Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study).

International audienceINTRODUCTION: In vitamin K antagonist (VKA)-treated patients with severe hemorrhage, guidelines recommend prompt VKA reversal with prothrombin complex concentrate (PCC) and vitamin K. The aim of this observational cohort study was to evaluate the impact of guideline concordant administration of PCC and vitamin K on 7-day mortality. METHODS: Data from consecutive patients treated with PCC were prospectively collected in 44 emergency departments. Type of hemorrhage, coagulation parameters, type of treatment and 7-day mortality were recorded. Guideline-concordant administration of PCC and vitamin K (GC-PCC-K) were defined by at least 20 IU/kg factor IX equivalent PCC and at least 5 mg of vitamin K performed within a predefined time frame of 8 hours after admission. Multivariate analysis was used to assess the effect of appropriate reversal on 7-day mortality in all patients and in those with intracranial hemorrhage (ICH). RESULTS: Data from 822 VKA-treated patients with severe hemorrhage were collected over 14 months. Bleeding was gastrointestinal (32%), intracranial (32%), muscular (13%), and "other" (23%). In the whole cohort, 7-day mortality was 13% and 33% in patients with ICH. GC-PCC-K was performed in 38% of all patients and 44% of ICH patients. Multivariate analysis showed a two-fold decrease in 7-day mortality in patients with GC-PCC-K (odds ratio (OR) = 2.15 (1.20 to 3.88); P = 0.011); this mortality reduction was also observed when only ICH was considered (OR = 3.23 (1.53 to 6.79); P = 0.002). CONCLUSIONS: Guideline-concordant VKA reversal with PCC and vitamin K within 8 hours after admission was associated with a significant decrease in 7-day mortality

Bibliothèques et autoformation

Dans un univers où les nouvelles technologies évoluent constamment et où l'individu est régulièrement amené à se recycler dans sa carrière professionnelle ou à maîtriser les outils de développement personnel, la bibliothèque est aujourd'hui le lieu d'expression d'une demande nouvelle en autoformation. Cette demande, dépendante pour partie de l'offre de la bibliothèque et du niveau de formation de l'usager, remet également en question le rôle des bibliothécaires et de leur médiation. Reprenant les actes du colloque organisé à la Bibliothèque publique d'information en décembre 2005, ainsi que le rapport de l'enquête réalisée par le service Études et recherche de la Bpi sur l'espace Autoformation de la Bpi, cet ouvrage se veut un outil de réflexion pour les professionnels des bibliothèques. Reformulant les questions auxquelles les bibliothécaires sont confrontées dans leur pratique quotidienne, s'appuyant sur leurs expériences et sur l'analyse théorique de chercheurs en sciences de l'information, il tente d'ouvrir de nouvelles pistes de travail pour établir à l'avenir, peut-être une « charte de l'autoformation en bibliothèque »

Micro-trottoir

Ce micro-trottoir a été réalisé aux alentours du Centre Pompidou en juin 2005. L’équipe « Autoformation » de la Bibliothèque publique d’information, avec l’aide d’un preneur de son, a posé la question : « Si je vous dis autoformation, à quoi cela vous fait-il penser ? » Les réponses à ces questions, dont nous vous proposons ici une sélection, ont été diffusées en toile de fond lors du colloque. Nous remercions celles et ceux qui ont accepté de prendre le temps de nous répondre. « Se former so..

Conclusion

L’autoformation à la Bpi, lorsqu’elle est évoquée par nos usagers, est dotée de significations différentes. Si cette notion se réfère parfois pour eux à une façon d’apprendre spécifique, reposant sur un projet autogéré, l’autoformation renvoie également à une norme d’usage qui consiste à se débrouiller seul. L’autonomie est alors vécue comme un point de passage obligé, pour accéder à des ressources difficiles d’accès et pourtant nécessaires. Nos usagers ressentent une certaine gratitude à l’é..

Vitamin K antagonists and emergencies

International audienc

Femoral blood gas analysis, another tool to assess hemorrhage severity following trauma: an exploratory prospective study

Abstract Background Veno-arterial carbon dioxide tension difference (ΔPCO2) and mixed venous oxygen saturation (SvO2) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO2 (ΔPCO2 fem) and SvO2 (SvO2 fem) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO2 fem, SvO2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBCH6) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBCH6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO2 fem was 9.1 ± 6.0 mmHg, SvO2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P < 0.001) in patients who were transfused than in those who were not transfused. Best thresholds to predict pRBCH6 were 8.1 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Best thresholds to predict the need for a hemostatic procedure were 5.9 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Blood lactate was not predictive of pRBCH6 or the need for a hemostatic procedure. Conclusion In severe trauma patients, ΔPCO2 fem and SvO2 fem at admission were predictive for the need of RBC transfusion and hemostatic procedures during the first six hours of management while admission lactate was not. ΔPCO2 fem and SvO2 fem appear thus to be more sensitive to blood loss than blood lactate in trauma patients, which might be of importance to early assess the adequation of tissue blood flow with metabolic needs