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Biomedical subjects

H Decousus

Publications and source records attributed to H Decousus.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Current indications of cava filters].

Permanent vena cava filters are useful in venous thromboembolism in some rare medical situations (i.e., contra-indication or failure of anticoagulant therapy). Other indications are controversial. Indeed filters increase the risk of recurrence of deep vein thrombosis and also probably the incidence of post-thrombotic syndrome. So filter placement remains a crucial decision, according to each individual case. The operator's choice is of prime importance. When a permanent filter is inserted the use of graded compression stockings and long-term anticoagulant therapy deserves to be considered. In case of transient risk, temporary filters might be an interesting therapeutic approach but their assessment is insufficient in order for them to be currently recommended.

Contraindications↗
PubMed1997

Evolution of blood coagulation and fibrinolysis parameters after abrupt versus gradual withdrawal of acenocoumarol in patients with venous thromboembolism: a double-blind randomized study.

A double-blind randomized trial was conducted to research a hypercoagulable state rebound after abrupt versus gradual withdrawal of acenocoumarol, 20 patients were included: 10 in the abrupt withdrawal group (AW) and 10 in the gradual withdrawal group (GW). Between days 1 and 15,F1 + 2 was higher in group AW (P < 0.002). A significant increase of D-dimer with time was found (P < 0.001) without difference between the two groups, tPA and PAI-1 levels remained stable throughout without difference between the two groups. No rebound phenomenon was observed. Four thrombotic recurrences were observed: group AW: 1, group GW: 3 (P = 0.29). There is neither clinical nor biological support for a gradual anticoagulation withdrawal.

Acenocoumarol↗
PubMed1996

[Search for the "optimal" dose of antithrombotic agents].

The determination of the "optimal" dose is an essential step in the development of a molecule. In the case of anti-thrombotic agents, the search for this "optimal" dose is based on dose-effect relationships on biological criteria in phase I, and, often, radiological criteria in phase II trials. The main objective of these dose studies is not to directly evaluate the benefit-risk ratio of the molecule under development, but to find the dose which will be tested in phase II to estimate the benefit-risk ratio. Errors of choice of dosage observed at the end of phase III trials may be due to problems of extrapolability of the results of the dose studies due to too strict a selection of subjects included and therefore not representative of the target population of the new treatment or to the use of intermediary criteria for the evaluation of the antithrombotic effect. However, these dosage errors are still mainly due to an inadequate search for the "optimal" dose despite the fact that the ethnical and economic consequences are not negligible.

Anticoagulants↗
PubMed1995

Chrono-pharmacological study of once daily curative dose of a low molecular weight heparin (200 IU antiXa/kg of Dalteparin) in ten healthy volunteers.

Low molecular weight heparin (LMWH) is currently prescribed for the treatment of deep vein thrombosis at the dose of 100 IU antiXa/kg twice daily or at a dose of 175 IU antiXa/kg once daily with a similar efficacy. We decided to study the chrono-pharmacology of curative dose of LMWH once daily administrated according to the one previously described with unfractionated heparin (UFH). Ten healthy volunteers participated in an open three-period crossover study according to three 24 h cycles, separated by a wash-out interval lasting 7 days: one control cycle without injection, two cycles with subcutaneous injection of 200 IU antiXa/kg of Dalteparin (Fragmin) at 8 a.m. or at 8 p.m. Parameters of heparin activity were analysed as maximal values and area under the curve. Activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT) and tissue factor pathway inhibitor (TFPI) were higher after 8 p.m. injection than after 8 a.m. injection (p < 0.05) while no chrono-pharmacological variation of anti factor Xa (AXa) activity was observed. Thus the biological anticoagulant effect of 200 IU antiXa/kg of Dalteparin seems to be higher after an evening injection than after a morning injection. A chrono-therapeutic approach with LMWH, as prescribed once daily, deserves further investigation since our results suggest that a preferential injection time may optimise the clinical efficacy of these LMWH.

Adult↗
PubMed1995

[Inflammatory pseudotumor of the intestine caused by necrotizing vasculitis in the course of Horton disease].

The authors report a case of giant-cell arteritis involving the digestive tract, revealed by a subocclusive syndrome. It appeared to be an unusual pattern according to the location, the tumour aspect and the histologic appearance of a periarteritis nodosa type. The digestive involvement and the histologic appearance are discussed in a review of the literature, as well as the link with the periarteritis nodosa.

Adrenal Cortex Hormones↗
PubMed1994

Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis.

OBJECTIVE: To compare the efficacy and safety of low molecular weight heparins and unfractionated heparin in the initial treatment of deep venous thrombosis for the reduction of recurrent thromboembolic events, death, extension of thrombus, and haemorrhages. DESIGN: Meta-analysis of results from 16 randomised controlled clinical studies. SUBJECTS: 2045 patients with established deep venous thrombosis. INTERVENTION: Treatment with low molecular weight heparins or unfractionated heparin. MAIN OUTCOME MEASURES: Incidences of thromboembolic events (deep venous thrombosis or pulmonary embolism, or both); major haemorrhages; total mortality; and extension of thrombus. RESULTS: A significant reduction in the incidence of thrombus extension (common odds ratio 0.51, 95% confidence interval 0.32 to 0.83; P = 0.006) in favour of low molecular weight heparin was observed. Non-significant trends also in favour of the low molecular weight heparins were observed for the recurrence of thromboembolic events (0.66, 0.41 to 1.07; P = 0.09), major haemorrhages (0.65, 0.36 to 1.16; P = 0.15), and total mortality (0.72, 0.46 to 1.4; P = 0.16). CONCLUSIONS: Low molecular weight heparins seem to have a higher benefit to risk ratio than unfractionated heparin in the treatment of venous thrombosis. These results, however, remain to be confirmed by using clinical outcomes in suitably powered clinical trials.

Dose-Response Relationship, Drug↗
PubMed1994

Fibrinolysis and elastic compression: no fibrinolytic effect of elastic compression in healthy volunteers.

The local and systemic fibrinolytic response to the placing of elastic compression in healthy volunteers was studied to determine whether this method of preventing venous thromboembolism has any profibrinolytic effect, as previously demonstrated with intermittent pneumatic compression. Variations in the major parameters of fibrinolysis (euglobulin lysis time, t-PA antigen, PAI-1 antigen, PAI-1 activity) were studied in an open randomized cross-over study in 21 healthy volunteers, in which three types of treatment were tested for periods of 24 h each (without elastic compression, elastic compression of an upper limb, elastic compression of the lower limbs). Four blood samples were taken from the upper limb during each period (at 08:00 h, 10:00 h, 18:00 h, 08:00 h on the following day). The placing of elastic compression did not cause any statistically significant change in the four parameters tested between the three types of treatment. In contrast, circadian rhythm was confirmed for all the fibrinolytic factors studied with a minimal fibrinolytic activity in the morning and a maximal activity in the evening. Elastic compression does not seem to have any profibrinolytic effect in healthy volunteers but other studies are needed in patients before a definitive conclusion can be reached.

Adolescent↗
PubMed1994

Dosing time optimizes sustained-release ketoprofen treatment of osteoarthritis.

A double-blind randomized parallel-group trial was undertaken to evaluate the influence of the dosing time of sustained-release ketoprofen (SRK) on its acceptability and efficacy. The SRK was prescribed for 2 weeks (200 mg once a day) to 117 outpatients with osteoarthritis of the knee and/or hip. One group received SRK in the morning (at 8 a.m.) and the other group in the evening (at 8 p.m.). The principal aim of the trial concerned the acceptability, whereas efficacy was its secondary aim. The principal trial criterion was defined as the number of spontaneous recordings of adverse effects. Results showed clearly that the acceptability of SRK in the SRK morning group was worse than that in the evening group (39% of patients with one or more adverse effects in the SRK morning group versus 19% in the evening group; p = 0.019). It is important to stress the difference concerning the number of adverse effects (48 for SRK morning group versus 23 for SRK evening group; p = 0.0234). The analgesic efficacy seemed to be similar, but one criterion was statistically significant: The duration of analgesic efficacy was more important for the SRK evening group than for the morning group (9.37 and 5.47 h, respectively; p = 0.001). To increase its acceptability, evening administration of SRK seems to be preferred over morning administration in osteoarthritis. However, other trials of the same type, assessing other antiinflammatory agents, are necessary before a general extrapolation of such results can be undertaken.

Adult↗
PubMed1993

Subcutaneous low-molecular-weight heparin compared with continuous intravenous unfractionated heparin in the treatment of proximal deep vein thrombosis.

BACKGROUND: A low-molecular-weight heparin, enoxaparin sodium, has been shown to be effective and safe in preventing deep vein thrombosis both in general surgery and in high-risk orthopedic surgery. We conducted a controlled, randomized trial with enoxaparin in the treatment of established deep vein thrombosis. METHODS: In a multicenter trial, we compared fixed-dose subcutaneous enoxaparin, given twice daily, with adjusted-dose intravenous unfractionated heparin (UFH) given by continuous intravenous infusion for the initial 10 days of treatment of patients with proximal vein thrombosis. The primary efficacy outcome was the change of the size of the thrombus assessed by repeated venograms between day 0 and day 10. The primary analysis of safety was based on the incidence of major bleeding during 10 days of treatment. RESULTS: There were 67 patients in each group. Venographic assessment of clot size evolution between day 0 and day 10 showed a statistically significant superiority (P < .002) of enoxaparin over the reference treatment with UFH. Moreover, the incidence of overall recurrent thromboembolic events during 10 days of treatment was significantly higher (P < .002) in the UFH group (seven of 67) than in the enoxaparin group (one of 67). There were no serious bleeding complications in either group. CONCLUSIONS: Enoxaparin is at least as effective and safe as UFH under the conditions of this study. Moreover, it is more comfortable for patients and less time-consuming for nurses and laboratories. Thus, our study confirmed, with the use of enoxaparin, other observations that low-molecular-weight heparin provides a real therapeutic advance in the treatment of deep vein thrombosis.

Acute Disease↗
PubMed1993

[Phlebitis following travel].

The term of economy class syndrome has been used to describe the deep vein thrombosis which may follow air travel. The mechanisms suggested for this include tendency to clot formation in the legs secondary to the reduced venous return induced by the sitting position with direct compression of popliteal and femoral veins, and secondary to dehydration and haemo-concentration. However, these conditions are also observed with others means of transport. We describe 16 patients with deep vein thrombosis following travel by bus, car, truck and train. These 16 patients represent 3.4 percent of 465 patients with thromboembolism managed over a 52-month period in our department. All but one patients had one or more risk factors for deep vein thrombosis. The mean duration of the trip was 14.2 hours and the first symptom occurred less than a week after the journey in 75 percent of the patients. These first symptoms suggested deep vein thrombosis in 8, pulmonary embolism in 5, and deep vein thrombosis with pulmonary embolism in 3 patients. Regular non alcoholic drinks and regular walks seem to be sufficient to prevent deep vein thrombosis in the great majority of travellers. However, low dose heparin on a temporary basis or elastic stockings could be considered in high risk subjects.

Adult↗
PubMed1993

[Systemic mastocytosis: incidence and risks of vasomotor seizures].

We report on 9 cases of systemic mastocytosis which underline the frequency and the potential severity of this disease. All patients had intercritical signs (usually urticaria). Seven patients had also typical crises with flush and vascular collapses are observed together, doctors should measure histamine blood level and perform correct biopsy.

Histamine Release↗
PubMed1993

[Circadian changes of myocardial infarction].

Several studies have demonstrated a circadian rhythm in the onset of myocardial infarction. Most show a peak rate between 8 and 12 o'clock in the morning. The frequency of infarction in this time period is one and a half to two times that observed during the rest of the day. This phenomenon has been observed in different countries and does not seem to be influenced by the characteristics of the population (sex, previous infarction). However, this circadian rhythm seems less pronounced in younger subjects. The prescription of calcium antagonists before infarction does not change the circadian rhythm whereas aspirin and betablocker therapy decrease the frequency of matinal infarction. The mechanism underlying the circadian rhythm is hypothetical: many factors could play a triggering role and circadian variations in coagulation, platelet aggregation, catecholamine levels and blood pressure may also be important. Recent studies have shown that the morning peak in onset of infarction could be related to the times of waking and getting up. Suppression of the morning peak of infarction (and also of episodes of myocardial ischaemia and sudden death) with betablocker therapy, suggests a direct or indirect role of circulating catecholamines in the induction of the phenomena leading to infarction. When using betablockers, the authors suggest prescribing the doses so as to obtain therapeutic efficacy in the morning.

Adrenergic beta-Antagonists↗
PubMed1993

[A rare cause of loss of consciousness: mastocytosis. Apropos of 3 cases].

The authors report three cases of syncope due to systemic mastocytosis. This is a rare cause of syncope but should be recalled in certain circumstances. In the light of these cases, the authors review the literature with respect to this unusual presentation. Syncope may occur at any age. Loss of consciousness may be more or less complete, brief or prolonged, isolated or recurrent and usually accompanied by prodromal symptoms. The least controversial physiopathogenic mechanism of these syncopes is intense vasoplegia induced by the release of vasoactive mediators, especially histamine. When there is a clinical suspicion of mastocytosis, even in the absence of skin changes, the diagnosis is confirmed by biopsy which shows abnormally high numbers of mastocytes irrespective of the organ biopsied. The treatment of acute forms with collapse is based on intravenous infusion of macromolecular fluids and injections of epinephrine. Prevention is by drugs which inhibit the synthesis of histamine, the degranulation of mastocytes and the production of prostaglandin D2.

Aged↗
PubMed1992

Acceptability and efficacy of two associations of paracetamol with a central analgesic (dextropropoxyphene or codeine): comparison in osteoarthritis.

A double-blind randomized parallel group trial was undertaken to compare the acceptability and efficacy of 2 forms of analgesic treatment, DI-Antalvic (Houde Laboratories, Puteaux, France) (30 mg dextropropoxyphene and 400 mg paracetamol per capsule) and Efferalgan-Codeine (UPSA Laboratories, Rueil Malmaison, France) (30 mg codeine and 500 mg paracetamol per tablet) prescribed for 1 week at doses of 6 capsules/day and 6 tablets/day, respectively, in 141 outpatients with active osteoarthritis of the knee or hip. The principal aim of the trial was concerned with acceptability, with efficacy as its secondary aim. The principal trial criterion was defined as overall assessment of acceptability by the patient at the end of the trial (success or failure) or by treatment dropouts because of an adverse effect (failure). Comparability of the groups was confirmed before any treatment regarding the physical characteristics of the patients, characteristics of osteoarthritis, and the initial level of pain and functional consequences of pain. Results show that the analgesic efficacy of the treatment was similar, but that the acceptability of Efferalgan-Codeine was significantly worse than that of DI-Antalvic: 53% failure with Efferalgan-Codeine versus 29% failure with DI-Antalvic (P = .005). Other trials of the same type would seem necessary (comparison of lower doses, other types of pain) before being able to generally extrapolate such findings.

Acetaminophen↗