Traitement de la maladie thromboembolique veineuse

Purpose: To describe the drugs used to treat venous thromboembolism (VTE) and to review particular aspects of the management (elastic stockings, thrombolysis, thrombectomy, vena cava filter). Source: Our review of the literature is focused on consensus documents and recent large randomized trials. Principal findings: Subcutaneous low molecular weight heparins (LMWH) have been shown to be both safe and effective for the initial treatment of VTE and have largely replaced unfractionated heparin, unless there is a contraindication to LMWH such as severe renal insufficiency. Low molecular weight heparins or unfractionated heparin are usually administered for five to seven days. Treatment is gradually switched from heparin to oral vitamin K antagonists (VKA) which are usually started the same day as heparin. The duration of oral anticoagulation must be tailored to the individual patient according to the presence of reversible or continuing risk factors. In patients with active cancer, long-term treatment of VTE with LMWH has been shown to be more effective than oral anticoagulation and is recommended for the first three to six months of long-term anticoagulant therapy as an alternative approach to VKA. Elastic stockings are recommended because they have been shown to prevent postthrombotic syndrome. Thrombolysis is, usually, not justified for the treatment of deep venous thrombosis, but is used in cases of massive pulmonary embolism with arterial hypotension and/or shock. Vena cava filter placement is mainly indicated in patients with a proximal deep venous thrombosis and an absolute contraindication to anticoagulation. Conclusions: The initial management of patients with acute VTE has largely been simplified due to the use of LMWH. Early conversion to VKA is recommended for the great majority of patients. New agents, such as anti-Xa or oral thrombin inhibitors, are promising alternatives to heparins or VKA. Objectif: Présenter les médicaments utilisés pour traiter la maladie thromboembolique veineuse (MTEV) et revoir des aspects particuliers de la thérapie comme les bas élastiques, la thrombolyse, la thrombectomie et le filtre cave. Source: Revue de documents de consensus et de grandes études récentes. Constatations principales: Les héparines de bas poids moléculaire (HBPM) sont sûres et efficaces comme traitement initial de la MTEV et remplacent largement ľhéparine non fractionnée, à moins ďune contre-indication à ľHBPM comme ľinsuffisance rénale sévère. Les HBPM ou ľhéparine non fractionnée sont habituellement administrées pendant cinq à sept jours. Puis, on passe graduellement de ľhéparine à la prise orale ďantagonistes de la vitamine K (AVK), débutés en général le même jour que ľhéparine. La durée de ľanticoagulation orale doit être adaptée au patient en fonction de facteurs de risque réversible ou continu. Dans les cas de cancer actif, le traitement de la MTEV avec ľHBPM s'est montré plus efficace que ľanticoagulation orale et il est recommandé pour les trois à six premiers mois de traitement. Les bas élastiques sont recommandés pour prévenir le syndrome post-thrombotique. La thrombolyse n'est pas habituellement justifiée pour traiter la thrombose veineuse profonde, mais est utilisée en cas ďembolie pulmonaire massive avec hypotension et/ou choc artériels. La mise en place ďun filtre cave est principalement indiquée chez les patients souffrant de thrombose veineuse profonde proximale chez qui ľanticoagulation est une contre-indication absolue. Conclusion: Le traitement initial des patients atteints de MTEV a été grandement simplifié avec ľusage de ľHBPM. Le passage précoce aux AVK est recommandé pour la grande majorité des patients. De nouveaux médicaments comme les anti-Xa ou les inhibiteurs de la thrombine oraux, sont des équivalents prometteurs des héparines ou des AV

Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Quel est l'intérêt de dépister et de suivre un anévrisme de l'aorte abdominale?

Abdominal aortic aneurysm is a serious and potentially fatal vascular disease. Surgical intervention is typically reserved for aneurysms 55 mm in diameter or greater. Randomized trials addressing the efficacy of ultrasound screening for abdominal aortic aneurysm have shown that screening reduced aneurysm-related mortality in men but not in women who have a lower prevalence of abdominal aortic aneurysm. Screening with ultrasonography is recommended in men 65 to 75 years of age with a history of smoking and is suggested in women in this age group if they have risk factors such as smoking and hypertension. Men and women with a family history of abdominal aortic aneurysm should undergo screening as well. Persons who have a stable aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Primary care physicians have to play a key role before prescribing screening in assessing risks and benefits of repair in each patient. For persons with an aneurysm of less than 55 mm in diameter, the primary care physicians should provide information and interventions for the prevention of cardiovascular disease such as screening for and treating hypertension and interventions for tobacco cessation for smokers. The family physicians should also ensure that radiological monitoring of aneurysms is complete.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Caractérisation de différentes classes de récepteurs de l'ATP dans les cellules endothéliales vasculaires

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Virus et cancer.

English AbstractJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Les nouveaux anticoagulants oraux: actualisation de l'intérêt clinique et rôle du médecin généraliste.

New oral anticoagulants offer several potential advantages including oral administration, fixed doses, no regular coagulation monitoring and dose adjustment and wide therapeutic index. The results from clinical studies for prevention and treatment of venous thromboembolism and for stroke prevention in patients with atrial fibrillation show that these agents are at least as effective as or superior to currently available therapies depending on the molecules and dose regimen. Physicians will have to make choices among available new agents taking into account their pharmacokinetic properties, half-life, route of elimination and patient comorbidities. But the use of these new agents in daily practice raises some issues such as temporary discontinuation in patients undergoing invasive procedures and management of patients with bleeding in the absence of specific antidote. New oral anticoagulants should be used with caution in daily practice in special populations such as elderly patients, patients with renal impairment and patients with cancer. Primary care physicians will have to play a role in monitoring and evaluating the long-term efficacy and safety of these agents in daily practice.English AbstractJournal ArticleSCOPUS: re.jinfo:eu-repo/semantics/publishe

Prise en charge diagnostique et thérapeutique de l'embolie pulmonaire.

Pulmonary embolism (PE) is a common disease that poses a major diagnostic challenge because symptoms and signs are neither sensitive nor specific. However, patients with suspected PE can be classified into low, moderate and high clinical probability groups on the basis of symptoms and signs of PE, the presence of risk factors and the presence or absence of a likely alternative diagnosis. Stratification of patients into groups according to the clinical or pretest probability is imperative for proper selection of further diagnostic tests. The role of D-dimer testing is limited to the ruling out of PE in patients with low or moderate clinical probability. Conversely D-dimer testing is useless in patients, with high clinical probability. Chest CT has become an attractive means for an accurate diagnosis of PE and may replace lung scanning as first-line imaging test in particular in patients with underlying pulmonary disease or abnormal chest radiograph. Initial treatment for patients with non massive PE consists of therapeutic anti-coagulation with low molecular weight heparin (LMWH) and early overlapping with oral anticoagulants. In patients with active cancer, long-term treatment with LMWH is recommended. Duration of anticoagulant treatment is based on the balance between the risk of recurrent venous thromboembolism (depending mainly on the reversibility of risk factor, the presence of cancer, thrombophilia or previous venous thromboembolic episodes) and the risk of bleeding.English AbstractJournal ArticleReviewSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Caractérisation de différentes classes de récepteurs de l'ATP dans les cellules endothéliales vasculaires

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe