Biomedical subjects

J N Labèque

Publications and source records attributed to J N Labèque.

7 recordsLinked to original sources

PubMed2006

[Direct thrombin inhibitors in coronary angioplasty. Value of bivalirudin ].

During coronary angioplasty, the association of platelet inhibitors and antithrombin agents is required to prevent myocardial infarction. Bivalirudine, a synthetic direct thrombin inhibitor, has been widely validated in this context and has shown its efficacy and safety in several comparative studies. It is officially recommended as a replacement of NFH and LMWH associated or not with anti-GPIIb/IIIa agents because at comparable efficacy it causes fewer bleeding complications. In acute coronary syndromes without ST elevation, anti GPIIb/IIIa agents reduce angioplasty-related complications and mortality, especially in high risk patients in salvage situations. In the REPLACE-2 trial the clinical efficacy of bivalirudine (associated only when necessary with anti-GPIIb/IIIa agents) was no less than that of NFH associated systematically with anti-GPIIb/IIIa agents at the time of intervention. The incidents of serious adverse events at 30 days (death, infarctus, emergency revascularisation, major bleeding) in the bivalirudine group was 9.2% versus 10.2% in the NFH group. In a retrospective analysis, these results did not seem to be influenced by the prior administration of clopidogrel. Finally, the one year follow-up results showed a lower mortality in patients treated with bivalirudine (1.9% versus 2.5%), essentially in the high risk sub-groups such as the elderly, the diabetic or the renal failure patients. Clinical trials are underway (ACUITY) to study the interaction of anti GPIIb/IIIa agents with bivalirudine in the first hours of acute coronary syndromes and should confirm a major role of direct anti-thrombin drugs in the safety of angioplasty.

Angioplasty, Balloon, Coronary↗

PubMed2002

[Fibrinolysis and thrombosis of mechanical valvular prosthesis: risk stratification by transesophageal echocardiography].

The place of fibrinolysis in the treatment of mechanical valvular prostheses is still much discussed. The aim of this work is to define the role of transoesophageal echocardiography in risk stratification. This monocentric study draws on 49 cases of thrombolysis preceded by transoesophageal echocardiography (average age 62.1 years, 37 mitral, 11 aortic, 1 tricuspid, 1 mitro-tricuspid). There were 41 obstructive thromboses (OT) and 8 non-obstructive thromboses (NOT). Clinical events and the effectiveness of fibrinolysis were studied as a function of the obstructive or non-obstructive character of the thrombosis and the size of the thrombus < 10 mm (n = 33) or > or = 10 mm (n = 16). Complete success was observed in 34 patients (69.4%). Follow up revealed 2 early cerebral haemorrhages (4.1%) of which one was in the NOT group, and six systemic emboli (12.2%) of which one was in the NOT group. There was a relationship between the size of the thrombus and embolus at the limit of significance in favour of an increased risk of embolus for a voluminous thrombus. Furthermore, the mobility of the thrombi went in hand with an increased rate of systemic emboli (p < 0.01). The rate of failure of fibrinolysis and/or complications correlated with the size of thrombus (complete success in 88% of the < 10 mm thrombus group, versus 35% in the > or = 10 mm; p < 0.01). This work underlines the significance of trans-oesophageal echocardiography in the therapeutic choice for valvular prosthesis thrombosis and suggests that the existence of a voluminous thrombus especially if mobile is a contra-indication for fibrinolysis.

Adult↗

PubMed2001

[Fibrinolysis in myocardial infarction with EKG elevation. Optimization of myocardial reperfusion by treatment with antithrombotic agents].

In the case of acute coronary syndrome with prolonged ST elevation on ECG showing an acute coronary obstruction, the urgent institution of fibrinolysis is a widely validated treatment. Since the first placebo controlled studies with streptokinase until the development of bolus administration rt-PA varieties, fibrinolytic agents have lowered mortality. Associated anti-thrombotic drugs are multiplying in parallel. Their association is recognised as necessary in order to avoid early reocclusions which worsen the prognosis of infarction, the fibrinolysis triggering a harmful prothrombotic effect, notably due to the clot thrombin re-exposed during thrombolysis. Aspirin has an essential place formally demonstrated in ISIS 2. Non-fractionated heparin has more complex effects and its administration protocol in association with fibrinolysis has recently been reviewed with a reduction in dosage because prolonged clotting times during fibrinolysis have provoked a distinct increase in the risk of intracranial haemorrhage. The low molecular weight heparins seem to have become the adjuvant treatment of choice following publication of the ASSENT-3 trial. Pentasaccharide seems attractive. The place of hirudine and its derivatives in the acute phase of MI appear limited after the results of the HERO-2 trial, associating hirulog and streptokinase, with the earlier studies also having been disappointing. The GPIIbIIIa blockers in association with a half dose of fibrinolysis do not aggravate the intracerebral haemorrhagic risk before 75 years old and clearly reduce hospital morbidity in infarction, at the price however of an increase in transfusions.

Aspirin↗

PubMed2001

[Anticoagulation in mechanical valve prostheses. A difficult situation].

Although long-term anticoagulant therapy in patients with mechanical valve prostheses is well codified, a number of difficult situations persists because of the high thromboembolic risk. The protocols of anticoagulation suggested in these situations are controversial as there are no large scale prospective therapeutic trials. However, modern protocols take more and more into account the thromboembolic risk in each individual case. The authors review the most common situations: the early postoperative period for which no precise consensus exists in the literature; anticoagulation in extra-cardiac surgery, a common situation for which the protocols remain very debatable; anticoagulation in pregnancy, a special situation because of the risk of embryopathy with oral anticoagulant therapy and the risk of thromboembolism with heparin; anticoagulation in cases of thromboembolic complications; anticoagulation during infectious endocarditis; anticoagulation during serious haemorrhage.

Anticoagulants↗

PubMed2000

[Hematoma of the aortic wall: from diagnosis to treatment].

Haematoma of the thoracic aortic wall is a relatively new concept, the physiopathology of which remains controversial. It results from an haemorrhage of the aortic wall due to rupture of the vasa-vasorum without communication with the arterial lumen. This is a diagnosis of elimination of dissection of the aorta which has been made possible by modern techniques of imaging, such as transoesophageal echocardiography, helicoidal scanner and magnetic nuclear resonance imaging. The prognosis of haematoma of the aortic wall is not as bad as that of dissection of the aorta. Recent studies have shown that the condition may stabilise, regress or progress towards complications of two types: early, dissection or fissuration of the aorta, and late, aortic aneurysm. This is a medico-surgical emergency, the treatment of which is not well codified. However, schematically, haematoma of the aortic wall should be managed in the same way as dissection of the aorta: surgery when the ascending aorta is affected, medical treatment in other cases in the absence of complications.

Aortic Dissection↗

PubMed2000

[Treatment of left atrial thrombosis by low-molecular-weight heparin. A preliminary study of 6 cases].

Left atrial thrombosis is a serious complication of atrial fibrillation because of its embolic potential, especially for the cerebral circulation. These thrombi are usually treated by oral anticoagulation. The authors studied the efficacy and tolerance of a low molecular weight heparin. Enoxaparin, in the treatment of this condition. This was a prospective study carried out over a 1 year period. Patient recruitment came from the transoesophageal echocardiography laboratory: of 15 thrombi detected, 6 were treated by ambulatory Enoxaparin therapy. Five of the 6 patients had no signs of left atrial thrombosis after 3 weeks of Enoxaparin therapy. The left atrial thrombus of the 6th patient remained hyperechogenic and had decreased in length from 27 to 24 mm. No cases of bleeding, haematoma, embolism or thrombopenia were observed with this treatment. This preliminary study shows that low molecular weight heparin may be used as an alternative to classical oral anticoagulation for the treatment of left atrial thrombosis.

Aged↗

PubMed1998

[Contrast echocardiography and myocardial perfusion: what is the current status?].

Progress in the field of echocardiographic contrast agent combined with progress in imaging techniques (second harmonic imaging, intermittent imaging, Doppler Energy) should allow a real revolution in the field of noninvasive cardiac imaging, and one of the main advantages will probably be myocardial perfusion imaging in ischaemic heart disease.

Contrast Media↗