[Intracranial hemorrhage and oral anticoagulants of patients treated between 2011 and 2013 at the Nancy Regional University Hospital]

OBJECTIVE

To perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital.

MATERIAL AND METHOD

The study period was from January 2011 to December 2013 and the computerized data (Programme de Médicalisation des Systèmes d'Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients' files. Regional healthcare system was queried for reimbursement data.

RESULTS

Among the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n=127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6-15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6-114,9).

CONCLUSION

During the 2011-2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.

Evaluation of ICSH schistocyte measurement guidelines in France

INTRODUCTION

The schistocytes are fragmented red blood cells mainly observed in the setting of hemolytic anemias where they remain an important criterion for the diagnosis. As the identification of these cells is still problematic, the International Council for Standardization in Hematology (ICSH) set up a consensus report in November, 2011. The French Group of Cellular Hematology (GFHC) aimed to collect the opinion of French biologists directly confronted to schistocytes measurements, about these guidelines.

METHODS

Among the 578 professionals, 169 (29%) answered to the 10 questions dealing with the identification and measurements of schistocytes as proposed by the ICSH.

RESULTS

A consensus was reached for the urgent need of such guidelines documents, especially in the current background of the European accreditation EN ISO 15189 rules. A traduction in native (French) language was warmly wished in order to facilitate the diffusion of the information. The pathologic threshold for the diagnosis of thrombotic microangiopathic anemia (TMA) (>1%) remained questionable. For half of the biologists, the new fragmented red blood cell (FRC) parameter recently provided by two manufacturers of automated blood cell counters was still doubtful for routine use.

CONCLUSION

This survey assessed the impact of international 'guidelines' on the French biological community. The will to implement validated recommendations was strong, reflecting the awareness of the biologists to standardize the laboratory investigations.

[Management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice in Lorraine region]

OBJECTIVE

The aim of the survey was to describe current practice in management of hypotension during spinal anaesthesia for elective caesarean section in Lorraine.

STUDY DESIGN

Cross-sectional study by a mail survey.

METHODS

A 20-item postal questionnaire was sent to all anaesthetists working in public or private hospital with a maternity unit in Lorraine.

RESULTS

The response rate was 65%. Fifty-one percent of the respondents did not have a written procedure for the management of spinal-induced hypotension. Fluid preloading with or without vasopressor was the most common practice. Colloids were used by 20% of the respondents. For prevention of hypotension, 37% used ephedrine, 28% used phenylephrine mostly in association with ephedrine and 9% based their choice on heart rate. Twenty-six percent did not administer any vasopressor to prevent hypotension. First choice vasopressor for treatment of hypotension was ephedrine. Anaesthetists in academic practice were more likely to use coloading and phenylephrine administration, but none of them used colloids for pre- or coloading.

CONCLUSION

Management of hypotension during spinal anaesthesia for elective caesarean section was significantly influenced by the type of practice.