Longitudinal profile of estrogen-related thrombotic biomarkers after cessation of combined hormonal contraceptives.

ABSTRACT: The persistence of risk of venous thromboembolism (VTE) due to combined hormonal contraceptives (CHCs), after their cessation, is unknown but important to guide clinical practice. The objective of this prospective cohort study was to define the time until normalization of estrogen-related thrombotic biomarkers after CHC cessation. We enrolled women aged 18 to 50 years who had decided to stop their CHC, excluding those with a personal history of VTE, anticoagulation, or pregnancy. The study started before cessation of CHC, with 6 visits afterwards (at 1, 2, 4, 6, and 12 weeks after cessation). Primary outcomes were normalized sensitivity ratios to activated protein C (nAPCsr) and to thrombomodulin (nTMsr), with sex hormone-binding globulin (SHBG) as a secondary end point. We also included control women without CHC. Among 66 CHC users, from baseline until 12 weeks, average levels of nAPCsr, nTMsr, and SHBG decreased from 4.11 (standard deviation [SD], 2.06), 2.53 (SD, 1.03), and 167 nmol/L (SD, 103) to 1.27 (SD, 0.82), 1.11 (SD, 0.58), and 55.4 nmol/L (SD, 26.7), respectively. On a relative scale, 85.8%, 81.3%, and 76.2% of the decrease from baseline until 12 weeks was achieved at 2 weeks and 86.7%, 85.5%, and 87.8% at 4 weeks after CHC cessation, respectively. Levels were not meaningfully modified throughout the study period among 28 control women. In conclusion, CHC cessation is followed by a rapid decrease in estrogen-related thrombotic biomarkers. Two to 4 weeks of cessation before planned major surgery or withdrawal of anticoagulants in patients with VTE appears sufficient for the majority of women. The trial is registered at www.clinicaltrials.gov as #NCT03949985.

[Angiology and hemostasis: what's new in 2023]. / Angiologie et hémostase: ce qui a changé en 2023.

We discuss four topics among the angiology and hemostasis studies of importance in 2023. The BASIL-2 study provides new data for the management of chronic limb-threatening ischemia by comparing surgical and endovascular treatment. The new classification of antiphospholipid antibody (aPL) syndrome integrates new clinical elements and gives a different weight among the isotype and titer of aPL. Concizumab, an antibody targeting the tissue factor pathway inhibitor, broadens the therapeutic arsenal for hemophilia A and B as evidenced by the results of the EXPLORER 7 study. The PREVENT-CLOT and CASTING study focus on the prevention of thrombosis after trauma, by testing the role of aspirin or the lack of thromboprophylaxis, respectively.

Parmi les sujets d'angiologie et d'hémostase qui ont marqué l'année 2023, quatre ont retenu notre attention. L'étude BASIL-2 apporte de nouvelles données pour la prise en charge de l'ischémie critique des membres inférieurs en comparant les traitements chirurgical et endovasculaire. La nouvelle classification du syndrome des anticorps antiphospholipides (aPL) intègre de nouveaux items cliniques et donne un poids différent aux isotypes et titres des aPL. Le concizumab, un anticorps ciblant l'inhibiteur de la voie du facteur tissulaire, vient élargir l'arsenal thérapeutique pour les hémophilies A et B comme en témoignent les résultats de l'étude EXPLORER 7. Les études PREVENT-CLOT et CASTING s'intéressent à la prévention de la thrombose après traumatisme, en testant la place de l'aspirine ou l'absence de thromboprophylaxie.

[Angiology and hemostasis : what's new in 2022]. / Angiologie et hémostase : ce qui a changé en 2022.

In this article, we have selected four topics that particularly caught our attention during the year 2022, and which are related to anticoagulation, its bleeding complications, and hemophilia. Thus, we discuss the issue of the treatment with rivaroxaban of atrial fibrillation associated with rheumatic valvulopathy, which has been studied in a randomized trial, the intensity of thromboprophylaxis in COVID outpatients and inpatients, and the bleeding risk of anticoagulation in patients with cerebral tumors. Finally, recent data on gene therapy in severe hemophilia A, an upcoming treatment, are discussed.

Dans cet article, nous avons sélectionné 4 sujets qui ont particulièrement retenu notre attention durant l'année 2022, en lien avec l'anticoagulation, ses complications hémorragiques et l'hémophilie. Ainsi, nous abordons le traitement par rivaroxaban de la fibrillation atriale associée à une valvulopathie rhumatismale qui a fait l'objet d'une étude randomisée, l'intensité de la thromboprophylaxie chez les patients hospitalisés ou traités en ambulatoire avec un Covid dont les données se sont bien étoffées, le risque associé à l'anticoagulation chez les patients avec une néoplasie cérébrale et, finalement, la thérapie génique dans l'hémophilie A sévère qui devrait apparaître sur le marché très prochainement.

[Direct oral anticoagulant for venous thrombosis in unusual sites]. / Place des anticoagulants oraux directs dans le traitement des thromboses veineuses de localisation inhabituelle.

Thrombosis in unusual sites account for approximately 4% of venous thromboembolic events. The safety of direct oral anticoagulants (DOACs) has led to the widespread use of these treatments. However, they have mainly been studied in deep vein thrombosis of the lower limbs and in pulmonary embolism. This review of the literature assesses the current knowledge of the use of DOACs for venous thrombosis in unusual sites (splanchnic, cerebral, ovarian, upper-extremity deep vein thrombosis). Numerous case reports or observational studies have been published, but very few randomized trials. Nevertheless, experts-based guidelines suggest that these anticoagulants may be considered in specific cases.

La maladie thromboembolique veineuse de localisation atypique (MTEV-LA) représente environ 4 % des événements thromboemboliques veineux. Les anticoagulants oraux directs (ACOD), faciles d'utilisation et sécuritaires, ont essentiellement été étudiés dans la MTEV classique (thrombose veineuse profonde des membres inférieurs et embolie pulmonaire). Dans cette revue de la littérature, nous dressons un état des lieux sur les connaissances actuelles concernant l'utilisation des ACOD dans la MTEV-LA, notamment les thromboses splanchnique, cérébrale, ovarienne et des membres supérieurs. De nombreuses descriptions de cas et études observationnelles ont été publiées mais très peu d'essais randomisés l'ont été. Malgré cela, plusieurs sociétés savantes proposent la prescription d'ACOD dans certains cas spécifiques de MTEV-LA.

[Hospital mechanical thromboprophylaxis]. / Thromboprophylaxie mécanique hospitalière.

Mechanical thromboprophylaxis is an important part of hospital prevention of venous thromboembolism. It comprises graduated compression stockings and intermittent pneumatic compression. In this review, we summarize its physiological effect on venous hemodynamics, recent clinical studies that offer contrasting results, and discuss its utility in contemporary clinical practice. Mechanical thromboprophylaxis is currently suggested in patients at high thrombotic and hemorrhagic risk, favoring intermittent pneumatic compression, but does not seem useful in addition to pharmacological thromboprophylaxis.

La thromboprophylaxie mécanique est une composante importante de la prévention hospitalière de la maladie thromboembolique veineuse. Elle comprend la compression graduée par bas ou chaussettes et la compression pneumatique intermittente (CPIn). Dans cet article, nous résumons son effet veineux physiologique et revenons sur les études cliniques récentes qui offrent des résultats contrastés. Enfin, nous discutons de sa place en clinique contemporaine. La thromboprophylaxie mécanique est actuellement suggérée chez des patients à hauts risques thrombotique et hémorragique, en privilégiant la compression pneumatique intermittente, mais ne semble pas utile en plus d'une thromboprophylaxie pharmacologique.

Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis.

BACKGROUND: COVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODS: This meta-analysis included original articles in English published from January 1st, 2020 to June 15th, 2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTS: In 33 studies (n = 4009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2 = 92.5) overall, and 21% (95%CI 14-28%, I2 = 87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2 = 87.0%) and 8% (95%CI 3-14%, I2 = 87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2 = 92.1%) and 17% (95%CI 11-25%, I2 = 89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%). CONCLUSIONS: The risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATION: The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews ( CRD42020193369 ).

[COVID-19, anticoagulation and venous thromboembolism: what have we learned ?] / Covid-19, anticoagulation et maladie thromboembolique veineuse : qu'a-t-on appris ?

Severe COVID-19 is associated with venous thromboembolic events and and immuno-thrombotic phenomena, responsible for pulmonary vascular damage. This review summarizes the current knowledge on thrombotic risk in COVID-19 inpatients, the potential predictive factors (including D-dimer) and the randomized trials studying the effect of intermediate or therapeutic-dose anticoagulation on the clinical and thrombotic prognosis. Despite the initial hope, therapeutic anticoagulation does not improve the clinical prognosis in critically ill inpatients, and standard prophylactic anticoagulation is therefore recommended. In non-critical inpatients, the use of therapeutic anticoagulation may help reduce the risk of severe clinical deterioration, but its risk-benefit will be clarified in ongoing studies and meta-analyzes.

Le Covid-19 sévère se complique fréquemment d'événements thromboemboliques veineux et de phénomènes d'immunothrombose responsables d'altérations vasculaires pulmonaires. Cet article résume les connaissances actuelles du risque thrombotique lié au Covid-19 hospitalier, les facteurs prédictifs (dont les D-dimères) et les résultats des essais randomisés d'anticoagulation à doses intermédiaire ou thérapeutique. Malgré l'espoir initial, une anticoagulation thérapeutique n'améliore pas le pronostic clinique aux soins intensifs et une anticoagulation prophylactique standard est donc préconisée. En médecine, l'utilisation d'une anticoagulation thérapeutique pourrait contribuer à réduire le risque de détérioration clinique, mais le rapport bénéfice-risque d'une telle stratégie sera précisé dans les résultats des études et méta-analyses en cours.

[Evolution of thromboprophylaxis after hip and knee arthroplasties]. / Évolution de la thromboprophylaxie après prothèses de hanche et de genou.

Venous thrombotic events frequently complicate major elective arthroplasties such as hip and knee replacements. The risk of proximal deep vein thrombosis and pulmonary embolism is estimated at 5 %. For decades, the use of low-dose heparins for up to 5 weeks post-surgery has helped to reduce the risk of thrombotic complications. In this narrative review, we describe the evidence supporting the use of direct oral anticoagulants (in Switzerland - rivaroxaban and apixaban), whose risk-benefit ratios appears superior to that of heparins, at a lower cost. Hybrid strategies combining a short-term anticoagulant followed by low-dose aspirin are also recommended for patients deemed at low thrombotic risk.

Les thromboses veineuses profondes proximales et les embolies pulmonaires sont des complications redoutées après des interventions électives majeures en chirurgie orthopédique (prothèses totales de la hanche et du genou), avec une incidence cumulée estimée à 5 %. Depuis des décennies, ce risque est réduit par l'utilisation d'héparine à dose préventive jusqu'à 5 semaines postopératoires. Dans cette revue narrative, nous décrivons les évidences motivant l'utilisation des anticoagulants oraux directs (rivaroxaban et apixaban en Suisse) qui semblent présenter un rapport bénéfice-risque supérieur aux héparines, à un coût moindre. Des stratégies hybrides comprenant un anticoagulant puis l'aspirine sont désormais également recommandées chez des patients considérés à bas risque thrombotique.

[Contraception and venous thromboembolism]. / Contraception et maladie thromboembolique veineuse.

Combined oral contraceptives remain in 2020 the most used contraceptive method in Switzerland and Europe, and are found in about half of venous thromboembolism (VTE) occurring in women aged up to 50 years. In this narrative review, we describe the determinants of the VTE risk, related to the types of oral contraceptives and to genetic or acquired risk factors of users, while summarizing several current recommendations of prescription for contraceptives. The complex management of contraception at the time of VTE should be discussed with patients, in order to minimize the risks of undesired pregnancy, abnormal uterine bleeding and recurrent VTE.

En 2020, la contraception orale combinée reste la méthode contraceptive la plus utilisée en Suisse et en Europe, et son usage est retrouvé dans environ la moitié des événements de maladie thromboembolique veineuse (MTEV) des femmes de moins de 50 ans. Dans cette revue narrative, nous décrivons les déterminants du risque de MTEV en fonction du type de contraceptif et des facteurs de risque acquis ou génétiques des utilisatrices, en se basant sur les recommandations actuelles de prescription. La gestion de la contraception lors d'un événement de MTEV reste complexe et doit alors être discutée avec la patiente, afin de minimiser les problèmes de grossesse non désirée, de ménorragies et de récidive thromboembolique.

[How to manage giant cell arteritis]. / Allergologie-immunologie - Prise en charge de l'artérite gigantocellulaire en 2019.

Giant cell arteritis (GCA) is the most common vasculitis in adults over 50 years, which requires an urgent treatment with corticosteroids to reduce ischemic complications. Because of their side-effects, a valid diagnosis is necessary. Histological confirmation remains the gold-standard but non-invasive imaging along specific clinical criteria can nowadays diagnose GCA, particularly temporal artery ultrasound. Alternatives to corticosteroids are being studied and recently, the addition of tocilizumab to corticosteroids has been validated by international institutions and is approved by Swissmedic. Similarly to tocilizumab, methotrexate has been shown to decrease the total dose of corticosteroids and the number of relapses. We will also discuss newer potential therapies (abatacept and ustekinumab).

L'artérite à cellules géantes est une vasculite des gros vaisseaux fréquentes après 50 ans, nécessitant un traitement par corticostéroïdes dès le diagnostic pour diminuer les complications ischémiques. En raison des effets secondaires du traitement, une certitude diagnostique est importante. Bien que la confirmation histologique reste le gold standard, l'imagerie permet désormais de poser un diagnostic non invasif en présence de critères bien définis. Des alternatives aux stéroïdes sont étudiées et récemment, l'adjonction de tocilizumab a été validée par Swissmedic, entre autres dans le but de diminuer la dose totale de stéroïdes et le nombre de rechutes. Le méthotrexate, alternative au tocilizumab, existe et est toujours d'actualité. Nous discuterons également de l'abatacept et de l'ustékinumab, molécules prometteuses en cours d'évaluation.

[Venous thrombotic risk related to SARS-CoV-2†: prevalence, recommendations and perspectives]. / Risque thrombotique veineux induit par le SARS-CoV-2†: prévalence, recommandations et perspectives.

Since the SARS-CoV-2 pandemic outbreak, growing evidence suggests that patients suffering from COVID-19 are at increased risk of thrombotic events. The sepsis-related activation of the coagulation combined with a high prevalence of common thrombotic risk factors could contribute to this prothrombotic state. Coagulation biomarkers could help in the identification of patients at risk of complications and mortality. The incidence of venous thromboembolic events appears to be increased, especially in severe COVID-19 patients. Based on that knowledge, several societies have provided recommendation on the prevention of venous thromboembolism. In this narrative review, we summarize available epidemiologic data on venous thromboembolism and recommendations on thromboprophylaxis in COVID-19.

Depuis le début de l'épidémie de SARS-CoV-2, des faisceaux d'évidences suggèrent que les patients souffrant de COVID-19 sont à risque augmenté d'événements thrombotiques. L'activation de la coagulation secondaire au sepsis associée à des facteurs de risques thrombotiques classiques pourrait contribuer à cet état prothrombotique. Les marqueurs de la coagulation semblent stratifier le risque de détérioration clinique et de mortalité. Le risque de la maladie thromboembolique veineuse (MTEV) semble très élevé, notamment chez les patients sévèrement atteints. Dans ce contexte, de nombreuses sociétés savantes ont émis des recommandations pour la prévention de la MTEV. Nous proposons une mise à jour des connaissances actuelles sur les données épidémiologiques disponibles et sur les recommandations pour la prévention de la MTEV dans le COVID-19.

[Thromboprophylaxis in gynecological surgery†: towards a comprehensive prevention]. / Thromboprophylaxie en chirurgie gynécologique†: vers une prévention cohérente.

Venous thromboembolic events (VTE), defined by deep vein thrombosis or pulmonary embolism, are potentially serious complications after gynecologic surgery. Without thromboprophylaxis, they are common and can lead to significant morbidity and mortality. Conversely, poorly adapted prophylaxis can be hazardous. Risk factors related to the patients and to the types of surgery have been identified and can be used to adapt the prophylaxis. Several recommendations have been proposed; however, no clear consensus exists. This article reviews the pathophysiology and specific risk factors of post-gynecologic surgical VTE and provides comprehensive and practical recommendations for perioperative thromboprophylaxis in gynecology, based on various international recommendations.

La maladie thromboembolique veineuse (MTEV), regroupant la thrombose veineuse profonde et l'embolie pulmonaire, est une complication potentiellement grave rencontrée en chirurgie gynécologique. En l'absence de thromboprophylaxie, elle est fréquente et peut entraîner une morbi-mortalité conséquente. À l'inverse, une prophylaxie mal adaptée peut s'avérer délétère. Des facteurs de risque liés aux patientes mais également aux types de chirurgie ont été identifiés, permettant d'adapter la prophylaxie périopératoire. Diverses recommandations ont été proposées, sans véritable consensus. Cet article rappelle la physiopathologie ainsi que les facteurs de risque de la MTEV et propose des recommandations cohérentes et pratiques sur la thromboprophylaxie périopératoire en chirurgie gynécologique, se basant sur les diverses recommandations internationales.

Natural history of patients with congenital dysfibrinogenemia.

We conducted a multicenter study of 101 patients with congenital dysfibrinogenemia (CD) to characterize the incidence of hemorrhagic and thrombotic events as well as complications of pregnancy and surgery. At the time of diagnosis, 10.9% and 13.9% had experienced major bleeding and thrombotic events, respectively. During a mean follow-up of 8.8 years after CD diagnosis, the incidence of major bleeding and thrombotic events was 2.5 and 18.7 per 1000 patient-years, respectively, with estimated cumulative incidences at age 50 years of 19.2% and 30.1%. We identified 111 pregnancies with an overall incidence of spontaneous abortions and postpartum hemorrhage of 19.8% and 21.4%, respectively. The risk of postpartum hemorrhage was associated with a previously identified bleeding phenotype (odds ratio, 5.8; 95% CI, 1.2 to 28.0). Among 137 surgical procedures analyzed, 9 (6.5%) were complicated by abnormal bleeding. Propositi vs relatives, sex, mutation hotspots, fibrinogen levels, and activity:antigen ratios were not associated with the risk of thrombotic or bleeding outcomes. In conclusion, the results of our study, the largest in genotyped CD and the first including long-term history, indicate that propositi with CD and their relatives carry not only a high risk of major bleeding, including postpartum hemorrhage, but also of thrombotic event.

[Prevention of thrombosis among medical inpatients : should we adapt enoxaparin doses to the patient's weight ?] / Thromboprophylaxie hospitalière : doit-on adapter la dose d'énoxaparine au poids des patients ?

Venous thromboembolism (VTE) is a common condition affecting hospitalized patients and it is associated with increased mortality, length of stay and health-care costs. Prophylaxis using low-molecular weight heparins (LMWH) is an efficient intervention preventing VTE in high-risk patients, yet some evidence suggests suboptimal prophylaxis in obese inpatients. This narrative review evaluates current evidence, both on clinical and surrogate outcomes, which can guide the adaptation of prophylactic doses of enoxaparin among obese medical inpatients.

La maladie thromboembolique veineuse (MTEV) est une affection fréquente en milieu hospitalier dont les conséquences incluent une augmentation de la mortalité, de la durée de séjour hospitalier et des coûts médicaux. La thromboprophylaxie par héparine de bas poids moléculaire (HBPM) permet de réduire la survenue de la MTEV. Néanmoins, les études indiquent une corrélation entre le poids et l'efficacité des HBPM, suggérant une efficacité diminuée chez les patients obèses hospitalisés. L'objectif de cet article est d'évaluer les évidences cliniques et biologiques pouvant guider l'adaptation de la dose prophylactique des HBPM chez des patients obèses et hospitalisés dans les services de médecine.

[Hormonal treatments and venous thrombosis in women]. / Traitements hormonaux et risque de thrombose veineuse chez la femme.

Venous thromboembolism is frequently associated with hormonal factors in women. A thorough medical history taking of vascular risks and an individual evaluation of the risk-benefit ratio should precede any prescription of hormonal therapies. In contrary to progestin-only-pills, estroprogestative contraceptives increase 3-6 times the risk of venous thrombosis. In assisted reproductive techniques, venous thrombosis is frequently associated with the occurrence of a severe ovarian hyperstimulation syndrome. Antagonist ovarian stimulation protocols lower the risk of hyperstimulation and should therefore be preferred. Finally, at menopause, hormonal treatments combining transdermal estradiol and micronized progesterone do not seem to increment the risk of thrombosis.

La maladie veineuse thromboembolique est fréquemment associée aux facteurs hormonaux chez la femme. La prescription de toute thérapeutique hormonale sera précédée d'un interrogatoire minutieux à la recherche de facteurs de risque vasculaires et d'une évaluation individuelle de la balance bénéfice-risque. Contrairement à la contraception micro-progestative, la contraception œstroprogestative augmente le risque de thrombose veineuse de 3 à 6 fois. En procréation médicalement assistée, la thrombose veineuse est fréquemment associée à la survenue d'un syndrome d'hyperstimulation ovarienne sévère. Les protocoles de stimulation antagonistes minimisant le risque d'hyperstimulation ovarienne sont donc à privilégier. Enfin, après la ménopause, le traitement hormonal associant de l'œstradiol par voie percutanée et de la progestérone micronisée ne semble pas augmenter le risque de thrombose veineuse.

[News in Angiology and Hemostasis]. / Angiologie et hémostase.

Several themes were selected from those that marked the year 2016. The analysis of registries with «real life¼ data regarding the use of direct oral anticoagulants is reassuring and overall confirm the data of the pivotal studies. We also present the validation of a prediction rule for risk stratification of thromboembolism recurrence and duration of anticoagulation after an unprovoked event. In addition, new data shed light on the treatment of distal vein thrombosis. We also address the issue of venous thromboembolism risk related to oral contraceptives and the issue of genetic testing prior prescription, and finally present a new factor VIII recently available for the treatment of patients with acquired hemophilia A.

Plusieurs thèmes ont été choisis parmi ceux qui ont marqué l'année 2016. L'analyse des registres de patients de la «vraie vie¼ concernant l'utilisation des anticoagulants oraux directs permet dans l'ensemble de confirmer les données des études pivots. Concernant la maladie thromboembolique veineuse, nous présentons la validation d'une règle de prédiction pour la stratification du risque de récidive et la durée d'anticoagulation après un événement idiopathique. De plus, des données nouvelles apportent un éclairage sur la prise en charge des thromboses veineuses distales. Finalement, nous abordons le risque d'événement thromboembolique veineux en relation avec la contraception orale et l'arrivée sur le marché de tests de dépistage génétique de même que d'un nouveau facteur VIII pour la prise en charge des patients avec une hémophilie A acquise.

Association between newborn birth weight and the risk of postpartum maternal venous thromboembolism: a population-based case-control study.

BACKGROUND: Postpartum venous thromboembolism (VTE) is a potentially fatal and preventable event leading to substantial short- and long-term morbidity. We sought to evaluate whether the delivery of term newborns of low or high birth weight was associated with greater risks of VTE. METHODS AND RESULTS: In a population-based case-control study conducted in Washington State from 1987 through 2011, cases of hospitalized VTE within 3 months of delivery were identified by using selected International Classification of Diseases, Ninth Revision, Clinical Modification codes. Controls were randomly selected postpartum women without VTE, matched on birth year. Birth weight and other maternal and pregnancy characteristics were extracted from birth certificate data. Among term live singleton deliveries, we compared the risk of VTE for mothers of newborns of low and high birth weights (<2500 g and >4000 g, respectively) versus mothers of newborns of normal birth weight (2500-4000 g). Logistic regression models were adjusted for maternal age, race, education, body mass index, parity, delivery methods, gestational length, smoking, gestational diabetes mellitus, and preeclampsia. Patients with VTE (n=547) were older, had a higher body mass index, and experienced more pregnancy-related complications than controls (n=9482). In comparison with mothers of newborns with normal birth weight, mothers of newborns with low birth weight had a 3-fold increased risk of VTE, which persisted after multivariable adjustment (odds ratio, 2.98; 95% confidence interval, 1.80-4.93). Mothers of newborns with high birth weight had only a slightly increased risk of VTE, which was attenuated after multivariable adjustment (odds ratio, 1.26; 95% confidence interval, 0.99-1.61). CONCLUSIONS: The delivery of a newborn with low birth weight is associated with a 3-fold increased risk of maternal postpartum VTE. This should be considered when assessing VTE risk at delivery.

Validation of methods for assessing cardiovascular disease using electronic health data in a cohort of Veterans with diabetes.

BACKGROUND: Electronic health data are routinely used to conduct studies of cardiovascular disease in the setting of the Veterans Health Administration (VA). Previous studies have estimated the positive predictive value (PPV) of International Classification of Disease, Ninth Revision (ICD-9) codes for acute myocardial infarction (MI), but the sensitivity of these codes for all true events and the accuracy of coding algorithms for prevalent disease status at baseline are largely unknown. METHODS: We randomly sampled 180 Veterans from the VA Puget Sound Health Care System who initiated diabetes treatment. The full electronic medical record was reviewed to identify prevalent conditions at baseline and acute MI events during follow-up. The accuracy of various coding algorithms was assessed. RESULTS: Algorithms for previous acute events at baseline had high PPV (previous MI: 97%; previous stroke: 81%) but low sensitivity (previous MI: 38%; previous stroke: 52%). Algorithms for chronic conditions at baseline had high PPV (heart failure: 72%; coronary heart disease [CHD]: 85%) and high sensitivity (heart failure: 90%, CHD: 84%). For current smoking status at baseline, ICD-9 codes with pharmacy data had a PPV of 77% and sensitivity of 73%. The coding algorithm for acute MI events during follow-up had high PPV (80%) and sensitivity (89%). CONCLUSIONS: ICD-9 codes for acute MI events during follow-up had high PPV and sensitivity. The sensitivity of ICD-9 codes for previous acute events at baseline was low, but a composite variable for baseline CHD had good accuracy.

[News in angiology and hemostasis]. / Angiologie et hémostase.

This update describes contemporary studies of clinical relevance in angiology and hemostasis. We discuss newer developments for the treatment of haemophilia, with a focus on drugs with longer-half lives. Direct anticoagulants (DOAC: rivaroxaban, apixaban, edoxaban and dabigatran) and their approved prescription in Switzerland are summarized, with a description of antidotes that will be available in the near future. We will present new data on the utility of cancer screening at the diagnosis of idiopathic venous thromboembolism (VTE) and on the evaluation of DOAC in patients with cancer-related VTE. Finally, new studies evaluating the clinical risk-benefit of anticoagulation bridging for patients with vitamin K antagonists undergoing procedures do not support the use of such bridging in the majority of patients.

[The evolution of imaging techniques for the diagnosis of pulmonary]. / Evolution des techniques d'imagerie dans le diagnostic de l'embolie pulmonaire.

Modern diagnostic strategies for pulmonary embolism (PE) rely on the sequential use of clinical probability assessment, D-dimer and thoracic imaging when necessary. Computed tomography pulmonary angiography (CTPA) has become the imaging modality of choice. Diagnostic strategies using CTPA are very safe for the diagnosis of PE and have been well validated in large prospective management outcome studies. With the widespread use of CTPA, concerns regarding radiation and overdiagnosis of PE have paved the way for investigating new diagnostic modalities. V/Q SPECT has arisen as a highly accurate test and a potential alternative to CTPA. However, prospective management outcome studies are still lacking and are warranted before its implementation in routine clinical practice.

Les stratégies diagnostiques modernes de l'embolie pulmonaire se basent sur l'utilisation séquentielle de la probabilité clinique, des D-dimères et si nécessaire d'une imagerie thoracique. L'angioscanner représente actuellement la modalité d'imagerie de choix. Cependant, l'utilisation à large échelle de l'angio-scanner soulève des inquiétudes concernant l'irradiation et le surdiagnostic qui ont ouvert la voie de la recherche de nouvelles modalités d'imagerie. La tomoscintigraphie par émission monophotonique (TEMP) ou single photon emission computed tomography (SPECT) de ventilation/perfusion (V/P) semble être un test aussi performant que l'angio-scanner, et pourrait représenter une alternative. Des études prospectives sont néanmoins nécessaires avant d'envisager son implémentation dans la pratique quotidienne.