42 research outputs found
Thrombin generation, bleeding and hemostasis in humans:Protocol for a scoping review of the literature
Pharmacokinetics for haemophilia treaters: Meaning of PK parameters, interpretation pitfalls, and use in the clinic
Caractéristiques des thromboses veineuses chez les patients porteurs des mutations facteur V Leiden ou facteur II G20210ATitre (étude rétrospective sur 403 cas consécutifs)
LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Phénotypage du système de coagulation sanguine par la mesure de génération de thrombine (étude pré-clinique et applications cliniques innovantes)
L'exploration de l'hémostase est basée sur la mesure des temps de coagulation ou des activités des différentes protéines de la coagulation. Cette approche a une faible valeur prédictive du risque individuel hémorragique ou thrombotique encouru par les patients. Nous avons étudié le test de génération de thrombine pour le phénotypage de la coagulation. Les conditions préanalytiques et analytiques permettant de s'approcher le plus possible des conditions physiologiques ont été déterminées avec une bonne répétabilité, reproductibilité du test permettant son utilisation dans des laboratoires hospitaliers. Nous avons montré que le test pouvait détecter l'hypo- et hypercoagulabilités liées à l'hémophilie et aux thromboses veineuses. Nous avons établi une relation entre l'ETP et le risque d'événement clinique hémorragique ou thrombotique chez les hémophiles et les patients thrombotiques. Le test peut aussi être utilisé pour la surveillance des traitements antihémophiliquesLYON1-BU.Sciences (692662101) / SudocSudocFranceF
Particularités de l’hémostase chez la femme enceinte et maniement des antithrombotiques
Evaluation of the Care Pathway in the Context of the Dispensing of Emicizumab (Hemlibra) in Community Pharmacies in France: Protocol for a Cross-sectional Study Based on the Kirkpatrick Model
International audienceBackground Commercialized since 2019, emicizumab (Hemlibra) was available only in French hospital pharmacies for prophylaxis of hemophilia A with or without inhibitors. Since June 15, 2021, patients can choose between a hospital and community pharmacy. These changes in the care pathway have important organizational consequences for patients, their relatives, and health professionals. Two training programs are available for community pharmacists: the “HEMOPHAR” training program proposed by the national reference center for hemophilia and the Roche training program proposed by the laboratory that markets the product. Objective The PASODOBLEDEMI study aims to evaluate the direct impact of the training programs provided to community pharmacists in the context of the dispensing of emicizumab, and to evaluate patients’ satisfaction with their treatment whether they choose dispensation from a community pharmacy or retained dispensation from the hospital pharmacy. Methods We designed a cross-sectional study based on the 4-level Kirkpatrick evaluation model: the immediate reaction of community pharmacists following training (Reaction), the knowledge acquired during the training (Learning), the professional practice of community pharmacists during dispensing of the product (Behavior), and patients’ satisfaction related to the treatment whether it is dispensed from a hospital or from a community pharmacy (Results). Results Considering that single outcome measures cannot adequately reflect the complexity of this new organization, the Kirkpatrick evaluation model provides 4 distinct outcomes: the immediate reaction after the HEMOPHAR training program, the level of knowledge acquired after the HEMOPHAR training program, the impact of training on professional practice, and patient satisfaction with access to emicizumab. We developed specialized questionnaires for each of the 4 levels of the Kirkpatrick evaluation model. All community pharmacists involved in dispensing emicizumab, whether they have followed the HEMOPHAR or the Roche training program or neither, were eligible for inclusion. All patients with severe hemophilia A were eligible, irrespective of inhibitor use, age, treatment with emicizumab, and whether they chose dispensation from a community pharmacy or retained dispensation from a hospital pharmacy. Conclusions The new organization for dispensing emicizumab to patients with hemophilia A in French community pharmacies must be accompanied by optimal safety and quality conditions due to the risk of serious and urgent bleeding situations in the management of rare bleeding diseases. The elaboration of the PASODOBLEDEMI protocol has already a positive impact with the commitment of all health professionals, physicians, hospital and community pharmacists, and the patient community. The results will be disseminated among the French authorities and will enable, if necessary, proposing this access model to other rare diseases. Trial Registration ClinicalTrials.gov NCT05449197, https://clinicaltrials.gov/ct2/show/NCT05449197?term=NCT05449197; ClinicalTrials.gov NCT05450640, https://clinicaltrials.gov/ct2/show/NCT05450640?term=NCT05450640 International Registered Report Identifier (IRRID) DERR1-10.2196/4309
Monitoring platelet dependent thrombin generation in mice
Calibrated automated thrombin generation assay was adapted to measure thrombin generation in platelet rich plasma from mice. Vena cava phlebotomy appeared the best technique for blood sampling. The concentration-effect curves of tissue factor and platelet count have been determined. Corn trypsin inhibitor 2 mu M inhibits contact activation effectively. Recombinant human thrombomodulin does not inhibit thrombin generation in mouse plasma but activated protein C (20 nM) does. Thrombin generation was dose dependently diminished by low molecular weight heparin and increased by high concentrations of exogenous factor VIII i.e. the assay can detect both hypo-and hypercoagulability