Publications by authors named "Isabelle Mahe"

Background: Few epidemiological data are available for venous thromboembolism (VTE) at French national and subnational levels.

Aims: To quantify VTE events in France in 2022 and describe the features of hospital management and outcomes.

Methods: Adults hospitalized for a VTE as the primary reason for hospitalization or treatment in a medical unit in 2022 were identified from medical administrative data.

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Sickle cell disease is a rare genetic disease resulting from an abnormality in hemoglobin. Hemostasis in the steady state, defined as ≥2 months without vaso-occlusive crises, is poorly described in the literature. We report the routine hemostasis profile in steady state patients with sickle cell disease (SCD), including during pregnancy and according to phenotype.

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This study generated evidence to guide anticoagulation in patients with VTE after vaccination for COVID-19. We provided data on the low recurrence rate after cessation of anticoagulant therapy and the findings for this study offer timely insights into the management of a potentially vaccine-related adverse event.

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Cancer-associated venous thromboembolism (CAT) is common in patients with cancer and associated with significant morbidity and mortality. The incidence of CAT continues to rise, complicating patient care and burdening healthcare systems. Patients with cancer experiencing VTE face poorer prognoses, making prevention and effective management imperative.

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Article Synopsis
  • * The article reviews current evidence and best practices for managing cancer-related VTE, highlighting complexities in treatment for patients with various tumors and specific health issues.
  • * Traditional treatments, like vitamin K antagonists and low-molecular-weight heparins, are being supplemented by new options like direct oral anticoagulants, though treatment must be tailored to individual patient circumstances.
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Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism.

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Inherited thrombophilia (IT) workup is commonly pursued in patients with venous thromboembolism (VTE). Recent American Society of Hematology guidelines recommend a selective approach to IT testing, nevertheless, evidence on whether thrombophilia testing can actually improve patient-important outcomes through tailored management is limited. Data from the large, prospective Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry were analyzed to compare VTE risk factors, management, and outcomes between patients who were tested for IT and untested patients, during anticoagulant treatment and after its discontinuation.

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Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service.

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Article Synopsis
  • Venous thromboembolism (VTE) significantly impacts cancer patients' health but education and awareness about it are severely lacking, with 63.5% of surveyed patients receiving inadequate information.
  • A study of 2262 cancer patients from 42 countries revealed that many felt unprepared to recognize VTE risks, with only 67.8% receiving guidance on seeking medical help when needed.
  • The research highlights critical gaps in VTE education and support, emphasizing the need for improved patient-centered care in managing cancer-associated VTE risks.
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BACKGROUND: Admission to the hospital is a major risk factor for the development of venous thromboembolism (VTE). Whether thromboprophylaxis with low-molecular-weight heparin prevents symptomatic VTE in medically ill, hospitalized older adults remains debated. METHODS: In a prospective, randomized, placebo-controlled, double-blind, multicenter trial, older adults (>70 years of age) hospitalized for acute medical conditions were randomly assigned to receive 40 mg a day of low-molecular-weight heparin (enoxaparin) or placebo for 6 to 14 days.

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Introduction: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE.

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Article Synopsis
  • A study evaluated the eligibility of patients with cancer-associated thrombosis (CAT) for randomized clinical trials assessing direct oral anticoagulants (DOACs) against low molecular weight heparin.
  • Out of 302 patients analyzed, nearly 46% for the HOKUSAI-VTE trial and 53% for the CARAVAGGIO trial had non-inclusion criteria, such as unusual site thrombosis and severe health conditions.
  • The 6-month follow-up showed no significant difference in event-free survival between those eligible and ineligible for the trials, highlighting the need for more research on DOACs' safety and effectiveness for ineligible CAT patients.
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Venous thromboembolism (VTE) is a frequent and potentially fatal complication in patients with cancer. During the initial period after the thromboembolic event, a patient receiving anticoagulant treatment is exposed both to a risk of VTE recurrence and also to an elevated bleeding risk conferred by the treatment. For this reason, the choice of anticoagulant is critical.

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Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service.

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Article Synopsis
  • The article discusses how to manage venous thromboembolism (VTE) in patients with malignant brain tumors, which include both primary and metastatic types.
  • It notes that there is limited data since brain tumor patients are often excluded from major clinical trials comparing various anticoagulants, making research mainly reliant on small observational studies.
  • The findings suggest that direct Factor Xa inhibitors might lead to fewer bleeding risks compared to low molecular weight heparins, indicating a generally favorable safety profile for these drugs in this patient group, but definitive recommendations are not yet established.
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Many patients with cancer require palliative care at some stage and the vast majority of people followed in palliative care are cancer patients. Patients with cancer are at high risk of venous thromboembolism (VTE), and this is particularly true during the advanced palliative phase when mobility is limited or absent. Patients with cancer in palliative cancer are at higher bleeding risk compared to non-cancer patients.

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Background: There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE).

Material And Methods: We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index ≥30 kg/m (obese) vs. those with BMI 18.

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Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC).

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Although all patients with cancer-associated thrombosis (CAT) have a high morbidity and mortality risk, certain groups of patients are particularly vulnerable. This may expose the patient to an increased risk of thrombotic recurrence or bleeding (or both), as the benefit-risk ratio of anticoagulant treatment may be modified. Treatment thus needs to be chosen with care.

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Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade.

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Venous thromboembolism (VTE) in patients with cancer is associated with a high risk of bleeding complications and hospitalisation, as well as with increased mortality. Good practice recommendations for diagnosis and treatment of VTE in patients with cancer have been developed by a number of professional bodies. Although these guidelines provide consistent recommendations on what treatment should be offered to patients presenting with cancer-associated thromboembolism (CAT), many questions remain unanswered, in particular about the modalities of management (Who? When? Where?) and, for this reason, we have developed a consensus proposal for an appropriate multidisciplinary care pathway for patients with CAT, which is presented in this article.

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Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism.

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Article Synopsis
  • Recent advancements in understanding cancer-associated thrombosis have prompted the development of new practical guidelines.
  • The guidelines, created by a collaborative effort from various scientific societies within the INNOVTE FCRIN Network, were based on a thorough literature review and adhered to the French National Authority for Health's clinical practice guidelines process.
  • They cover key topics such as epidemiology, treatment strategies, and specific scenarios like recurrent thrombosis and catheter-related issues, aiming to improve patient management in this area.
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Article Synopsis
  • This study examines the uncertainty surrounding the ideal duration of anticoagulation therapy in cancer patients with venous thromboembolism (VTE), noting current guidelines typically suggest 3-6 months.
  • A systematic review and meta-analysis were conducted, analyzing studies on VTE recurrence after stopping anticoagulation in cancer patients who had completed at least 3 months of treatment.
  • Out of 3856 studies reviewed, 14 studies with 1922 patients were included, leading to the pooled rate of recurrent VTE being estimated, although specific results were not detailed in the provided text.
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