biologiques (UF 0827), Brest University Hospital, Brest, France
| | - Sandy Lucier
- CIC 1412, INSERM, Brest University Hospital, Brest, France
| | - Ingrid Pabinger
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Internal Medicine, Vascular Medicine and Pneumology Department, Brest University Hospital, Brest, France
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France; Haemophilia Treatment Centre, Haematology, Brest University Hospital, Brest, France
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Anouilh F, de Moreuil C, Trémouilhac C, Jacquot M, Salnelle G, Bellec V, Touffet N, Cornec C, Muller M, Dupré PF, Bellot C, Morcel K, Joliff DL, Drugmanne G, Gelebart E, Lucier S, Nowak E, Bihan L, Couturaud F, Tromeur C, Moigne EL, Pan-Petesch B. Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter Haemorrhages and Thromboembolic Venous Disease of the Postpartum cohort study. Am J Obstet Gynecol MFM 2023; 5:101062. [PMID: 37343695 DOI: 10.1016/j.ajogmf.2023.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a major component of perinatal morbidity and mortality that affects young women worldwide and is still often unpredictable. Reducing the incidence of postpartum hemorrhage is a major health issue and identifying women at risk for postpartum hemorrhage is a key element in preventing this complication. OBJECTIVE This study aimed to estimate postpartum hemorrhage prevalence after vaginal delivery and to identify postpartum hemorrhage risk factors. STUDY DESIGN Unselected pregnant women ≥16 years of age admitted to 1 of 6 maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective, multicenter cohort study between June 1, 2015, and January 31, 2019. Postpartum hemorrhage was defined as blood loss ≥500 mL in the 24 hours following delivery. Independent risk factors for postpartum hemorrhage were determined using logistic regression. Missing data were imputed using the Multivariate Imputation by Chained Equations method. RESULTS Among 16,382 included women, the postpartum hemorrhage prevalence was 5.37%. A first-degree family history of postpartum hemorrhage (adjusted odds ratio, 1.63; 95% confidence interval, 1.24-2.14) and a personal transfusion history (adjusted odds ratio, 1.90; 95% confidence interval, 1.23-2.92) were significantly associated with postpartum hemorrhage. The use of oxytocin during labor was also a risk factor for postpartum hemorrhage (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk for postpartum hemorrhage (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.91, and 0.34; 95% confidence interval, 0.13-0.87, respectively). CONCLUSION In addition to classical risk factors, this study identified a family history of postpartum hemorrhage and personal transfusion history as new characteristics associated with postpartum hemorrhage after vaginal delivery. The association of postpartum hemorrhage with a family history of postpartum hemorrhage suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for postpartum hemorrhage is a key element of being prepared for this complication.
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Affiliation(s)
- François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé - Brest, Brest, France (Mr Anouilh); UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch)
| | - Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne).
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Jacquot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Gilles Salnelle
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Violaine Bellec
- Service de Gynécologie Obstétrique, Centre Hospitalier Privé de Brest - Keraudren, Brest, France (Dr Bellec)
| | - Nathalie Touffet
- Service de Gynécologie Obstétrique, CH de Landerneau, Landerneau, France (Dr Touffet)
| | - Caroline Cornec
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Muller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Karine Morcel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Delphine Le Joliff
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Guillaume Drugmanne
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Elodie Gelebart
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Sandy Lucier
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Emmanuel Nowak
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Line Bihan
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Cécile Tromeur
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Centre de Ressources et de Compétence des Maladies Hémorragiques, Centre de Ressources et de Compétence des Maladies Hémorragiques, Hémostase, Service Hématologie, Centre Hospitalier Universitaire Brest, Brest, France (Dr Pan-Petesch)
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de Moreuil C, Anouilh F, Pan-Petesch B. Reply: A need for further investigations on the family risk for postpartum hemorrhage after vaginal delivery. Am J Obstet Gynecol MFM 2023; 5:101089. [PMID: 37433347 DOI: 10.1016/j.ajogmf.2023.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Claire de Moreuil
- Department of Internal Medicine, Vascular Medicine and Pneumology, University and Regional Hospital Centre Brest, Brest, France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France
| | - François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé, Brest, France; Gynecology and Obstetric department, Brest University Hospital, Brest, France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie, Centre de Ressources et de Compétence des Maladies Hémorragiques, University and Regional Hospital Centre Brest, Brest France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France.
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Herbreteau L, Couturaud F, Hoffmann C, Bressollette L, Pan-Petesch B, Rio L, Lippert E, Ianotto JC. Atrial fibrillation and peripheral arterial disease define MPN patients with very high risk of thrombosis. Thromb Res 2023; 226:93-99. [PMID: 37141796 DOI: 10.1016/j.thromres.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
Myeloproliferative neoplasms (MPNs) are associated with a high risk of thrombotic and hemorrhagic complications, especially in elderly patients. Atrial fibrillation (AF) and peripheral arterial disease (PAD), also frequently discovered in aging patients, are associated with similar complications. We analysed the incidence and complication rates of AF and PAD in a large cohort of MPN patients. In total, 289/1113 patients (26 %) suffered at least one of these diseases as follows: 179 (16.1 %) with AF alone, 81 with PAD alone (7.3 %) and 29 (2.6 %) with both conditions. Postdiagnosis thrombotic events were observed in 31.3 % of AF patients (p = 0.002, OR = 1.80 [1.23;2.61]), 35.8 % of PAD patients (p = 0.002, OR = 2.21[1.31;3.67]) and 62.1 % of AF/PAD patients (p < 0.0001, OR = 6.47 [2.83;15.46]) compared to 20.1 % of no-AF/no-PAD patients. Postdiagnosis hemorrhagic events were also identified in 17.9 %, 16 %, 24.1 % and 10.1 % of AF, PAD, AF/PAD, and no-AF/no-PAD patients, respectively (p = 0.003). This significantly higher risk of thrombosis/bleeding was also observed in patients <60 years old. AF and PAD were significant risk factors for both thrombotic and hemorrhagic risks in multivariate analysis. We identified AF and PAD as criteria for high risk of thrombosis, hemorrhage, and death, emphasizing the interest in early detection and efficient treatment of these conditions.
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Affiliation(s)
- Laura Herbreteau
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Clément Hoffmann
- Service de Médecine vasculaire, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Luc Bressollette
- Service de Médecine vasculaire, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Laetitia Rio
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France
| | - Eric Lippert
- Laboratoire d'Hématologie, CHU de Brest, Brest, France; France Intergroupe des syndromes Myéloprolifératifs (FIM), Paris, France
| | - Jean-Christophe Ianotto
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France; France Intergroupe des syndromes Myéloprolifératifs (FIM), Paris, France.
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Le Gall-Ianotto C, Ficheux AS, Lippert E, Herbreteau L, Rio L, Pan-Petesch B, Misery L, Ianotto JC. Differences between aquagenic and non-aquagenic pruritus in myeloproliferative neoplasms: An observational study of 500 patients. J Eur Acad Dermatol Venereol 2023; 37:1175-1183. [PMID: 36808754 DOI: 10.1111/jdv.18990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pruritus is a frequent symptom experienced by patients with myeloproliferative neoplasms (MPN). Aquagenic pruritus (AP) is the most common type. The Myeloproliferative Neoplasm-Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) self-report questionnaires were distributed to MPN patients before consultations. OBJECTIVES The aim of this study was to assess clinical incidence (phenotypical evolution and response to treatment) of pruritus, especially AP, in MPN patients during their follow-ups. PATIENTS AND METHODS We collected 1444 questionnaires from 504 patients [54.4% essential thrombocythaemia (ET) patients, 37.7% polycythaemia vera (PV) patients, and 7.9% primary myelofibrosis (PMF) patients]. RESULTS Pruritus was reported by 49.8% of the patients, including 44.6% of AP patients, regardless of type of MPN or driver mutations. Patients suffering from pruritus were more symptomatic and had a higher rate of evolution into myelofibrosis/acute myeloid leukaemia (19.5% vs. 9.1%, OR = 2.42 [1.39; 4.32], p = 0.0009) than MPN patients without pruritus. Patients with AP had the highest pruritus intensity values (p = 0.008) and a higher rate of evolution (25.9% vs. 14.4%, p = 0.025, OR = 2.07) than patients with non-AP. Disappearance of pruritus was observed in only 16.7% of AP cases, compared to 31.7% of cases with other types of pruritus (p < 0.0001). Ruxolitinib and hydroxyurea were the most effective drugs to reduce AP intensity. CONCLUSIONS In this study, we demonstrate the global incidence of pruritus across all MPN. Pruritus, especially AP, which is a major constitutional symptom observed in MPN, should be assessed in all MPN patients due to higher symptom burden and higher risk of evolution.
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Affiliation(s)
| | - Anne-Sophie Ficheux
- Service de Dermatologie, CHRU de Brest, Brest, France.,Univ Brest, LIEN, CHRU Brest, Brest, France
| | - Eric Lippert
- Laboratoire d'Hématologie, CHRU de Brest, Brest, France.,France Intergroupe des Néoplasies Myéloprolifératives (FIM), Paris, France
| | - Laura Herbreteau
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
| | - Laetitia Rio
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France.,INSERM, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Laurent Misery
- Service de Dermatologie, CHRU de Brest, Brest, France.,Univ Brest, LIEN, CHRU Brest, Brest, France
| | - Jean-Christophe Ianotto
- France Intergroupe des Néoplasies Myéloprolifératives (FIM), Paris, France.,Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France.,INSERM, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
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Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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9
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de Moreuil C, Pan-Petesch B, Trémouilhac C, Dupré PF, Merviel P, Anouilh F, Bellot C, Müller M, Drugmanne G, Nowak E, Coadic J, Bihan L, Gourhant L, Lemarié C, Robin S, Couturaud F, Moigne EL. Clinical risk factors for vasculo-placental disorders: results from a prospective case-control study nested in HEMOTHEPP French cohort study. J Gynecol Obstet Hum Reprod 2023; 52:102511. [PMID: 36417979 DOI: 10.1016/j.jogoh.2022.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Determine clinical risk factors for vasculo-placental disorders in singleton pregnancies. DESIGN Prospective case-control study nested in HEMOTHEPP French cohort. SETTING Women delivered between June, 2015 and January, 2019 in any maternity ward of Finistère. POPULATION Cases were women with vasculo-placental disorders (pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption or stillbirth). Controls were women matched for age at delivery and parity. METHODS Clinical data were collected by obstetricians or midwives during antenatal care visits and delivery, and recorded by trained research assistants. MAIN OUTCOME MEASURES Occurrence of a vasculo-placental disorder. RESULTS 505 women with vasculo-placental disorder (299 pre-eclampsia, 253 IUGR, 44 placental abruptions, 11 stillbirths) and 1515 matched controls were selected out of 20,075 participants. In multivariable analysis, four clinical parameters were associated with pre-eclampsia: obesity (Odd ratio (OR) = 3.11, 95%CI 2.11-4.58), French overseas origin (OR = 4.41, 95%CI 1.87-10.42), previous vasculo-placental disorder (OR = 5.14, 95%CI 2.72-9.70), aspirin during pregnancy (OR = 10.10, 95%CI 1.99-51.08). Three clinical parameters were associated with IUGR: auto-immune/inflammatory disorder (OR = 3.75, 95%CI 1.83-7.68), previous vasculo-placental disorder (OR = 3.63, 95%CI 2.06-6.41), smoking during pregnancy (OR = 2.66, 95%CI 1.91- 3.71). A previous venous thromboembolism (VTE) was associated with IUGR in univariable but not in multivariable analysis (OR = 3.72, 95%CI 0.82-17.00, p = 0.09). CONCLUSIONS Clinical risk factors differ between IUGR and pre-eclampsia, the later, but not the former, being associated with cardiovascular risk factors.
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Affiliation(s)
- Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France.
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest (France), France
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France; INSERM 1078, équipe GTCA, France
| | - Philippe Merviel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France
| | - François Anouilh
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Ecole de Sage-femmes, UFR Santé - Brest (France), France
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper - Quimper (France), France
| | - Matthieu Müller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix - Morlaix (France), France
| | | | | | | | - Line Bihan
- CIC1412, INSERM - Brest (France), France
| | - Lénaick Gourhant
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France
| | - Catherine Lemarié
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France
| | - Sara Robin
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
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10
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Bihan L, Nowak E, Anouilh F, Tremouilhac C, Merviel P, Tromeur C, Robin S, Drugmanne G, Le Roux L, Couturaud F, Le Moigne E, Abgrall JF, Pan-Petesch B, de Moreuil C. Development and Validation of a Predictive Tool for Postpartum Hemorrhage after Vaginal Delivery: A Prospective Cohort Study. Biology (Basel) 2022; 12:biology12010054. [PMID: 36671746 PMCID: PMC9855728 DOI: 10.3390/biology12010054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity worldwide. This study aimed to develop and validate a predictive model for PPH after vaginal deliveries, based on routinely available clinical and biological data. The derivation monocentric cohort included pregnant women with vaginal delivery at Brest University Hospital (France) between April 2013 and May 2015. Immediate PPH was defined as a blood loss of ≥500 mL in the first 24 h after delivery and measured with a graduated collector bag. A logistic model, using a combination of multiple imputation and variable selection with bootstrap, was used to construct a predictive model and a score for PPH. An external validation was performed on a prospective cohort of women who delivered between 2015 and 2019 at Brest University Hospital. Among 2742 deliveries, PPH occurred in 141 (5.1%) women. Eight factors were independently associated with PPH: pre-eclampsia (aOR 6.25, 95% CI 2.35−16.65), antepartum bleeding (aOR 2.36, 95% CI 1.43−3.91), multiple pregnancy (aOR 3.24, 95% CI 1.52−6.92), labor duration ≥ 8 h (aOR 1.81, 95% CI 1.20−2.73), macrosomia (aOR 2.33, 95% CI 1.36−4.00), episiotomy (aOR 2.02, 95% CI 1.40−2.93), platelet count < 150 Giga/L (aOR 2.59, 95% CI 1.47−4.55) and aPTT ratio ≥ 1.1 (aOR 2.01, 95% CI 1.25−3.23). The derived predictive score, ranging from 0 to 10 (woman at risk if score ≥ 1), demonstrated a good discriminant power (AUROC 0.69; 95% CI 0.65−0.74) and calibration. The external validation cohort was composed of 3061 vaginal deliveries. The predictive score on this independent cohort showed an acceptable ability to discriminate (AUROC 0.66; 95% CI 0.62−0.70). We derived and validated a robust predictive model identifying women at risk for PPH using in-depth statistical methodology. This score has the potential to improve the care of pregnant women and to take preventive actions on them.
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Affiliation(s)
| | | | - François Anouilh
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Ecole de Sage-Femmes, UFR Santé, 29200 Brest, France
| | - Christophe Tremouilhac
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
| | - Philippe Merviel
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
| | - Cécile Tromeur
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | - Sara Robin
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | | | - Liana Le Roux
- CIC1412, INSERM, 29200 Brest, France
- CIC-RB Ressources Biologiques (UF 0827), CHU Brest, 29200 Brest, France
| | - Francis Couturaud
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | - Emmanuelle Le Moigne
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | | | - Brigitte Pan-Petesch
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Centre de Traitement de L’hémophilie, Hématologie, CHU Brest, 29200 Brest, France
| | - Claire de Moreuil
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
- Correspondence:
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Horvais V, Wargny M, Repessé Y, Guillet B, Beurrier P, Ardillon L, Pan-Petesch B, Cussac V, Trossaërt M. rFVIII-Fc in severe haemophilia A: The incentive switch in case of high risk of joint bleedings. Eur J Clin Invest 2022; 52:e13824. [PMID: 35699345 DOI: 10.1111/eci.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Efmoroctocog alfa, the first recombinant factor VIII fusion protein with extended half-life (rFVIII-Fc), has been hypothesized to lower FVIII consumption in patients with severe Haemophilia A (pwSHA), without reducing clinical efficacy. What about real life? METHOD MOTHIF-II was a noninterventional, multicentre, before/after study, via the collection of retrospective data from July 2015 to June 2016 (called T1), and from July 2017 to June 2018 (called T2), in 7 French haemophilia treatment centres. We examined the prescriptions and dispensations of factor VIII and the Annual Bleeding Rate (ABR), in pwSHA without current inhibitors on prophylaxis, before and after the introduction of rFVIII-Fc. The data gathered from the BERHLINGO research database and from the French Healthcare claims database with a determinist pairing process based on the national unique identification number. RESULTS A total of 156 pwSHA were included in the prescription cohort and 83 in the ABR cohort. For switched patients, the mean amounts of prescribed FVIII were significantly higher during T1 compared to T2 (4333 (2052) vs. 3921 (2029) IU/kg/year/patient, p: 0.028); a significant decrease in their ABR was also observed between T1 and T2 (6.3 (6.0) vs. 4.4 (5.4), p: 0.047). These patients had a more severe bleeding profile centred on haemarthrosis. CONCLUSION The results are related to those of the pivotal clinical trials for the reduction in FVIII consumption following the switch to rFVIII-Fc, with a significant improvement in the haemorrhagic phenotype for pwSHA.
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Affiliation(s)
- Valérie Horvais
- CHU de Nantes, Pôle Hospitalo-Universitaire 7, Biologie: Unité d'Investigation Clinique 17, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM CIC-1413, Pôle Hospitalo-Universitaire 11, Santé Publique: Clinique des Données, Nantes, France
| | - Yohann Repessé
- Haemophilia Treatment Centre CRC-MHC, University Hospital of Caen Normandie, Caen, France
| | - Benoît Guillet
- Haemophilia Treatment Centre CRC-MHC, Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Philippe Beurrier
- Haemophilia Treatment Centre CT-MHC, University Hospital of Angers, Angers, France
| | - Laurent Ardillon
- Haemophilia Treatment Centre CRC-MHC, University Hospital of Tours, Tours, France
| | - Brigitte Pan-Petesch
- Haemophilia Treatment Centre CRC-MHC, University Hospital of Brest, Brest, France
| | - Vincent Cussac
- Haemophilia Treatment Centre, Hospital of Le Mans, Le Mans, France
| | - Marc Trossaërt
- Haemophilia Treatment Centre CRC-MHC, University Hospital of Nantes, Nantes, France
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12
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Nicol C, Pan-Petesch B, Ianotto JC. Acquired von Willebrand syndrome and lymphoid neoplasms: A review of malignancy management, and propositions of practical recommendations. Haemophilia 2022; 28:938-949. [PMID: 36006003 DOI: 10.1111/hae.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/13/2022] [Accepted: 07/17/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Acquired von Willebrand syndrome (AWS) is a rare and potentially life-threatening bleeding disorder. AWS is primarily associated with lymphocyte-related disorders (AWS-LRD), such as lymphoma and IgM monoclonal gammopathy of undetermined significance (MGUS), and plasmocyte-related disorders (AWS-PRD), such as non-IgM MGUS and myeloma. Symptomatic treatments are important to control and prevent bleeding, but AWS-LRD and AWS-PRD can only be cured by targeting the responsible clonal cell. No reviews exist on this specific subgroup of AWS. AIM We performed a literature review to help manage these rare cases. METHOD Thirty-two AWS-PRD and 43 AWS-LRD cases with data on malignancy treatment were reported in 56 articles from the Medline database. RESULTS LRDs were exclusively indolent and primarily associated with IgM monoclonal compounds. LRDs and PRDs may be treated because of severe bleeding symptoms, but severe VWF deficiency did not necessarily correlate with severe bleeding. Immunosuppressive drugs in AWS-PRD, including rituximab, provided an overall response rate of AWS (AWS-ORR) of 30% (3/10), including short responses. Anti-myeloma drugs provided an AWS-ORR of 71.4% (20/28), with long-lasting remissions. Bortezomib was the most commonly used drug and provided an AWS-ORR of 66.7% (6/9), including therapeutic associations with other anti-myeloma drugs. Autologous and allogeneic stem cell transplantation was performed in eight and two patients, respectively, and some details on the management of AWS during these procedures were provided. Rituximab in AWS-LRD provided an AWS-ORR of 60% (3/5), and a chemotherapy + rituximab regimen increased the AWS-ORR to above 50%. Bleeding syndrome in AWS-PRD and AWS-LRD generally improved prior to AWS biological improvement. CONCLUSION Long term remission of AWS due to lymphoid neoplasms is attainable by treating the underlying clonal cell. Some data and recommendations are provided to help answer difficult questions, including treatment timing, choice of drug, and the timing of evaluations and treatment changes.
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Affiliation(s)
- Christophe Nicol
- Service d'Onco-Hématologie, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France.,Centre de ressources et de compétence des maladies hémorragiques, CHRU de Brest, Brest, France
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13
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Herbreteau L, Papageorgiou L, Le Clech L, Garcia G, James C, Pan-Petesch B, Couturaud F, Gerotziafas G, Lippert E, Ianotto JC. Benefice and pitfall of direct oral anticoagulants in very high-risk myeloproliferative neoplasms. Thromb Res 2022; 216:25-34. [DOI: 10.1016/j.thromres.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
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14
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Nicol C, Ajzenberg N, Lacut K, Couturaud F, Pan-Petesch B, Lippert E, Ianotto JC. Hemorrhages in polycythemia vera and essential thrombocythemia: epidemiology, description, and risk factors, learnings from a large cohort. Thromb Haemost 2022; 122:1712-1722. [PMID: 35545123 DOI: 10.1055/a-1849-8477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The management of myeloproliferative neoplasms (MPN) is based on the reduction of thrombosis risk. The incidence, impact, and risk factors of bleedings have been less studied. METHOD All patients with polycythemia vera (n=339) or essential thrombocythemia (n=528) treated in our center are included in OBENE cohort (NCT02897297). Major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) occurring after diagnosis were included, except after leukemic transformation. RESULTS With a median follow-up of 8.3 years, incidence of hemorrhages was 1.85% patient/year, with an incidence of MB of 0.95% patient/year. The 10-year bleeding-free survival was 89%. The most frequent locations were digestive tractus, "mouth, nose and throat" and muscular hematoma. The case fatality rate of MB was 25%. The proportion of potentially avoidable iatrogenic bleeding was remarkable (17.6%). In multivariable analysis, eight risk factors of bleeding were identified: leukocytes >20 giga/l at diagnosis (HR=5.13 95%CI [1.77;14.86]), secondary hemopathies (HR=2.99 95%CI [1.27;7.04]), aspirin use at diagnosis (HR=2.11 95%CI [1.24;3.6]), platelet count >1000 giga/l at diagnosis (HR=1.93, 95%CI [1.11;3.36]), history of hemorrhage (HR=1.82 95%CI [1.03;3.24]), secondary cancers (HR=1.71 95%CI [1.01;2.89]), atrial fibrillation (HR=1.66, 95%CI [1.01;2.72]) and male gender (HR=1.54, 95%CI [1.02-2.33]). The majority of patients taking hydroxyurea displayed a non-macrocytic median corpuscular value in the months preceding bleeding (51.4%). DISCUSSION The morbidity and mortality of bleedings in MPN should not be underestimated, and some patients could beneficiate from cytoreduction in order to reducing bleeding risk. Iatrogenic bleedings represent a substantial proportion of bleeding and could be better prevented.
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Affiliation(s)
| | | | - Karine Lacut
- CIC1412, Inserm, Brest, France.,EA 3878, Brest University, Brest, France
| | - Francis Couturaud
- Department of internal medicine and chest diseases, Brest University Hospital Centre, Brest, France
| | | | - Eric Lippert
- Laboratoire d'Hématologie, CHU de Brest, Brest, France.,Equipe ECLA, INSERM U1078, France
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15
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Klamroth R, Hayes G, Andreeva T, Gregg K, Suzuki T, Mitha IH, Hardesty B, Shima M, Pollock T, Slev P, Oldenburg J, Ozelo MC, Stieltjes N, Castet SM, Mahlangu J, Peyvandi F, Kazmi R, Schved JF, Leavitt AD, Callaghan M, Pan-Petesch B, Quon DV, Andrews J, Trinh A, Li M, Wong WY. Global seroprevalence of pre-existing immunity against AAV5 and other AAV serotypes in people with hemophilia A. Hum Gene Ther 2022; 33:432-441. [PMID: 35156839 PMCID: PMC9063149 DOI: 10.1089/hum.2021.287] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adeno-associated virus (AAV)-mediated gene therapy may provide durable protection from bleeding events and reduce treatment burden for people with hemophilia A (HA). However, pre-existing immunity against AAV may limit transduction efficiency and hence treatment success. Global data on the prevalence of AAV serotypes are limited. In this global, prospective, noninterventional study, we determined the prevalence of pre-existing immunity against AAV2, AAV5, AAV6, AAV8, and AAVrh10 among people ≥12 years of age with HA and residual FVIII levels ≤2 IU/dL. Antibodies against each serotype were detected using validated, electrochemiluminescent-based enzyme-linked immunosorbent assays. To evaluate changes in antibody titers over time, 20% of participants were retested at 3 and 6 months. In total, 546 participants with HA were enrolled at 19 sites in 9 countries. Mean (standard deviation) age at enrollment was 36.0 (14.87) years, including 12.5% younger than 18 years, and 20.0% 50 years of age and older. On day 1, global seroprevalence was 58.5% for AAV2, 34.8% for AAV5, 48.7% for AAV6, 45.6% for AAV8, and 46.0% for AAVrh10. Considerable geographic variability was observed in the prevalence of pre-existing antibodies against each serotype, but AAV5 consistently had the lowest seroprevalence across the countries studied. AAV5 seropositivity rates were 51.8% in South Africa (n = 56), 46.2% in Russia (n = 91), 40% in Italy (n = 20), 37.2% in France (n = 86), 26.8% in the United States (n = 71), 26.9% in Brazil (n = 26), 28.1% in Germany (n = 89), 29.8% in Japan (n = 84), and 5.9% in the United Kingdom (n = 17). For all serotypes, seropositivity tended to increase with age. Serostatus and antibody titer were generally stable over the 6-month sampling period. As clinical trials of AAV-mediated gene therapies progress, data on the natural prevalence of antibodies against various AAV serotypes may become increasingly important.
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Affiliation(s)
- Robert Klamroth
- Vivantes Klinikum im Friedrichshain, 27695, Comprehensive Care Haemophilia Treatment Center, Berlin, Germany;
| | - Gregory Hayes
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
| | - Tatiana Andreeva
- Municipal Center of Hemophilia Therapy, St. Petersburg, Russian Federation;
| | - Keith Gregg
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
| | | | - Ismail Haroon Mitha
- Lakeview Hospital, Worthwhile Clinical Trials, Benoni, Gauteng, South Africa;
| | - Brandon Hardesty
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, United States;
| | - Midori Shima
- Nara Medical University, 12967, Kashihara, Nara, Japan;
| | - Toni Pollock
- ARUP Laboratories, 33294, Salt Lake City, Utah, United States;
| | - Patricia Slev
- ARUP Laboratories, 33294, Salt Lake City, Utah, United States;
| | | | - Margareth C Ozelo
- University of Campinas Department of Internal Medicine, 215029, Hemocentro UNICAMP, Campinas, SP, Brazil;
| | - Natalie Stieltjes
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Paris Cité, Université Paris Descartes, Department of Haematology and Regional Centre of Haemophilia Treatment, Paris, Île-de-France, France;
| | - Sabine-Marie Castet
- CHU de Bordeaux, 36836, Centre de Ressources et de Compétence des Maladies Hémorragiques Constitutionnelles, Bordeaux, Aquitaine, France;
| | - Johnny Mahlangu
- University of the Witwatersrand and National Health Laboratory Service, Haemophilia Comprehensive Care Centre, Johannesburg, South Africa;
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, 9304, Department of Pathophysiology and Transplantation, Milano, Lombardia, Italy;
| | - Rashid Kazmi
- Southampton University Hospitals NHS Trust, 7425, Department of Haematology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland;
| | - Jean-François Schved
- Hôpital Saint-Eloi, CHRU de Montpellier, Centre Régional de Traitement des Hémophiles, Montpellier, France;
| | - Andrew D Leavitt
- University of California San Francisco, 8785, Departments of Medicine and Laboratory Medicine, San Francisco, California, United States;
| | - Michael Callaghan
- Central Michigan University, 5649, Division of Pediatric Hematology/Oncology, Detroit, Michigan, United States;
| | - Brigitte Pan-Petesch
- Hopital Morvan, 55162, Centre Hospitalier Régional Universitaire de Brest, Brest, Bretagne, France;
| | - Doris V Quon
- Orthopaedic Institute for Children, Orthopaedic Hemophilia Treatment Center, Los Angeles, California, United States;
| | - Jayson Andrews
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
| | - Alex Trinh
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
| | - Mingjin Li
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc, 10926, Novato, California, United States;
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16
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Desprez D, Drillaud N, Flaujac C, Volot F, Pan-Petesch B, Beurrier P, Cussac V, Feugeas O, Pailler Y, Callegarin A, Trossaërt M, de Raucourt E. Efficacy and safety of a recombinant Von Willebrand Factor treatment in patients with inherited Von Willebrand Disease requiring surgical procedures. Haemophilia 2021; 27:270-276. [PMID: 33550648 DOI: 10.1111/hae.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Von Willebrand Disease is a common inherited haemorrhagic disorder due to a deficiency of Von Willebrand Factor (VWF). In case of surgical procedures in patients who are not responsive or have contraindications to desmopressin, replacement therapy with VWF concentrates is indicated. Until recently, only plasma-derived VWF concentrates were available. A new recombinant VWF (rVWF) concentrate that contains no Factor VIII (FVIII) but a high amount of high molecular weight VWF multimers has been available in France since 2018. AIM Describe real-world experience of using rVWF in surgical procedures. METHODS Sixty-three surgeries for 55 patients were retrospectively analysed in 7 French haemostasis centres. RESULTS During minor surgeries, the median (range) number of infusions was 1 (1-8) with a preoperative loading dose of 35 (19-56) rVWF IU/kg and a total median dose of 37.5 IU (12-288). During major surgeries, the median (range) number of infusions was only 3 (1-14) with a median preoperative loading dose of 36 IU (12-51) rVWF IU/kg, and a total median dose of 108 IU (22-340) rVWF IU/kg. The overall clinical efficacy was qualified as excellent/good in 61 of the procedures (97%), moderate in 1 (1.5%) and poor in 1 (1.5%). There was no accumulation of VWF or FVIII during postoperative monitoring. No thromboembolic events, anti-VWF antibodies or adverse events were reported. CONCLUSION This French 'real-world' experience shows that a few infusions and low doses of rVWF provided effective prevention of bleeding in major and minor surgeries in inherited VWD, with no clinically significant safety concerns.
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Affiliation(s)
- Dominique Desprez
- Department of Haemostasis, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Drillaud
- Department of Haemostasis, Nantes University Hospital, Nantes, France
| | - Claire Flaujac
- Department of Haemostasis, Versailles Hospital, Versailles, France
| | - Fabienne Volot
- Department of Haemostasis, Dijon University Hospital, Dijon, France
| | | | - Philippe Beurrier
- Department of Haemostasis, Angers University Hospital, Angers, France
| | - Vincent Cussac
- Department of Haemostasis, Le Mans Hospital, Le Mans, France
| | - Olivier Feugeas
- Department of Haemostasis, Strasbourg University Hospital, Strasbourg, France
| | - Yoann Pailler
- Department of Haemostasis, Nantes University Hospital, Nantes, France
| | | | - Marc Trossaërt
- Department of Haemostasis, Nantes University Hospital, Nantes, France
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17
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de Moreuil C, Le Mao R, Le Moigne E, Pan-Petesch B, Tromeur C, Hoffmann C, Salaun PY, Nonent M, Danguy des Déserts M, Savary X, Guegan M, Poulhazan E, Leroyer C, Lacut K, Couturaud F. Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort. Eur J Intern Med 2021; 84:24-31. [PMID: 33214024 DOI: 10.1016/j.ejim.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Data on long-term venous thromboembolism (VTE) recurrence risk according to gender are conflicting. OBJECTIVE To evaluate long-term VTE recurrence risk after a first VTE in men and women under 50 years old. METHODS Since May 2000, 875 consecutive patients (315 men, 560 women) with a first symptomatic VTE under 50 years old were enrolled in a French prospective multicentre cohort study and were followed up as long as possible. The primary outcome was symptomatic recurrent VTE during follow-up. RESULTS At baseline, men were older and had more comorbidities than women. First VTE was mainly unprovoked in men (80.6%) and hormone-related in women (84.3%). During a median follow-up of 7.0 years (inter-quartile range, 5.0-11.0), recurrent VTE occurred in 97 men (30.8%) and in 72 women (12.9%) (annual incidence rates of recurrent VTE of 4.8% versus 1.8%-person-years, P<0.001). However, there was no difference according to gender in subgroups of patients with a first unprovoked VTE (5.8% versus 3.8%-person-years, P = 0.09). In women, duration of hormonal treatment before first VTE did not influence recurrence risk. In multivariable analysis, unprovoked VTE and family history of VTE were independently associated with recurrence (hazard ratio of 2.50 (95% confidence interval, 1.61 to 3.85) and 1.52 (1.11 to 2.09) respectively). LIMITATIONS Number of women with unprovoked VTE was low. CONCLUSIONS In patients with a first VTE under 50 years old, a first unprovoked episode and a family history of VTE, but not gender, were associated with a high risk of long-term recurrence.
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Affiliation(s)
- Claire de Moreuil
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Raphael Le Mao
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | - Emmanuelle Le Moigne
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Brigitte Pan-Petesch
- EA3878, GETBO, Univ Brest, Brest, France; Service d'hématologie, CHU Brest, Univ Brest, Brest, France
| | - Cécile Tromeur
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Clément Hoffmann
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Pierre-Yves Salaun
- EA3878, GETBO, Univ Brest, Brest, France; Service de médecine nucléaire, CHU Brest, Univ Brest, Brest, France
| | - Michel Nonent
- EA3878, GETBO, Univ Brest, Brest, France; Service de radiologie, CHU Brest, Univ Brest, Brest, France
| | - Marc Danguy des Déserts
- EA3878, GETBO, Univ Brest, Brest, France; Service d'anesthésie réanimation, HIA, Brest, France
| | - Xavier Savary
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Marie Guegan
- EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | | | - Christophe Leroyer
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | - Karine Lacut
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France.
| | - Francis Couturaud
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
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18
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Rauch A, Paris C, Repesse Y, Branche J, D'Oiron R, Harroche A, Ternisien C, Castet SM, Lebreton A, Pan-Petesch B, Volot F, Claeyssens S, Chamouni P, Gay V, Berger C, Desprez D, Falaise C, Biron Andreani C, Marichez C, Pradines B, Zawadzki C, Itzhar Baikian N, Borel-Derlon A, Goudemand J, Gerard R, Susen S. Gastrointestinal bleeding from angiodysplasia in von Willebrand disease: Improved diagnosis and outcome prediction using videocapsule on top of conventional endoscopy. J Thromb Haemost 2021; 19:380-386. [PMID: 33113216 DOI: 10.1111/jth.15155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/09/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite a high prevalence of angiodysplasia, no specific guidelines are available for the modalities of endoscopic exploration of gastrointestinal (GI) bleeding in von Willebrand disease (VWD). Whether VWD patients could benefit from video capsule endoscopy (VCE) looking for angiodysplasia eligible to endoscopic treatment or at high risk of bleeding is unknown. OBJECTIVES To assess the diagnostic efficacy for angiodysplasia and the prognostic value of VCE on top of conventional endoscopy in VWD patients with GI bleeding. PATIENTS/METHODS A survey was sent to the 30 centers of the French-network on inherited bleeding disorders to identify VWD patients referred for endoscopic exploration of GI bleeding from January 2015 to December 2017. Data obtained included patient characteristics, VWD phenotype/genotype, GI bleeding pattern, results of endoscopic investigations, and medical management applied including endoscopic therapy. We assessed by Kaplan-Meier analysis the recurrence-free survival after the first GI bleeding event according to endoscopic categorization and, in patients with angiodysplasia, to the presence of small-bowel localizations on VCE exploration. RESULTS GI bleeding source localization was significantly improved when including VCE exploration (P < .01), even in patients without history of angiodysplasia (P < .05). Patients with angiodysplasia had more GI bleeding recurrences (P < .01). A lower recurrence-free survival was observed in patients with angiodysplasia (log-rank test, P = .02), and especially when lesions were located in the small bowel (log-rank test, P < .01), even after endoscopic treatment with argon plasma coagulation (log-rank test, P < .01). CONCLUSION VCE should be more systematically used in VWD patients with unexplained or recurrent GI bleeding looking for angiodysplasia eligible to endoscopic treatment or at high risk of relapse.
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Affiliation(s)
- Antoine Rauch
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | - Camille Paris
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | | | - Julien Branche
- Department of Gastroenterology, CHU Lille, Lille, France
| | - Roseline D'Oiron
- Center for Hemophilia and Rare Congenital Bleeding Disorders, University Hospital Paris-Sud, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | | | | | | | | | | | | | - Valérie Gay
- CH Métropole Savoie - Site de Chambéry, Chambéry, France
| | | | | | - Céline Falaise
- Centre régional de traitement des hémophiles, Hôpital de La Timone, AP-HM, Marseille, France
| | | | - Catherine Marichez
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | - Benedicte Pradines
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | - Christophe Zawadzki
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | - Nathalie Itzhar Baikian
- Laboratoire d'Hématologie, GH St-Louis Lariboisière F.Widal - Hôpital Lariboisière APHP, Paris, France
| | | | - Jenny Goudemand
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
| | - Romain Gerard
- Department of Gastroenterology, CHU Lille, Lille, France
| | - Sophie Susen
- Department of Hematology and Transfusion, CHU Lille, Institut d'Hématologie Transfusion, Lille, France
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19
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guillet S, Loustau V, Zarour A, Boutin E, Comont T, Odile S, Costedoat-Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Jean-François V, Morin A, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Michel M, Godeau B. Évolution du purpura thrombopenique immunologique pendant la grossesse : Résultats d’une étude cas-contrôles observationnelle prospective multicentrique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Guillet S, Loustau V, Zarour A, Boutin E, Comont T, Odile S, Costedoat-Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Jean-François V, Morin A, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Michel M, Godeau B. Facteurs de risques de thrombopénie immunologique néonatale chez les nouveau-nés de femmes atteintes de purpura thrombopénique immunologique : résultats d’une étude multicentrique prospective. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Nicol C, Lacut K, Pan-Petesch B, Lippert E, Ianotto JC. Hemorrhage in Essential Thrombocythemia or Polycythemia Vera: Epidemiology, Location, Risk Factors, and Lessons Learned from the Literature. Thromb Haemost 2020; 121:553-564. [PMID: 33186994 DOI: 10.1055/s-0040-1720979] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hemorrhage is a well-known complication of essential thrombocythemia (ET) and polycythemia vera (PV), but evidence-based data on its management and prevention are lacking to help inform clinicians. In this review, appropriate published data from the past 15 years regarding bleeding epidemiology, classification, location, and risk factors are presented and discussed. Research was conducted using the Medline database. The bleeding classifications were heterogeneous among the collected studies. The median incidences of bleeding and major bleeding were 4.6 and 0.79% patients/year, in ET patients and 6.5 and 1.05% patients/year in PV patients, respectively. The most frequent location was the gastrointestinal tract. Bleeding accounted for up to 13.7% of deaths, and cerebral bleeding was the main cause of lethal hemorrhage. Thirty-nine potential risk factors were analyzed at least once, but the results were discrepant. Among them, age >60 years, bleeding history, splenomegaly, myeloproliferative neoplasm subtype, and platelet count should deserve more attention in future studies. Among the treatments, aspirin seemed to be problematic for young patients with ET (especially CALR-mutated ET patients) and anagrelide was also identified as a bleeding inducer, especially when associated with aspirin. Future studies should analyze bleeding risk factors in more homogeneous populations and with common bleeding classifications. More tools are needed to help clinicians manage the increased risk of potentially lethal bleeding events in these diseases.
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Affiliation(s)
- Christophe Nicol
- Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France
| | - Karine Lacut
- Département de Médecine Interne et Pneumologie, CHRU de Brest, Bretagne, France.,GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France.,GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France
| | - Eric Lippert
- Laboratoire d'Hématologie, CHRU de Brest, Bretagne, France.,FIM, France Intergroupe des Néoplasies Myéloprolifératives, France
| | - Jean-Christophe Ianotto
- Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Bretagne, France.,GETBO, Groupe d'Etude de la Thrombose de Bretagne Occidentale, CHRU de Brest, Brest, Bretagne, France.,FIM, France Intergroupe des Néoplasies Myéloprolifératives, France
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22
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Nau A, Gillet B, Guillet B, Beurrier P, Ardillon L, Cussac V, Guillou S, Raj L, Trossaërt M, Horvais V, Bayart S, Potin J, Rose J, Macchi L, Couturaud F, Lacut K, Pan-Petesch B. Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study. Haemophilia 2020; 26:1046-1055. [PMID: 32842170 DOI: 10.1111/hae.14117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy, delivery and the postpartum period expose haemophilia carriers, as well as their potentially affected neonates to a high risk of haemorrhagic complications. OBJECTIVES To describe bleeding complications in haemophilia carriers and their newborns throughout pregnancy and postpartum and to identify potential factors increasing the risk of bleeding in this population. PATIENTS/METHODS The ECHANGE multicentre observational cohort study was conducted between January 2014 and February 2019 using the BERHLINGO database comprised of patients from seven French haemophilia centres. RESULTS During the 5 years study period, a total of 104 haemophilia carriers and 119 neonates were included, representing 124 pregnancies and 117 deliveries. Thirty-five (30%) bleeding events were observed, most of them (83%) occurred during the postpartum period, and 37% were reported during the secondary postpartum. Neuraxial anaesthesia was not complicated by spinal haematoma. Three (2.5%) neonates experienced cerebral bleeding. Caesarean section was associated with an increased risk of maternal bleeding in primary and secondary postpartum periods. Basal factor level <0.4 IU/mL was also found to be associated with an increased risk of bleeding during secondary postpartum. CONCLUSION In our cohort, bleeding events occurred in more than a third of haemophilia carriers mainly in the postpartum period, and a significant portion of this bleeding occurred during the secondary postpartum. Haemophilia carriers warrant specific attention during primary and secondary postpartum, in particular in case of caesarean section and low basal factor level. The ECHANGE study is registered at clinicaltrials.gov identifier: NCT03360149.
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Affiliation(s)
- Alice Nau
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France
| | - Benjamin Gillet
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Benoît Guillet
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France.,INSERM, U1085, IRSET, Université Rennes 1, Rennes, France
| | | | - Laurent Ardillon
- Service d'hématologie - hémostase, Hôpital Trousseau, CHU Tours, Tours, France
| | | | - Sophie Guillou
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Leela Raj
- EA3878, Université de Bretagne Occidentale, Brest, France
| | - Marc Trossaërt
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Valérie Horvais
- Centre de traitement de l'hémophilie, CHU Hôtel-Dieu Nantes, Nantes, France
| | - Sophie Bayart
- Centre de traitement des maladies hémorragiques, CHU Rennes, Rennes, France
| | - Jérôme Potin
- Service d'obstétrique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Johan Rose
- Laboratoire d'hématologie, CH Le Mans, Le Mans, France
| | - Laurent Macchi
- Service d'hématologie biologique, CHU Poitiers, Poitiers, France.,INSERM, U1082, IRTOMIT, Université de Poitiers, Poitiers, France
| | - Francis Couturaud
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Karine Lacut
- Département de Médecine Interne, Pneumologie et Médecine Vasculaire, CHU Brest, Brest, France.,EA3878, Université de Bretagne Occidentale, Brest, France
| | - Brigitte Pan-Petesch
- EA3878, Université de Bretagne Occidentale, Brest, France.,Centre de traitement des maladies hémorragiques, Hémostase clinique, Service d'hématologie clinique, CHU Brest, Brest, France
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23
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Pan-Petesch B, Nagao A, Karim FA, Tosetto A, Roman MTA, Seifert W, Li Y, Négrier C. Efficacy and safety of rIX-FP in surgery: An update from a phase 3b extension study. Thromb Res 2020; 193:139-141. [PMID: 32559570 DOI: 10.1016/j.thromres.2020.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Brigitte Pan-Petesch
- Hématologie Hémostase, Centre Hospitalier Régional Universitaire de Brest, Hôpital A. Morvan, Brest, France
| | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Alberto Tosetto
- Haemophilia and Thrombosis Centre, Department of Haematology, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Yanyan Li
- CSL Behring, King of Prussia, PA, USA
| | - Claude Négrier
- Hôpital Louis Pradel, University Claude Bernard Lyon 1, Lyon, France.
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24
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Jacamon AS, Merviel P, Herrmann S, Pan-Petesch B, Lacut K, Thereaux J. Outcomes of pregnancy after bariatric surgery: results of a French matched-cohort study. Surg Obes Relat Dis 2020; 16:1275-1282. [PMID: 32654896 DOI: 10.1016/j.soard.2020.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND While the benefits of bariatric surgery (BS) on pregnancy outcomes have been demonstrated for women compared with matched controls on presurgery body mass index (pB-BMI), data are lacking and those benefits are uncertain compared with matched controls on prepregnancy BMI (pP-BMI). OBJECTIVES Our study aimed to evaluate outcomes (obstetrical and neonatal) of single pregnancy in women previously exposed to BS compared with women unexposed to BS matched on pB-BMI and pP-BMI. SETTINGS Retrospective matched cohort study from 2 observational studies of pregnant women conducted in a French administrative county (Finistère). METHODS From April 1, 2015 to January 31, 2019, pregnant women with previous BS (n = 52) were included and compared with 2 different control groups as follows: group A (n = 104), matched for pB-BMI, age, and parity; and group B (n = 104), matched for pP-BMI, age, and parity. RESULTS In women exposed to BS, mean age was 27.1 (±4.9) years and pB-BMI was 46.0 (±4.6) kg/m2. Operated women differed significantly from group A but not from group B for pP-BMI (29.4 ± 6.1 versus 45.3 ± 4.5 group A versus 28.6 ± 6.6 group B) and gestational diabetes (12.0% versus 44.0% group A versus 17.0% group B), respectively. In the group of women exposed to BS, birth weight (g) was significantly lower (2960 ± 545 versus 3381 ± 735 group A versus 3310 ± 645 group B) and large-for-gestational-age infants less frequent (0% versus 13% group A versus 8% group B). CONCLUSION Bariatric surgery reduced risks of excessive fetal growth and gestational diabetes with a trend for a higher risk of small-for-gestational-age, despite matching on pP-BMI suggesting a risk associated to BS and solely to previous surgery-induced weight loss.
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Affiliation(s)
- Anne-Solenn Jacamon
- Department of Obstetrics, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Philippe Merviel
- Department of Obstetrics, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Sarah Herrmann
- Department of Obstetrics, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Brigitte Pan-Petesch
- Department of Hematology, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France
| | - Karine Lacut
- Department of Internal Medicine, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France; Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University of Bretagne Occidentale, Brest, France
| | - Jérémie Thereaux
- Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University of Bretagne Occidentale, Brest, France; Department of Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France.
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25
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Rugeri L, Martinaud C, Beurrier P, Borg Y, Chambost H, Chirila-Hetsch M, Desprez D, Harroche A, Milien V, Pan-Petesch B, Meunier S. Gynecological and obstetric outcome in the French cohort of women with factor XIII deficiency. Thromb Res 2020; 191:22-25. [PMID: 32360976 DOI: 10.1016/j.thromres.2020.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Congenital factor XIII deficiency is a very rare bleeding disorder affecting 33 patients in France. Besides its role in fibrin clot stabilization, factor XIII is involved in placental attachment. Fetal miscarriages represent a frequent and concerning issue for these patients. The aim of the present study was to describe clinical characteristics of women presenting severe congenital FXIII deficiency in France, to focus on gynecological and obstetrical events, and to report the management of these rare situations. METHODS We conducted a retrospective study in the French Hemophilia Comprehensive Care and Clinical Hemostasis Centers. Women between 15 and 65 years with factor XIII activity <10 IU dL-1 were included. Biological, clinical and therapeutic events that occurred to these patients during their gynecological and obstetrical period were recorded. RESULTS Among 31 centers, eleven patients were included. The median age at diagnosis was 1.5 years (range: 0-35), and at inclusion it was 30 years (range: 15-63). Fetal miscarriage was the primary manifestations in 2 (18%) patients, the remaining were diagnosed during hemorrhage. Menorrhagias were reported by 2 women (27%), 13 pregnancies were reported by 9 women including one abortion. Every pregnancy was conducted under factor XIII substitution, no hemorrhagic episode was reported. Four patients (36%) experienced at least one fetal miscarriage with a total amount of 30 miscarriages with 6 occurring during substitution. CONCLUSION Altogether, our data confirmed the high incidence of miscarriage in women with factor XIII deficiency. Good outcome of pregnancies required prophylaxis in accordance with international guidelines.
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Affiliation(s)
- Lucia Rugeri
- Hospices Civils de Lyon, Unité Hémostase Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.
| | | | | | - Yvonne Borg
- Unité Hémostase et Centre Régional de Traitement des maladies Hémorragiques, Institut de Biologie Clinique, Hôpital Charles Nicolle, Rouen, France
| | - Hervé Chambost
- Centre for Bleeding Disorders, Pediatric Haematology Oncology Department, University Hospital La Timone, AP-HM, and Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
| | | | - Dominique Desprez
- Centre de Traitement de l'Hémophilie, CHU Strasbourg, Strasbourg, France
| | - Annie Harroche
- Hemophilia Care Centre, Hematology Unit, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Vanessa Milien
- FranceCoag, University Hospital La Timone, AP-HM, Marseille, France
| | | | - Sandrine Meunier
- Hospices Civils de Lyon, Unité Hémostase Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
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26
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Couturaud F, Pernod G, Presles E, Duhamel E, Jego P, Provost K, Pan-Petesch B, Sollier CBD, Tromeur C, Hoffmann C, Bressollette L, Lorillon P, Girard P, Le Moigne E, Le Hir A, Guégan M, Laporte S, Mismetti P, Lacut K, Bosson JL, Bertoletti L, Sanchez O, Meyer G, Leroyer C, Mottier D. Six months versus two years of oral anticoagulation after a first episode of unprovoked deep-vein thrombosis. The PADIS-DVT randomized clinical trial. Haematologica 2019; 104:1493-1501. [PMID: 30606789 PMCID: PMC6601089 DOI: 10.3324/haematol.2018.210971] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/02/2019] [Indexed: 11/09/2022] Open
Abstract
The optimal duration of anticoagulation after a first episode of unprovoked deep-vein thrombosis is uncertain. We aimed to assess the benefits and risks of an additional 18 months of treatment with warfarin versus placebo, after an initial 6 months of anticoagulation for a first unprovoked proximal deep-vein thrombosis. We conducted a multicenter, randomized, double-blind, controlled trial comparing an additional 18 months of warfarin with placebo in patients with a unprovoked proximal deep-vein thrombosis initially treated for 6 months (treatment period: 18 months; follow up after treatment period: 24 months). The primary outcome was the composite of recurrent venous thromboembolism or major bleeding at 18 months. Secondary outcomes were the composite at 42 months, as well as each component of the composite, and death unrelated to pulmonary embolism or major bleeding, at 18 and 42 months. All outcomes were centrally adjudicated. A total of 104 patients, enrolled between July 2007 and October 2013 were analyzed on an intention-to-treat basis; no patient was lost to follow-up. During the 18-month treatment period, the primary outcome occurred in none of the 50 patients in the warfarin group and in 16 out of 54 patients (cumulative risk, 29.6%) in the placebo group (hazard ratio, 0.03; 95% confidence interval: 0.01 to 0.09; P<0.001). During the entire 42-month study period, the composite outcome occurred in 14 patients (cumulative risk, 36.8%) in the warfarin group and 17 patients (cumulative risk, 31.5%) in the placebo group (hazard ratio, 0.72; 95% confidence interval: 0.35-1.46). In conclusion, after a first unprovoked proximal deep-vein thrombosis initially treated for 6 months, an additional 18 months of warfarin therapy reduced the composite of recurrent venous thrombosis and major bleeding compared to placebo. However, this benefit was not maintained after stopping anticoagulation. Clinical registration: this trial was registered at www.clinicaltrials.gov as #NCT00740493.
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Affiliation(s)
- Francis Couturaud
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Gilles Pernod
- Département de Médecine Vasculaire, CHU de Grenoble, Université de Grenoble 1, F-CRIN INNOVTE, Grenoble
| | - Emilie Presles
- Unité de Recherche Clinique, Innovation et Pharmacologie, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Elisabeth Duhamel
- Service de Médecine Interne, Centre Hospitalier Général de Saint-Brieuc, F-CRIN INNOVTE, Saint-Brieuc
| | - Patrick Jego
- Service de Médecine Interne, CHU de Rennes, Université de Rennes 1, Rennes
| | - Karine Provost
- Service de Cardiologie, Centre Hospitalier Général de Lannion, Lannion
| | | | - Claire Bal Dit Sollier
- Clinique des Anticoagulants d'Ile de France (C.R.E.A.T.I.F.), CHU de Lariboisière, Paris
| | - Cécile Tromeur
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Clément Hoffmann
- Service d'Echo-Doppler Vasculaire, and EA 3878, CIC INSERM 1412, CHU de Brest, Université de Bretagne Occidentale, F-CRIN INNOVTE, Brest
| | - Luc Bressollette
- Service d'Echo-Doppler Vasculaire, and EA 3878, CIC INSERM 1412, CHU de Brest, Université de Bretagne Occidentale, F-CRIN INNOVTE, Brest
| | - Philippe Lorillon
- Pharmacie Centrale, CHU de Brest, Université de Bretagne Occidentale, Brest
| | - Philippe Girard
- Département Thoracique, Institut Mutualiste Montsouris, F-CRIN INNOVTE, Paris
| | - Emmanuelle Le Moigne
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Aurelia Le Hir
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Marie Guégan
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation et Pharmacologie, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Karine Lacut
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Jean-Luc Bosson
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, CHU de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, F-CRIN INNOVTE, Saint-Etienne
| | - Oliver Sanchez
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Guy Meyer
- CIC and UMR CNRS 5525, CHU de Grenoble, Université de Grenoble 1, Grenoble, France
| | - Christophe Leroyer
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
| | - Dominique Mottier
- Départementde Médecine Interne et Pneumologie, CHU de Brest, Université de Bretagne Occidentale, EA 3878, CIC INSERM 1412, F-CRIN INNOVTE, Brest
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27
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Tromeur C, Le Mao R, Jego P, El-Kouri D, Gruel Y, Pan-Petesch B, Bertoletti L, Morange PE, Lemoigne E, Paleiron N, Leroyer C, Couturaud F. [Risk factors for thromboembolic disease in young women-the role of hormones]. Rev Mal Respir 2018; 36:219-226. [PMID: 30318429 DOI: 10.1016/j.rmr.2018.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Abstract
Hormonal exposure in young women increases the risk of venous thromboembolic disease (VTE). Thrombophilia testing is often proposed in women of childbearing age before the initiation of contraception. However, the presence of a familial history of VTE has the potential to be more accurate than the presence of inherited thrombophilia. OBJECTIVE To demonstrate an association between the risk of VTE in young women with hormonal exposure (pregnancy or oral contraceptive use) and the presence of a previous episode of VTE in their first-degree relatives, according to whether or not a detectable inherited thrombophilia was present. METHODS We will perform a multicenter case-control cross-sectional study. The main risk factor is defined by the presence of a symptomatic VTE in young women with hormonal exposure. The principle variable is the presence of an objectively diagnosed episode of VTE in first-degree relatives. We will need to include 2,200 family members in 440 cases. EXPECTED RESULTS We expect to improve understanding of the thrombotic risk in first-degree relatives of patients in hormonal context with or without a past history of VTE.
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Affiliation(s)
- C Tromeur
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France
| | - R Le Mao
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France
| | - P Jego
- Service de médecine interne, université de Rennes 1, centre hospitalo universitaire de Rennes, 35033 Rennes, France
| | - D El-Kouri
- Service d'hématologie, centre hospitalo universitaire de Nantes, 44093 Nantes, France
| | - Y Gruel
- Service d'hématologie, centre hospitalo universitaire de Tours, 37044 Tours, France
| | - B Pan-Petesch
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France
| | - L Bertoletti
- EA3065, unité de pharmacologie clinique, service de médecine et thérapeutique, université Jean-Monnet, centre hospitalo universitaire de Saint-Etienne, 42277 Saint-Etienne, France
| | - P-E Morange
- Inserm 1062, service d'hématologie, centre hospitalo universitaire de la Timone, 13385 Marseille, France
| | - E Lemoigne
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France
| | - N Paleiron
- Service de pneumologie, hôpital d'instruction des armées de Clermont-Tonnerre, 29200 Brest, France
| | - C Leroyer
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France
| | - F Couturaud
- EA 3878, CIC Inserm 1412, département de médecine interne et pneumologie, université de Bretagne Occidentale, centre hospitalo universitaire de Brest, 29609 Brest cedex, France.
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28
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Resseguier N, Rosso-Delsemme N, Beltran Anzola A, Baumstarck K, Milien V, Ardillon L, Bayart S, Berger C, Bertrand MA, Biron-Andreani C, Borel-Derlon A, Castet S, Chamouni P, Claeyssens Donadel S, De Raucourt E, Desprez D, Falaise C, Frotscher B, Gay V, Goudemand J, Gruel Y, Guillet B, Harroche A, Hassoun A, Huguenin Y, Lambert T, Lebreton A, Lienhart A, Martin M, Meunier S, Monpoux F, Mourey G, Negrier C, Nguyen P, Nyombe P, Oudot C, Pan-Petesch B, Polack B, Rafowicz A, Rauch A, Rivaud D, Schneider P, Spiegel A, Stoven C, Tardy B, Trossaërt M, Valentin JB, Vanderbecken S, Volot F, Voyer-Ebrard A, Wibaut B, Leroy T, Sannie T, Chambost H, Auquier P. Determinants of adherence and consequences of the transition from adolescence to adulthood among young people with severe haemophilia (TRANSHEMO): study protocol for a multicentric French national observational cross-sectional study. BMJ Open 2018; 8:e022409. [PMID: 30049701 PMCID: PMC6067371 DOI: 10.1136/bmjopen-2018-022409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Severe haemophilia is a rare disease characterised by spontaneous bleeding from early childhood, which may lead to various complications, especially in joints. It is nowadays possible to avoid these complications thanks to substitutive therapies for which the issue of adherence is major. The transition from adolescence to adulthood in young people with severe haemophilia is a critical period as it is associated with a high risk of lack of adherence to healthcare, which might have serious consequences on daily activities and on quality of life. METHODS AND ANALYSIS We present the protocol for a cross-sectional, observational, multicentric study to assess the differences between adolescents and young adults with severe haemophilia in France through the transition process, especially on adherence to healthcare. This study is based on a mixed methods design, with two complementary and consecutive phases, comparing data from a group of adolescents (aged 14-17 years) with those from a group of young adults (aged 20-29 years). The quantitative phase focuses on the determinants (medical, organisational, sociodemographic and social and psychosocial and behavioural factors) of adherence to healthcare (considered as a marker of the success of transition). The qualitative phase explores participants' views in more depth to explain and refine the results from the quantitative phase. Eligible patients are contacted by the various Haemophilia Treatment Centres participating in the French national registry FranceCoag. ETHICS AND DISSEMINATION The study was approved by the French Ethics Committee and by the French National Agency for Medicines and Health Products Safety (number: 2016-A01034-47). Study findings will be disseminated to the scientific and medical community in peer-reviewed journals and presented at scientific meetings. Results will be popularised to be communicated via the French association for people with haemophilia to participants and to the general public. TRIAL REGISTRATION NUMBER NCT02866526; Pre-results.
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Affiliation(s)
| | - Natacha Rosso-Delsemme
- LPCPP, Aix Marseille Unviersity, Aix-en-Provence, France
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
| | | | - Karine Baumstarck
- CERESS, Aix Marseille University, Marseille, France
- FranceCoag Network, Marseille, France
| | - Vanessa Milien
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
- FranceCoag Network, Marseille, France
| | - Laurent Ardillon
- Haemophilia Treatment Centre, University Hospital of Tours, Tours, France
| | - Sophie Bayart
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Claire Berger
- Haemophilia Treatment Centre, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marie-Anne Bertrand
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | | | | | - Sabine Castet
- Haemophilia Treatment Centre, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre Chamouni
- Haemophilia Treatment Centre, University Hospital of Rouen, Rouen, France
| | | | | | - Dominique Desprez
- Haemophilia Treatment Centre, University Regional Hospital of Strasbourg, Strasbourg, France
| | - Céline Falaise
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
| | - Birgit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Valérie Gay
- Haemophilia Treatment Centre, Hospital of Chambery, Chambery, France
| | - Jenny Goudemand
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Yves Gruel
- Haemophilia Treatment Centre, University Hospital of Tours, Tours, France
| | - Benoît Guillet
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Annie Harroche
- Haemophilia Treatment Centre, Hospital Necker, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Abel Hassoun
- Haemophilia Treatment Centre, Hospital of Simone Veil d’Eaubonne, Montmorency, France
| | - Yoann Huguenin
- Haemophilia Treatment Centre, University Hospital of Bordeaux, Bordeaux, France
| | - Thierry Lambert
- Haemophilia Treatment Centre, Hospital Bicêtre, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Aurélien Lebreton
- Haemophilia Treatment Centre, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Lienhart
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Michèle Martin
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Sandrine Meunier
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Fabrice Monpoux
- Haemophilia Treatment Centre, University Hospital of Nice, Nice, France
| | - Guillaume Mourey
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | - Claude Negrier
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Philippe Nguyen
- Haemophilia Treatment Centre, University Hospital of Reims, Reims, France
| | - Placide Nyombe
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Caroline Oudot
- Haemophilia Treatment Centre, University Hospital of Limoges, Limoges, France
| | | | - Benoît Polack
- Haemophilia Treatment Centre, University Hospital of Grenoble, Grenoble, France
| | - Anne Rafowicz
- Haemophilia Treatment Centre, Hospital of Versailles, Versailles, France
- Haemophilia Treatment Centre, Hospital Bicêtre, Assistance Publique—Hopitaux de Paris, Paris, France
| | - Antoine Rauch
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Delphine Rivaud
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Pascale Schneider
- Haemophilia Treatment Centre, University Hospital of Rouen, Rouen, France
| | - Alexandra Spiegel
- Haemophilia Treatment Centre, University Regional Hospital of Strasbourg, Strasbourg, France
| | - Cecile Stoven
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Brigitte Tardy
- Haemophilia Treatment Centre, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marc Trossaërt
- Haemophilia Treatment Centre, University Hospital of Nantes, Nantes, France
| | | | - Stéphane Vanderbecken
- Haemophilia Treatment Centre, University Hospital of Reunion, Reunion Island, France
| | - Fabienne Volot
- Haemophilia Treatment Centre, University Hospital of Dijon, Dijon, France
| | | | - Bénédicte Wibaut
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Tanguy Leroy
- CERESS, Aix Marseille University, Marseille, France
- Social Psychology Research Group (GRePS EA 4163), Lumière Lyon 2 University, Lyon, France
| | - Thomas Sannie
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Hervé Chambost
- Department of Paediatric Haematology, Children Hospital La Timone, APHM, Marseille, France
- FranceCoag Network, Marseille, France
| | - Pascal Auquier
- CERESS, Aix Marseille University, Marseille, France
- FranceCoag Network, Marseille, France
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de Moreuil C, Fauchais AL, Merviel P, Tremouilhac C, Le Moigne E, Pasquier E, Pan-Petesch B, Lacut K. [Pre-eclampsia prevention in 2018 in general population and in lupic women: At the dawn of a personalized medicine?]. Rev Med Interne 2018; 39:935-941. [PMID: 29933972 DOI: 10.1016/j.revmed.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia prevention represents a major public health issue, as this vasculo-placental disorder generates a great burden of foeto-maternal morbi-mortality. Aspirin has proved its efficacy in primary and secondary pre-eclampsia prevention, especially when it is given at 150mg per day bedtime before 15 weeks of gestation to high-risk women. In the English trial ASPRE, high-risk women were identified by an algorithm taking into account angiogenic biomarkers ascertained at the end of first trimester of pregnancy. This article focuses on physiopathological mechanisms and risk factors of pre-eclampsia and on the interest of early angiogenic biomarkers dosing during pregnancy, for the assessment of pre-eclampsia risk. Unlike Great Britain or Israel, cost-effectiveness of this algorithm in general population has not been assessed in France. Finally, systemic lupus erythematous is at high risk of vasculo-placental disorders. Although few studies of angiogenic biomarkers dosing during lupus pregnancies identified a correlation between high sFlt1 levels at the end of first trimester and subsequent onset of severe vasculo-placental disorders, with a very good negative predictive value of sFtl1. Angiogenic biomarkers ascertainment for screening of vasculo-placental disorders in pregnant women with systemic lupus erythematous could allow targeting at best women needing an aspirin treatment and a closer monitoring.
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Affiliation(s)
- C de Moreuil
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France.
| | - A-L Fauchais
- Département de médecine interne, CHU de Limoges, 29200 Limoges, France
| | - P Merviel
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - C Tremouilhac
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - E Pasquier
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - B Pan-Petesch
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Fédération de cancérologie et d'hématologie, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - K Lacut
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
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Mollard LM, Le Mao R, Tromeur C, Le Moigne E, Gouillou M, Pan-Petesch B, Delluc A, Couturaud F, Lacut K. Antipsychotic drugs and the risk of recurrent venous thromboembolism: A prospective cohort study. Eur J Intern Med 2018; 52:22-27. [PMID: 29548526 DOI: 10.1016/j.ejim.2018.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/21/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Numerous studies have suggested that antipsychotic drugs are associated with an increased risk for a first episode of venous thromboembolism (VTE). However, after anticoagulation discontinuation, the impact of antipsychotic drugs on the risk of recurrent VTE (rVTE) remains unknown. OBJECTIVE To estimate the risk of rVTE in association with antipsychotic drugs. METHODS Between May 2000 and December 2012, we included all consecutive patients with a first unprovoked symptomatic VTE and who discontinued anticoagulation. During follow-up, exposure to antipsychotic drugs was systematically assessed. RESULTS A total of 736 patients with a first unprovoked symptomatic VTE were followed-up during a median period of 27.0 months (interquartile range (IQR) 6.2-60.0). Patients' median age was 66.0 years (IQR 49.0-76.0), 404 (54.9%) were men, and 61 (8.3%) were exposed to antipsychotics during follow-up. The incidence rate of r VTE was 12.1% person-year (95% CI 7.2-20.5) in antipsychotics users compared with 8.3% person-year (95% CI 7.1-9.8) in non-users (p = 0.20). Multivariate analysis showed a significant increased risk of recurrence associated with antipsychotic exposure (adjusted hazard ratio 1.9, 95% CI 1.1-3.3). CONCLUSIONS In this cohort study, exposure to antipsychotic drugs was found to be associated with an increased risk of rVTE among patients with a previous first unprovoked symptomatic VTE and who discontinued anticoagulation. Larger studies are needed to confirm and further explore this association.
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Affiliation(s)
- L M Mollard
- Département de médecine interne et pneumologie, CHU Brest - Brest, France
| | - R Le Mao
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - C Tromeur
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | | | - B Pan-Petesch
- EA3878, Université de Bretagne Occidentale - Brest, France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest, France
| | - A Delluc
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - F Couturaud
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France; CIC1412, INSERM - Brest, France
| | - K Lacut
- EA3878, Université de Bretagne Occidentale - Brest, France; CIC1412, INSERM - Brest, France.
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Robin S, Rezig S, Galinat H, Hoffmann C, Kerspern H, Pan-Petesch B. Quand la vitamine K ne fonctionne pas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Delluc A, Lacut K, Pan-Petesch B, Galinat H, Lippert E, Ianotto JC. Statin exposure and thrombosis risk in patients with myeloproliferative neoplasms. Thromb Res 2018; 167:57-59. [PMID: 29787944 DOI: 10.1016/j.thromres.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Aurélien Delluc
- EA 3878 (GETBO), Brest University, 29200 Brest, France; Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France.
| | - Karine Lacut
- EA 3878 (GETBO), Brest University, 29200 Brest, France; INSERM CIC 1412, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | - Brigitte Pan-Petesch
- EA 3878 (GETBO), Brest University, 29200 Brest, France; Oncology and Hematology Institute, Hôpital Morvan, 29609 Brest Cedex, France
| | - Hubert Galinat
- EA 3878 (GETBO), Brest University, 29200 Brest, France; Oncology and Hematology Institute, Hôpital Morvan, 29609 Brest Cedex, France
| | - Eric Lippert
- Laboratoire d'Hématologie, Equipe ECLA, UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", Brest University, IBSAM, 29200 Brest, France
| | - Jean-Christophe Ianotto
- EA 3878 (GETBO), Brest University, 29200 Brest, France; Oncology and Hematology Institute, Hôpital Morvan, 29609 Brest Cedex, France
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Tromeur C, Sanchez O, Presles E, Pernod G, Bertoletti L, Jego P, Duhamel E, Provost K, Parent F, Robin P, Deloire L, Leven F, Mingant F, Bressollette L, Le Roux PY, Salaun PY, Nonent M, Pan-Petesch B, Planquette B, Girard P, Lacut K, Melac S, Mismetti P, Laporte S, Meyer G, Mottier D, Leroyer C, Couturaud F. Risk factors for recurrent venous thromboembolism after unprovoked pulmonary embolism: the PADIS-PE randomised trial. Eur Respir J 2018; 51:51/1/1701202. [DOI: 10.1183/13993003.01202-2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/04/2017] [Indexed: 11/05/2022]
Abstract
We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion (i.e. at 6 months of anticoagulation).During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33–9.99) for age 50–65 years, 4.70 (95% CI 1.78–12.40) for age >65 years, 2.06 (95% CI 1.14–3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15–4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence.After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.
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Nau A, Pan-Petesch B, Sassolas B, Le Moigne E, Delluc A, Paret R, De Moreuil C. Éruption cutanée fébrile et pancytopénie : infection, hémopathie ou iatrogénie ? Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Le Moigne E, Pan-Petesch B, Tromeur C, Tremouilhac C, Jacquot M, Drugmanne G, Jolas S, Delluc A, Lacut K, Mottier D. Prophylaxie de la maladie veineuse thromboembolique par HBPM en post-partum en pratique : effets indésirables et problèmes rapportés par les patientes. Étude prospective dans deux maternités. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Grimaldi-Bensouda L, Rossignol M, Koné-Paut I, Krivitzky A, Lebrun-Frenay C, Clet J, Brassat D, Papeix C, Nicolino M, Benhamou PY, Fain O, Costedoat-Chalumeau N, Courcoux MF, Viallard JF, Godeau B, Papo T, Vermersch P, Bourgault-Villada I, Breart G, Abenhaim L, Abbas F, Abdelmoumni A, Hilliquin P, Requeda E, Adoue D, Brassat D, Agard C, Masseau A, Aladjidi N, Clet J, Fernandes H, Lemasson G, Perel Y, Raymond I, Richer O, Vital A, Allain-Launay E, Bru M, Nicolino M, Thomas C, Altman JJ, Amsallem D, Aras N, Boukari L, Dubrel M, Fain O, Letellier E, Lucidarme N, Mekinian A, Morin AS, Stirnemann J, Atlan C, Audry D, Augustin J, Bakir R, Bartolucci P, Chevalier X, Godeau B, Guillaud C, Khellaf M, Limal N, Lousteau V, Mahevas M, Méliksetyan G, Michel M, Roumier M, Bayart S, Bonnet F, Decaux O, Bekherraz A, Brihaye B, Dachez R, Daugas E, Hayem G, Meyer O, Papo T, Pasqualoni E, Sacre K, Travert F, Bellon H, Beltrand J, Lefrere F, Simon A, Benhamou PY, Benveniste O, Bolgert F, Costedoat-Chalumeau N, De Paz R, Demeret S, Fautrel B, Jacqueminet S, Louapre C, Maillart E, Morel N, Papeix C, Rigabert J, Bensaid P, Berger C, Berquin P, Le Moing AG, Berroir S, Besson G, Boutte C, Casez O, Bonnotte B, Audia S, Bossu-Estour C, Bourgarit A, Dupuy A, Keshmandt H, Bourre B, Brac A, Perrin A, Pondarré C, Villar-Fimbel S, Bruckert I, Cosson A, Magy-Bertrand N, Tisserand G, Camu W, Carlander B, Morales RJ, Cances C, Pasquet M, Castilla Lievre MA, Chabroux S, Charif M, Chatelus E, Sibilia J, Chevrant-Breton J, Clavel S, Bille-Turc F, Cohen J, Courcoux MF, Leverger G, Machet L, Cuisset JM, Cony-Makhoul P, Darsy P, Favre S, Giraud P, Leitenschenck L, Monteiro I, Morati C, DeSeze J, Dinulescu M, Dhaoui T, Dommange-Romero F, Drevard E, Dupuis C, Dumuis ML, Durand JM, Farad S, Lecomte P, Pierre P, Fouyssac F, Gaudin P, Gautier A, Gellen-Dautremer J, Jarrin I, Richette P, Georget E, Gras P, Moreau T, Giraud E, Hacini M, Mayer A, Guillaumat C, Guillaume S, Guitton C, Kone-Paut I, Marsaud C, Rossi L, Guyot MH, Hassler P, Heimfert C, Heinzlef O, Hillion B, Hocquelet C, Husson H, Ichai P, Jeziorski E, Deslandre CJ, Le Guern V, Kamenov K, Kerlan V, Lemoine P, Misery L, Pan-Petesch B, Krivitzky A, Labauge P, Rodier M, Lacade C, Razafimahefa B, Lachgar K, Larmarau MP, Leblanc T, Lebrun-Frenay C, Lefèbvre P, Lejoyeux P, Leske C, Ly K, Magy L, Mansuy S, Marechaud R, Martin Negrier ML, Sole G, Maupetit J, Mazingue F, Mochon S, Moktar B, Morcamp D, Morlet-Barla N, Nicolas G, Pautot V, Pellier I, Verret JL, Outteryck O, Vermersch P, Pallot-Prades B, Paquet JM, Puechal X, Sortais A, Pelletier J, Rico A, Pez D, Stankoff B, Quittet P, Rémy C, Roba E, Rosario H, Roudaut N, Sonnet E, Ruel M, Sebban S, Schaepelynck P, Simonin MJ, Vial C, Viallard JF, Ladedan I, Zenone T. Risk of autoimmune diseases and human papilloma virus (HPV) vaccines: Six years of case-referent surveillance. J Autoimmun 2017; 79:84-90. [DOI: 10.1016/j.jaut.2017.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/08/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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Le Moigne E, Pan-Petesch B, Tromeur C, Tremouilhac C, Jacquot M, Drugmanne G, Jolas S, Alavi Z, Lacut K, Mottier D. P-038: Women’s self-reported experience on LMWH injections for venous thromboembolism prophylaxis during post-partum. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grimaldi-Bensouda L, Nordon C, Michel M, Viallard JF, Adoue D, Magy-Bertrand N, Durand JM, Quittet P, Fain O, Bonnotte B, Morin AS, Morel N, Costedoat-Chalumeau N, Pan-Petesch B, Khellaf M, Perlat A, Sacre K, Lefrere F, Abenhaim L, Godeau B. Immune thrombocytopenia in adults: a prospective cohort study of clinical features and predictors of outcome. Haematologica 2016; 101:1039-45. [PMID: 27229715 DOI: 10.3324/haematol.2016.146373] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/24/2016] [Indexed: 11/09/2022] Open
Abstract
This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 10×10(9)/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome.
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Affiliation(s)
| | | | - Marc Michel
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Hôpital Haut-Lévêque, Pessac; Université Bordeaux 2, Bordeaux, France
| | | | | | - Jean-Marc Durand
- Service de Médecine Interne, Hôpital de la Timone, Marseille, France
| | - Philippe Quittet
- Département d'Hématologie Clinique, Hôpital St-Eloi, Montpellier, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint Antoine; Hôpitaux Universitaires de l'Est Parisien, AP-HP Université Paris 6, Paris, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, INSERM 1098, CHU Bocage Central, Dijon, France
| | - Anne-Sophie Morin
- Service de Médecine Interne CHU Jean Verdier, Université Paris 13, Assistance Publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - Nathalie Morel
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | | | | | - Mehdi Khellaf
- Service des Urgences, Centre Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | | | - Karim Sacre
- Université Paris-Diderot, Paris; Assistance Publique Hôpitaux de Paris; INSERUM U1149, Paris, France
| | | | | | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, Créteil, France
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Guéguen P, Chauvin A, Quémener-Redon S, Pan-Petesch B, Férec C, Abgrall JF, Le Maréchal C. Revisiting the molecular epidemiology of factor XI deficiency: nine new mutations and an original large 4qTer deletion in western Brittany (France). Thromb Haemost 2011; 107:44-50. [PMID: 22159456 DOI: 10.1160/th11-06-0415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 10/10/2011] [Indexed: 11/05/2022]
Abstract
Constitutional deficiency in factor XI (FXI) is a rare bleeding disorder in the general population, with the exception of Ashkenazi Jews. During the last decade, the detection of FXI-deficient patients has shifted from clinical screening identifying mostly severe bleeders to biological screening combining findings of prolonged activated partial thromboplastin time and FXI coagulation activity (FXI:C) below 50 U/dl. The goal of this study was to determine the molecular basis of FXI deficiency in western Brittany, France. Over the course of four years, we detected 98 FXI-deficient patients through biological screening, and 44 patients agreed to participate in this study corresponding to 25 index cases. We developed an efficient mutation detection strategy (combining direct sequencing and QFM-PCR to search for heterozygous rearrangements in a routine setting) that detected F11 mutations in 24 out of the 25 index cases. An unexpected allelic heterogeneity was found, with 14 different single point mutations being detected, among which nine are new. Moreover, a large heterozygous deletion of the entire F11 gene was detected, and was then further defined using a CGH array as a 4q34.2 telomeric deletion of 7 Mb containing 77 genes. We propose that the observed recurrent mutations may be considered as genetic tags of a population. This study highlights the importance of screening for large deletions in molecular studies of F11 .
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Affiliation(s)
- Paul Guéguen
- Université de Brest, Faculté de Médecine et des Sciences de la Santé, UMR-S613, Brest, France
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Guéguen P, Galinat H, Blouch MT, Bridey F, Duchemin J, Le Gal G, Abgrall JF, Pan-Petesch B. Biological determinants of bleeding in patients with heterozygous factor XI deficiency. Br J Haematol 2011; 156:245-51. [DOI: 10.1111/j.1365-2141.2011.08945.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Duchemin J, Pan-Petesch B, Arnaud B, Blouch MT, Abgrall JF. Influence of coagulation factors and tissue factor concentration on the thrombin generation test in plasma. Thromb Haemost 2008; 99:767-73. [PMID: 18392335 DOI: 10.1160/th07-09-0581] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The thrombin generation test is used to study coagulation in patients with haemorrhagic diseases or with high thrombotic risk. To our knowledge, this is the first study investigating the relative influence of coagulation factors on thrombin generation in plasma. The aim was to investigate the influence of coagulant factors, anticoagulant factors, and tissue factor (TF) on three parameters: endogenous thrombin potential (ETP), peak thrombin concentration, and lag time for the appearance of thrombin. At a low TF concentration, all factors except factor XI influenced thrombin generation. At a high TF concentration, only the factors of the extrinsic pathway exerted an influence. ETP and peak thrombin were linearly correlated to factor II concentration. Factor V and factor VII effects increased hyperbolically with factor concentration. The influence of factor X on thrombin generation depended on TF concentration. In the absence of factor VIII and factor IX, ETP fell to 60-70% of the normal when peak thrombin fell to 25-30% of the normal. Fibrinogen concentration influenced ETP and peak thrombin and decreasing fibrinogen levels shortened the lag time. As expected, decreasing antithrombin concentration caused dramatic increases in thrombin generation. Protein S prolonged the lag time, especially at a low TF concentration. No effect of protein C was observed, likely due to the absence of thrombomodulin. The thrombin generation test was more sensitive to factor deficiencies at low than at high TF concentration. ETP was not the most critical parameter for studying coagulation factor deficiencies. Instead, peak thrombin was the most sensitive parameter.
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Affiliation(s)
- Jérôme Duchemin
- Service d'Hématologie biologique, Hôpital La Cavale Blanche, Bd Tanguy Prigent, 29609 Brest Cedex, France.
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