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Rousseau F, Guillet B, Mura T, Fournel A, Volot F, Chambost H, Suchon P, Frotscher B, Biron-Andréani C, Marlu R, Hezard N, Clayssens S, Boissier E, Blanc-Jouvan F, Chamouni P, Tieulie N, Rugeri L, Borel-Derlon A, de Raucourt E, Martin-Toutain I, Castet S, Lebreton A, Girault S, Helley-Russick D, D’Oiron R, Schved JF, Giansily-Blaizot M. Surgery in rare bleeding disorders: the prospective MARACHI study. Res Pract Thromb Haemost 2023; 7:102199. [PMID: 37867585 PMCID: PMC10585326 DOI: 10.1016/j.rpth.2023.102199] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 10/24/2023] Open
Abstract
Background Despite the wide use of bleeding scores and the reliability of clotting factor level measurement, bleeding risk stratification before surgery remains challenging in patients with rare inherited bleeding disorders. Objectives This multicenter observational prospective study assessed in patients with rare coagulation factor deficiency, the perioperative hemostatic management choices by hemostasis experts and the bleeding outcomes after surgery. Methods One hundred seventy-eight patients with low coagulation activity level (factor [F] II, FV, combined FV-FVIII, FVII, FX, or FXI <50%) underwent 207 surgical procedures. The bleeding outcome, Tosetto's bleeding score, and perioperative hemostatic protocols were collected. Results Among the 81 procedures performed in patients with severe factor deficiency (level ≤10%), 27 were done without factor replacement (including 6 in patients at high bleeding risk), without any bleeding event. Factor replacement therapy was used mainly for orthopedic procedures. In patients with mild deficiency, 100/126 surgical procedures were carried out without perioperative hemostatic treatment. In patients with FVII or FXI deficiency, factor replacement therapy was in function of the procedure, bleeding risk, and to a lesser extent previous bleeding history. Tranexamic acid was used in almost half of the procedures, particularly in case of surgery in tissues with high fibrinolytic activity (76.8%). Conclusions The current perioperative hemostatic management of patients with rare bleeding disorders appears to be adapted. Among the 207 procedures, only 6 were associated with excessive bleeding. Our findings suggest that rather than the bleeding score, factor level and surgery type are the most relevant criteria for perioperative factor replacement therapy.
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Affiliation(s)
- Florence Rousseau
- Département d’hématologie biologique, CHU Montpellier, France
- CRC-MHC, CHU Montpellier, France
| | - Benoit Guillet
- Haemophilia Treatment Center, University Hospital, Rennes, France and Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Thibault Mura
- Département d’informatique médicale, CHU Montpellier, CHU Nîmes, Université de Montpellier FR 34090, France
| | - Alexandra Fournel
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | | | | | - Pierre Suchon
- Aix Marseille University, Inserm, Inrae, C2VN, Marseille, France
| | - Brigit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, France
| | | | - Raphaël Marlu
- Hemostasis Unit, CHU Grenoble Alpes, Université Grenoble Alpes, France
| | - Nathalie Hezard
- Laboratoire d’hématologie, CHU Reims, France
- Laboratoire d’hématologie AP-HM Marseille, France
| | | | | | | | | | | | - Lucia Rugeri
- Unité Hémostase Clinique, Hospices Civils de Lyon, France
| | | | | | | | | | - Aurélien Lebreton
- Laboratoire d’hématologie, CHU Clermont Ferrand, Unité de Nutrition Humaine UMR1019, INRAE / Université Clermont Auvergne, Clermont-Ferrand, France
| | | | | | - Roseline D’Oiron
- Centre de référence de l’hémophilie et des maladies hémorragiques constitutionnelles, Hôpital Bicêtre, APHP and Hith, UMR_S1176, INSERM, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Jean-François Schved
- Département d’hématologie biologique, CHU Montpellier, France
- CRC-MHC, CHU Montpellier, France
| | - Muriel Giansily-Blaizot
- Département d’hématologie biologique, CHU Montpellier, France
- Université Montpellier d’excellence, Montpellier, France
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Dufies M, Nollet M, Ambrosetti D, Traboulsi W, Viotti J, Borchiellini D, Grépin R, Parola J, Giuliano S, Helley-Russick D, Bensalah K, Ravaud A, Bernhard JC, Schiappa R, Bardin N, Dignat-George F, Rioux-Leclercq N, Oudard S, Négrier S, Ferrero JM, Chamorey E, Blot-Chabaud M, Pagès G. Soluble CD146 is a predictive marker of pejorative evolution and of sunitinib efficacy in clear cell renal cell carcinoma. Am J Cancer Res 2018; 8:2447-2458. [PMID: 29721091 PMCID: PMC5928901 DOI: 10.7150/thno.23002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/14/2017] [Indexed: 12/25/2022] Open
Abstract
The objective of the study was to use CD146 mRNA to predict the evolution of patients with non-metastatic clear cell renal cell carcinoma (M0 ccRCC) towards metastatic disease, and to use soluble CD146 (sCD146) to anticipate relapses on reference treatments by sunitinib or bevacizumab in patients with metastatic ccRCC (M1). Methods: A retrospective cohort of M0 patients was used to determine the prognostic role of intra-tumor CD146 mRNA. Prospective multi-center trials were used to define plasmatic sCD146 as a predictive marker of sunitinib or bevacizumab efficacy for M1 patients. Results: High tumor levels of CD146 mRNA were linked to shorter disease-free survival (DFS) and overall survival (OS). ccRCC patients from prospective cohorts with plasmatic sCD146 variation <120% following the first cycle of sunitinib treatment had a longer progression-free survival (PFS) and OS. The plasmatic sCD146 variation did not correlate with PFS or OS for the bevacizumab-based treatment. In vitro, resistant cells to sunitinib expressed high levels of CD146 mRNA and protein in comparison to sensitive cells. Moreover, recombinant CD146 protected cells from the sunitinib-dependent decrease of cell viability. Conclusion: CD146/sCD146 produced by tumor cells is a relevant biological marker of ccRCC aggressiveness and relapse on sunitinib treatment.
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