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Biomedical subjects

H Lévesque

Publications and source records attributed to H Lévesque.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Venous tromboembolic treatment in patients with cancer].

PURPOSE: Venous tromboembolic treatment in patients with cancer can be a clinical dilemma. Comorbid conditions, significant risk of recurrence of bleeding associated with warfarin, difficult venous access, are some of the factors that often complicate anticoagulants therapy in patients with cancer. EXEGESIS: Low molecular weight heparin has replaced unfractionated heparin as the first line treatment in the majority of patients with venous thromboembolism and cancer, in hospital or safely at home. Recent trial demonstrated that long-term low molecular weight heparin administrated over a 6-month period reduced the rate of recurrence venous thromboembolism with non increase in bleeding compared with oral anticoagulant therapy. Placement of an inferior vena caval filter should be reserved for patients with active or very high risk of bleeding, but oncologist should consider these sobering results in such patients. Whether anticoagulants might also improve cancer survival rates independent of their effect on thromboembolism deserves further investigation. PERSPECTIVE: In future, new antithrombotic agents such as oral direct thrombin or long-acting synthetic factor Xa inhibitor may be useful in these patients.

Humans↗
PubMed2004

[Peripheral arterial disease: what management practices for general practitioners?].

OBJECTIVE: The purpose of this study was to analyze the results of the ATTEST study in order to evaluate general medicine management practices for peripheral arterial disease (PAD). Our analysis was based on the guidelines for good practice which recommend measurement of the systolic pressure index (SPI), search for other localizations of atherothrombosis, treatment of risk factors including smoking, walking exercises, and long-term prescription of anti-platelets. METHODS: ATTEST is a cross-sectional multicentric observational epidemiologic study conducted in metropolitan France. The study has recruited 8.475 analyzable patients with symptomatic PAD alone (3811 patients) or associated with other atherothrombotic localizations (2416 patients) or other cardiovascular diseases (2248 patients). These patients were followed by 3020 physicians. The current analysis thus included 6227 patients (81.2% men, 18.8% women, mean age 67.2 years), including 78.8% who had reached the stage of intermittent claudication. Risk factors included current or past smoking (61%), hypercholesterolemia (66.3%), hypertension (63.1%) and diabetes mellitus (26%). RESULTS: Arterial duplex Doppler exams of the lower limbs were performed in 91.2% of the patients but measurement of the SPI for diagnostic purposes had been performed in only 17%. The majority (85.8%) of the patients with proven coronary artery disease or cervico-encephalic involvement had had an ECG and 69.3% had had a duplex Doppler of the supra-aortic trunks. Smoking continued in 39% of the patients and an aid to cease smoking had been prescribed for only 7% of the patients who were non-smokers for less than one year. Nearly two-thirds of the patients analyzed had received advice concerning physical activities. Finally, anti-platelets had been prescribed for 92.2% of the patients. CONCLUSIONS: The general practitioner plays a crucial role in the diagnosis and treatment of PAD. Although measurement of the SPI is recommended as an early diagnostic tool and for evaluation of severity, it had been performed in less than one-third of the patients. Search for another localization of atherothrombosis had been performed in more than half of the patients. The physicians generally delivered advice on physical exercise and prescribed anti-platelets. The fight against smoking was however largely insufficient. The results of this study warrant further optimization of the collaboration between general practitioners and vascular disease specialists.

Adult↗
PubMed2003

Tolerance of Iloprost and results of treatment of chronic severe lower limb ischaemia in diabetic patients. A retrospective study of 64 consecutive cases.

BACKGROUND: The aim of this study was to assess the tolerance and report obtained results with a stable prostacyclin analogue (iloprost) in diabetic patients with severe forms of permanent lower limb ischaemia. METHODS: Sixty-four consecutive unselected patients, in stage III and IV of Leriche and Fontaine, turned down for vascular surgery after angiography and treated with iloprost during 28 days, were enrolled in this study. Patients were followed-up clinically (ischemic pain, trophic change, walking distance) and with transcutaneous oxymetry (D28). Long-term assessment (6 and 12 months) was expressed as rate of death, major amputation and of live patients with viable limbs and walking. There was no manifestation of intolerance to iloprost. Were considered as responders patients offering a lack or significant decrease in pain, a reduction of trophic lesions and improvement or recovery of walking. RESULTS: Response at two months is lasting: 29 responders (45.3%) and 35 non-responders (54.7%). At 6 months and one year, we observed that 8 (12.5%) and 15 (24.1%) patients respectively had died; 19 (29.6%) and 22 (34.3%) patients underwent major amputation, but 41 (64%) and 34 (53.1%) patients were still alive with their limb and conservative walking. In responder group, at 6 months, 28 (96.5%) patients were alive without amputation for only 13 (37.1%) among non-responders. At one year, 79.3% of the responders and 31.4% of the non-responders were alive without amputation. A total loss of walking, a segmental amputation and a previous amputation of opposite limb were more often noted in no responder group. But no predictive factor was referred to TcPO(2) in particular. Results ware similar in the group of 136 non diabetic patients treated during the same period (67.9% alive with limb at 6 months). CONCLUSIONS: This retrospective study, despite its limitations, underlines the clinical particularities of critical ischaemia in diabetics and the good tolerance to iloprost. This point allowed patients, in non-surgical chronic critical ischaemia, to avoid being confined to bed and to access to benefits of a early physiotherapy, in association with local treatment. However, no predictive criterion of long-term results could be established, except initial clinical severity and clinical change one month after treatment.

Aged↗
PubMed2003

[Platelet aggregation inhibitors and vitamin K antagonists in stomatology and maxillo-facial surgery].

Anti-thrombin, anti-platelet and anti-vitamin K agents are common treatments given for the prevention of thrombotic or embolic events. In oral or maxillofacial surgery, the question is whether oral anticoagulants or anti-platelets should be discontinued or not: temporary interruption could limit the risk of bleeding, but would increase the risk of thrombosis, and inversely. The best risk/benefit ratio must be achieved, but in many cases anti-platelet agents or even anti-vitamin K agents can be continued. In case of "potentially hemorrhagic" oral surgery, anti-platelet agents should be interrupted about ten days before the intervention. Anti-vitamin K agents should be interrupted four days before surgery and if required, replaced by low-molecular weight heparin at preventive or curative doses. In the very large majority of patients however, surgery (avulsion for example) can be performed without interrupting anticoagulation. Data in the literature have demonstrated that despite the theoretical risk of hemorrhage, bleeding is minimal and can be easily controlled by local treatments; the risk of thrombotic or thromboembolic events after discontinuing anticoagulation is much greater. A close collaboration between the dentist, the stomatologist, and the clinician is required to determine whether anti-thrombosis prevention should be continued and whether the anticoagulation level is adapted to the thrombotic risk. Good surgical technique and local anti-hemorrhagic treatment are essential in oral surgery, particularly in patients taking anti-platelets or oral anticoagulants.

Administration, Oral↗