001 Predictive Value of Post Treatment Platelet Reactivity for Occurrence of Post-discharge Bleeding After Non ST Elevation Acute Coronary Syndrome

AimsWe assessed prospectively the association between occurrence of post-discharge non–CABG-related TIMI major and minor bleedings and post treatment platelet reactivity in patients with Non ST Elevation Acute Coronary Syndrome (NSTE ACS).Methods and Results597 consecutive patients admitted with NSTE ACS were prospectively included. Between hospital discharge and one month follow-up, we observed 16 (2.7%) non–CABG-related TIMI hemorrhagic complications including 5 (0.84%) major and 11 (1.8%) minor bleeds. Patients with bleeding had significantly lower post treatment values of ADP-induced aggregation (43±14% versus. 56±19%, P=0.002) and platelet reactivity index VASP (43±14% versus 54±23%; P=0.04) and a trend for lower values of arachidonic acid-induced aggregation (2.4±5.4 versus 13±21; P=0.27). After stratification by quartiles based on post treatment ADP-induced platelet aggregation, we identified patients in the first quartile as hyper-responders with very low post treatment platelet reactivity, below <40%. The risk of TIMI major and minor bleeding was significantly higher in the first quartile of hyper-responders than in the others quartiles: 10 (6.6%) versus 6 (1.4%), p=0.001.ConclusionOur results suggest that assessment of post treatment platelet reactivity might be used to detect hyper responders to antiplatelet therapy with higher risk of non-CABG related bleedings and tailor antiplatelet therapy according to both ischemic and bleeding risk

Hémostase et marqueurs individuels de thrombose chez le patient cancéreux

International audienc

Etude des déterminants génétiques du TAFI [Thrombin-Activatable Fibrinolysis Inhibitor] chez les Africains de Côte d'Ivoire (comparaison avec les Caucasiens)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Commentary on “Risk of venous thromboembolism after COVID‐19 vaccination”

International audienceNo abstract availabl

Prophylaxis of venous thromboembolism in cancer patients

International audienceVenous thromboembolism (VTE) is an independent prognostic factor and the second leading cause of death in cancer patients. VTE is however a largely preventable disease when thromboprophylaxis is appropriately used. As recommended worldwide by international Clinical Practice Guidelines, cancer patients undergoing surgery or hospitalization for acute medical illness or with reduced mobility should benefit from thromboprophylaxis, in the absence of bleeding or other contraindications to anticoagulants. Thromboprophylaxis in cancer outpatients receiving systemic therapies is still under debate, except for pancreatic ambulatory cancer patients where prophylaxis confers a sustained reduction in VTE. Numerous strategies are currently developed to improve VTE prophylaxis practices in cancer patients, and to elucidate the best appropriate anticoagulant regimen for each individual cancer patient

Management of Cancer-Associated Thrombosis: An Evolving Area

International audienceThe management of cancer-associated thrombosis (CAT) is an evolving area. With the use of direct oral anticoagulants as a new option in the management of CAT, clinicians now face several choices for the individual cancer patient with venous thromboembolism. A personalized approach, matching the right drug to the right patient, based on drug properties, efficacy and safety, side effect profile of each drug, and patient values and preference, will probably supplant the one size fits all approach of use of only low-molecular-weight heparin in the near future. We herein present eight translational, clinical research, and review articles on recent advances in the management of CAT published in the Special Issue "Treatment for Cancer-Associated Thrombosis" of Cancers. For now, a multidisciplinary patient-centered approach involving a close cooperation between oncologists and other specialists is warranted to guide clinical decision making and optimize the treatment of VTE in cancer patient

Parameters of complete blood count do not predict on-treatment platelet reactivity in acute coronary syndrome patients

LetterOver the past ten years, a large body of evidence clearly demonstrated that acute coronary syndrome (ACS) patients with persistent high on-treatment platelet reactivity (HTPR) despite a well conducted treatment with P2Y12 receptor antagonists are at higher risk for adverse cardiovascular events (ACVE) [1].Bothgeneticpolymor-phisms [2] and clinical variables [3] have been associated with HTPR, but all together these factors predict only a slight part of the observed variability in response to clopidogrel and other P2Y12-ADP receptor antagonists. Platelet function testing therefore remains the more accurate way to identify high risk patients with HTPR who may benefit from intensified antiplatelet regimen, even though ran-domized trials investigating the effect of antiplatelet regimen adjusted to the results of platelet function testing failed to demonstrate a clinical benefit yet. Nevertheless, platelet reactivity (PR) testing presents to date some limitations: it lacks of standardization, it requires specialized equipment and substantial blood sample volumes, and it is often costly and technically challenging. Recently, parameters of complete blood count (CBC) which are widely available for routine clinical use, reproducible, inexpensive and non-invasive, have gained an increasing interest in the cardiovascular setting. The mean platelet volume (MPV) was indeed proposed as a marker of platelet activity, since larger platelets are haemostatically more active and thought to display a greater prothrombotic potential than smaller platelets [4]. Scarce studies investigating whether MPV might increase on-treatment PR found conflicting results [5,6,7,8], but meanwhile MPV was shown to predict outcomes in ACS patients in several studies [9].Otherwise, inflammation has been demonstrated to be significantly associated with high PR [10].New inflammatory markers derived from CBC as the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) could also potently be associated with PR since they were recently demonstrated to correlate with adverse cardiovascular outcomes in myocardial infarction patients [11], and unstable angina patients [12]. The aim of the present study was to investigate, in a large sample size cohort of ACS patients treated with P2Y12-ADP receptor antagonists, whether any of these CBC parameters could independently predict on-treatment PR assessed with the well established vasodilator stimulated phosphoprotei

Recent Advances in the Management of Cancer-Associated Thrombosis: New Hopes but New Challenges

Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients and leads to a significant increase in health care costs. Cancer patients often suffer from multiple co-morbidities and have both a greater risk of VTE recurrence and bleeding compared to non-cancer patients. Anticoagulation is therefore challenging. For many years, long-term therapy with Low-Molecular-Weight Heparin (LMWH) was the standard of care for the management of cancer-associated VTE. Direct oral anticoagulants (DOAC), which offer the convenience of an oral administration and have a rapid onset of action, have recently been proposed as a new option in this setting. Head-to-head comparisons between DOAC and LMWHs for the treatment of established VTE are now available, and data on the efficacy and safety of these drugs for primary prophylaxis of VTE in ambulatory cancer patients receiving systemic anticancer therapy are emerging. This narrative review aims to summarize the main recent advances in the prevention and treatment of cancer-associated VTE, including recent data on the use of individualized factors to stratify the risk of VTE in each individual patient, quality-of-life in patients treated with LMWH, and the place that DOACs will likely take in the cancer-associated VTE management landscape

Hemostasis testing in patients with liver dysfunction: Advantages and caveats

International audienceDue to concomitant changes in pro- and anti-coagulant mechanisms, patients with liver dysfunction have a “rebalanced hemostasis”, which can easily be tipped toward either a hypo- or a hypercoagulable phenotype. Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities. Conventional coagulation screening tests, such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures. The introduction of global coagulation assays, such as viscoelastic testing (VET), has been an important step forward in the assessment of the overall hemostasis profile. A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings. The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding