Assessment of bleeding risk in cancer patients treated with anticoagulants for venous thromboembolic events

IntroductionAnticoagulant is the cornerstone of the management of VTE at the cost of a non-negligible risk of bleeding. Reliable and validated clinical tools to predict thromboembolic and hemorrhagic events are crucial for individualized decision-making for the type and duration of anticoagulant treatment. We evaluate the available risk models in real life cancer patients with VTE. The objectives of the study were to describe the bleeding of cancer patients with VTE and to evaluate the performance of the different bleeding models to predict the risk of bleeding during a 6-month follow-up.Materials and MethodsVTE-diagnosed patient's demographic and clinical characteristics, treatment regimens and outcomes for up to 6 months were collected. The primary endpoint was the occurrence of a major bleeding (MB) or a clinically relevant non major bleeding (CRNMB) event, categorized according to the ISTH criteria.ResultsDuring the 6-months follow-up period, 26 out of 110 included patients (26.7%) experienced a bleeding event, with 3 recurrences of bleeding. Out of the 29 bleeding events, 19 events were CRNMB and 10 MB. One patient died because of a MB. Bleeding occurred in 27 % of the patients treated with DOACs and 22% of the patients treated with LMWH. Most of the bleedings were gastrointestinal (9 events, 31%); 26.9% of the bleedings occurred in patient with colorectal cancer and 19.6% in patients with lung cancer. In our cohort, none of the 10 RAMs used in our study were able to distinguish cancer patients with a low risk of bleeding, from all bleeding or non-bleeding patients. The Nieto et al. RAM had the best overall performance (C-statistic = 0.730, 95% CI (0.619–0.840)). However, it classified 1 out of 5 patients with major bleeding in the low risk of bleeding group. The rest of the RAMs showed a suboptimal result, with a range of C-statistic between 0.489, 95%CI (0.360–0.617)) and 0.532, 95%CI (0.406–0.658)).ConclusionsThe management of CAT patients is challenging due to a higher risk of both recurrent VTE and bleeding events, as compared with non-cancer patients with VTE. None of the existing RAMs was able to consistently identify patients with risk of anticoagulant associated bleeding events

15-year fertilization increased soil organic carbon stock even in systems reputed to be saturated like permanent grassland on andosols

International audiencePrevious long-term experiments conducted more than 10 years ago, showed that long-term application of organic fertilizer increased soil organic carbon (SOC) of grasslands. However, it was usually assumed that, independent of the successive additions of fertilizer, soils have an upper limit to their SOC due to the inability of the soil mineral phase to fix additional carbon. Andosols of the volcanic Reunion Island are typically very rich in carbon and are usually considered as saturated in SOC. To assess the long-term effect of different types of fertilization on SOC in these soils, SOC concentrations were recorded at yearly intervals for 15 years in one arenosol site and in two andosols sites across a topo-sequence. The types of fertilization tested included inorganic, organic, and a mix of inorganic and organic nutrient sources. The addition of organic fertilizers increased soil carbon in the top (0–15 cm) horizon in both the arenosol and the two andosols (up to +250% in the arenosol and up to +41% in the andosol), whereas inorganic fertilizers and the control treatment did not always result in a significant increase in SOC. After 15 years, no plateau was reached in C stocks even with the highest fertilization rates. Our results suggest that the increase in SOC was mainly caused by direct carbon inputs, while the effect of the increase in litter resulting from the increase in yield caused by fertilization, remained uncertain. In the andosol, all the fertilization treatments led to higher concentrations of carbon in the deeper layers. This suggests that SOC inputs lead to downward migration of OC to deep horizons. For C-rich soils like andosols, assessing the variations in carbon in the deep horizon is thus critical in estimating the effects of soil management on carbon sequestration

In Search of the Appropriate Anticoagulant-Associated Bleeding Risk Assessment Model for Cancer-Associated Thrombosis Patients

Patients with venous thromboembolism events (VTE) in the context of cancer should receive anticoagulants as long as the cancer is active. Therefore, a tailor-made anticoagulation strategy should rely on an individualized risk assessment model (RAM) of recurrent VTE and anticoagulant-associated bleeding. The aim of this review is to investigate the applicability of the currently available RAMs for anticoagulant-associated bleeding after VTE in the CAT population and to provide new insights on how we can succeed in developing a new anticoagulant-associated bleeding RAM for the current medical care of CAT patients. A systematic search for peer-reviewed publications was performed in PubMed. Studies, including systematic reviews, were eligible if they comprised patients with VTE and used a design for developing a prediction model, score, or other prognostic tools for anticoagulant-associated bleeding during anticoagulant treatment. Out of 15 RAMs, just the CAT-BLEED was developed for CAT patients and none of the presented RAMs developed for the VTE general population were externally validated in a population of CAT patients. The current review illustrates the limitations of the available RAMs for anticoagulant-associated bleeding in CAT patients. The development of a RAM for bleeding risk assessment in patients with CAT is warranted

Various Genital and Reproductive Phenotypes in 46,XX/46,XY Chimeras

International audienceTetragametic chimeras are due to the fusion of 2 different zygotes after fertilization. When occurring between embryos of different chromosomal sex, the phenotype ranges from fertile individuals to infertile patients and even to patients with variations in sex development. Here, we report 3 new cases of XX/XY chimeras, one in a young boy carrying an abnormal gonad which turned out to be an ovary and 2 in phenotypically normal infertile men, one of whom had been diagnosed previously as a XX-SRY negative male. These cases highlight the importance of combining several cytogenetic and molecular techniques on different tissues for a proper diagnosis and an appropriate prognosis