Patient Characteristics and Preferences Regarding Anticoagulant Treatment in Venous Thromboembolic Disease

Background: Anticoagulants are the recommended treatment for venous thromboembolic disease (VTE). The mode of anticoagulant administration may influence compliance, and therefore the effectiveness of the treatment. Unlike in atrial fibrillation or cancer-associated thrombosis, there is only limited data on patient preferences regarding the choice of anticoagulation in VTE. This study aims to evaluate patient preferences regarding anticoagulants in terms of administration: types (oral or injectable treatment) and number of doses or injections per day.Patients and Methods: This is a national survey through a questionnaire sent by e-mail to 1936 French vascular physicians between February and April 2019. They recorded the responses for each patient admitted for VTE.Results: Three hundred and eleven (response rate of 16%) of the 1936 contacted physicians responded for 364 patients. Among these, there were 167 fully completed questionnaires. Most patients (63%) express concerns about VTE and prefer oral treatment (81.5%), justified by the ease of administration (74%) and a fear of the injections (22%). When patients were taking more than three oral treatments they statistically chose injectable treatment more often (54%) than oral treatment (25%, p = 0.002). Patients who chose injectable treatment were also older (70 ± 16 vs. 58 ± 17 years old, p = 0.001). There was no statistically difference in anticoagulation preference according to gender or to the expected duration of treatment (6 weeks, 3 months, 6 months or unlimited). When oral treatment was preferred (81%), most chose oral treatment without dose adjustment and biomonitoring (74.3%). Among them, very few (5.8%) preferred a twice-daily intake.Conclusion: Patient preference in terms of anticoagulant treatment in VTE disease is in favor of oral treatment without adjustment or biomonitoring and with once-daily intake. When an injectable treatment is chosen, a prolonged duration of treatment does not seem to be a constraint for the patient.Clinical Trial Registration:ClinicalTrials.gov, identifier [NCT03889457]

Hémodynamique cérébrale et périphérique dans un contexte de variation de pression de perfusion d'origine environnementale ou pathologique

The work presented here explore the spectral analysis of the sonogram and the impact of microgravity on cerebral hemodynamics. The reproducibility of sonogram analysis by classification is low (κ=0.522 [0.520-0.523], p<0.005 with 4 categories, κ=0.546 [0.544-0.547], p<0.001 with 13 categories) independently of the professional’s diploma or experience. The 13-category classification had a low deviance rate (5% compared with 82% to 88%). Gravitational transitions can promote a minor rupture of the blood-brain barrier (significant increase in specific biomarkers, p < 0.05). Microgravity causes a selective increase in external carotid artery blood flow ( ̇��ECA, 46%; p = 0.030) while cerebral blood flow (CBF) remains unchanged. The variations in CBF associated with hypercapnia (+29% ±18) or simulated hypovolemia (-11% ±10) and the distribution of this CBF were independent of intracranial arterial anatomy. These results encourage us to evaluate the combined effect of hypoxia and microgravity on the ̇��ECA as well as the link with the spaceflight associated neuro-ocular syndrome. The common perspective is to study the control of peripheral vascular resistance in order, on the one hand, to standardize the conditions for acquiring sonograms in the context of arteriopathy and, on the other hand, to study potential countermeasures for regulating the arterial flow in the context of gravitational physiology.L’hémodynamique occupe une place centrale dans la prise en charge des maladies vasculaires et en physiologie gravitationnelle. Les travaux présentés ici explorent l’analyse spectrale du signal doppler (ou sonogramme) dans l’artériopathie et l’effet de la microgravité sur l’hémodynamique cérébrale. La reproductibilité de l’analyse de sonogramme est faible quelle que soit la classification utilisée (κ=0.522 [0.520-0.523], p < 0.005 avec 4 catégories, κ=0.546 [0.544-0.547], p < 0.001 avec 13 catégories), indépendamment du diplôme ou de l’expérience. La classification à 13 catégories a un taux de déviance faible par rapport aux autres (5% contre 82 à 88%). Ces résultats encouragent à identifier une méthode d’analyse du sonogramme plus reproductible. Les transitions gravitationnelles sont associées à une augmentation des biomarqueurs de rupture de la barrière hémato-encéphalique ainsi que du stress oxydant et nitrosant (augmentation des protéines GFAP et S100ß, augmentation des radicaux libres et réduction du monoxyde d’azote biodisponible, p < 0,05). La microgravité entraine une augmentation sélective rapide du débit sanguin de l’artère carotide externe ( ̇��ECA, 46% ; p = 0,030, mesuré en échodoppler) alors que le débit sanguin cérébral (DSC) reste identique. Les variations de DSC liées à l’hypercapnie (+ 29% ±18) ou à l’hypovolémie simulée (- 11% ±10) ainsi que la distribution de ce DSC (entre les circulations cérébrales antérieure et postérieure, mesuré en angiographie de flux par résonance magnétique) sont indépendantes de l’anatomie artérielle intracrânienne. Ces résultats encouragent à évaluer l’effet combiné de l’hypoxie et de la microgravité sur le ̇��ECA ainsi que le lien avec les troubles neuro-oculaires associés aux vols spatiaux. La perspective commune est l’étude des résistances vasculaires périphériques afin d’une part de standardiser les conditions d’acquisition des sonogrammes dans le cadre de l’artériopathie ; et d’autre part, d’étudier les potentielles contre-mesures permettant une régulation des débits artériels dans le cadre de la physiologie gravitationnelle

Lanéelle et al. Supplemental Figure and Table S1

Supplemental data from the article "Selective elevation in external carotid artery flow during acute gravitational transition to microgravity during parabolic flight." by Lanéelle et al. published in American Journal of Physiology-Heart and Circulatory Physiology .</p

Inter-observer reliability of a 4-item Doppler ultrasound waveforms classification.

International audienceLID - 10.1024/0301-1526/a000906 [doi

Use of a Pre-Trained Neural Network for Automatic Classification of Arterial Doppler Flow Waveforms: A Proof of Concept

International audienceBackground: Arterial Doppler flow waveform analysis is a tool recommended for the management of lower extremity peripheral arterial disease (PAD). To standardize the waveform analysis, classifications have been proposed. Neural networks have shown a great ability to categorize data. The aim of the present study was to use an existing neural network to evaluate the potential for categorization of arterial Doppler flow waveforms according to a commonly used classification. Methods: The Pareto efficient ResNet-101 (ResNet-101) neural network was chosen to categorize 424 images of arterial Doppler flow waveforms according to the Simplified Saint-Bonnet classification. As a reference, the inter-operator variability between two trained vascular medicine physicians was also assessed. Accuracy was expressed in percentage, and agreement was assessed using Cohen's Kappa coefficient. Results: After retraining, ResNet-101 was able to categorize waveforms with 83.7 and PLUSMN; 4.6% accuracy resulting in a kappa coefficient of 0.79 (0.75-0.83) (CI 95%), compared with a kappa coefficient of 0.83 (0.79-0.87) (CI 95%) between the two physicians. Conclusion: This study suggests that the use of transfer learning on a pre-trained neural network is feasible for the automatic classification of images of arterial Doppler flow waveforms.&lt;/p&gt

Near infrared spectroscopy would be assessed for lower extremity peripheral artery disease diagnosis in patients with normal ankle-brachial index at rest

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Vascular medicine residents lack adequate training for limb pressure measurement: A nationwide survey in France

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French vascular physicians’ practices in indicating antiplatelet and anticoagulation therapy in venous thromboembolism

International audienceBackground: As antiplatelet therapy becomes widespread, physicians face the issue patients being treated with antiplatelet agents (APA) and anticoagulants for venous thromboembolism (VTE). Bleeding risk of this combination is increased 1.5-2.5-fold. The aim of this survey is to assess French vascular physician's management of this combination at the beginning of the treatment and at 6 months of treatment for VTE. Patients and methods: French vascular physicians were surveyed between September and December 2017, using 4 fictional scenarios regarding a VTE event diagnosed in a patient under antiplatelet therapy plus isolated questions in an online questionnaire, sent by the French Society of Vascular Medicine to its members. Out of 1812 physicians, 179 returned valid questionnaires: the response rate was 9.9%. Results: Firstly 97.2% of respondents acknowledged extra risk with this combination; and 63% ceased antiplatelet therapy when initiating anticoagulants; while 36% did not. Secondly, four strategies emerged: 31.4% ceased APA and prescribed full-dose anticoagulants at initiation and at 6 months; 32% associated reduced-dose anticoagulation with APA at 6 months, regardless of what they decided at initiation; 16.5% prescribed isolated full-dose anticoagulants at initiation and reduced-dose at 6 months; lastly 11.2% associated full-dose anticoagulant with antiplatelet therapy at initiation and at 6 months. Conclusions: French vascular physicians adopted different strategies according to estimated risk/benefit ratio. Prospective randomized controlled trials should compare these strategies in order to make recommendations

Description of Doppler waveforms to detect lower extremity peripheral artery disease

International audienceDoppler waveforms analysis is a interesting to diagnose peripheral artery disease as suggested by the international recommendations. However as mentioned in the present letter, there is a lack of consensus about the terminology that should be used