[Screening for cancer in case of venous thromboembolism: when and how?].

International audienceScreening for cancer in case of venous thromboembolism: when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina\lnottion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved. Screening for cancer in case of venous thromboembolism: when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina\lnottion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved

What route of care to propose for patients with proximal DVT? Who to hospitalise?

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A pan-cancer analysis of the human tumor coagulome and its link to the tumor immune microenvironment

International audienceObjective Solid tumors often establish a procoagulable state that can lead to venous thromboembolism (VTE). Although some of the key genes involved in this process are known, no previous study has compared the ``coagulome'', i.e., the expression of coagulation/fibrinolysis genes, across different primary tumor types. It is also unclear whether the coagulome is associated with specific characteristics of the tumor microenvironment (TME). We aimed to address this question. Methods We analyzed the expression of the genesF3, PLAU, PLAT, PLAUR, SERPINB2,andSERPINE1in 32 cancer types using data from The Cancer Genome Atlas (TCGA) and other freely available resources. Results We identified specific expression patterns of procoagulant and fibrinolytic genes. The expression of the Tissue Factor (F3) was found to be tumor type dependent, with the highest expression in glioblastoma (GBM), a highly procoagulable tumor type. Conversely, high expression of the fibrinolysis gene clusterPLAU, PLAUR, SERPINE1was consistently linked to the characteristics of the TME (monocytic infiltration) and high expression of important checkpoints of the immune response, such as PD-L2 and CD276/B7-H3. Conclusion These tumor-specific patterns of expression might partially explain the differences in VTE risk among tumor types. We propose that biomarkers of coagulation fibrinolysis might provide valuable information about the TME in cancer patients

Discontinuation of vascular therapeutics during the COVID-19 pandemic first wave in France

International audience[No abstract available

The coagulome of Head and Neck Squamous Cell Carcinoma

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JAK2 allele burden is correlated with a risk of venous but not arterial thrombosis

International audienceBackground: Thrombosis is the main complication in myeloproliferative neoplasms (MPN). A JAK2V617F mu-tation has been shown to be a risk factor for thrombosis. The implication of other risk factors alongside a mu-tation allele burden needs to be clarified (Trifa et al., 2018; Borowczyk et al., 2015). Objective: Our aim was to investigate the role of the JAK2 mutation allele burden in the risk of cardiovascular events (CVE) and/or venous thrombosis (VTE) in a cohort of patients with confirmed MPN, as well as in patients without confirmed MPN. Methods: We restrospectively included all consecutive patients who were positive for JAK2V617F seen by our unit between December 2008 and September 2016. Inclusion criteria were a positive test for the JAK2V617F mutation, with at least 1% allele burden, with or without confirmed MPN. Results: We included 239 patients of median age 71 years [60-81], followed-up for a median of 82.8 months [41.08-146.88]. For JAK2V617F positive patients having an allele burden superior to 50% the cumulative incidence of VTE was significantly higher than for those with an allele burden inferior to 50% (HR 3.11 95% CI [1.10-8.76] p = 0.031). The cumulative incidence of VTE was also higher in patients with obesity (HR 4.58 95% CI [1.33-15.8] p = 0.016). There was no significant association between a JAK2V617F allele burden and arterial thrombosis (manifesting as CVE). Previous VTE was also associated with a higher cumulative incidence of recurrence during follow-up HR 3.22 95% CI [1.17-8.81] p = 0.0231. Conclusion: We show that a JAK2V617F allele burden is associated with risk of VTE but not with CVE

Critical limb ischaemia and the response to bone marrow-derived cell therapy according to tcPO 2 measurement

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Cancer-associated thrombosis: how many patients seen in clinical practice would be eligible to a randomized controlled trial?

11th International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC), Bergamo, ITALY, MAY 27-29, 2022International audienc

A clinical prediction score for upper extremity deep venous thrombosis.

It was the objective of this study to design a clinical prediction score for the diagnosis of upper extremity deep venous thrombosis (UEDVT). A score was built by multivariate logistic regression in a sample of patients hospitalized for suspicion of UEDVT (derivation sample). It was validated in a second sample in the same university hospital, then in a sample from the multicenter OPTIMEV study that included both outpatients and inpatients. In these three samples, UEDVT diagnosis was objectively confirmed by ultrasound. The derivation sample included 140 patients among whom 50 had confirmed UEDVT, the validation sample included 103 patients among whom 46 had UEDVT, and the OPTIMEV sample included 214 patients among whom 65 had UEDVT. The clinical score identified a combination of four items (venous material, localized pain, unilateral pitting edema and other diagnosis as plausible). One point was attributed to each item (positive for the first 3 and negative for the other diagnosis). A score of -1 or 0 characterized low probability patients, a score of 1 identified intermediate probability patients, and a score of 2 or 3 identified patients with high probability. Low probability score identified a prevalence of UEDVT of 12, 9 and 13%, respectively, in the derivation, validation and OPTIMEV samples. High probability score identified a prevalence of UEDVT of 70, 64 and 69% respectively. In conclusion we propose a simple score to calculate clinical probability of UEDVT. This score might be a useful test in clinical trials as well as in clinical practice