Duration of anticoagulation for upper extremity deep vein thrombosis associated with cancer and central venous catheter: Outcome of a cohort study.

INTRODUCTION: In cancer patients with catheter-associated upper extremity deep vein thrombosis, 3 months of anticoagulation is recommended. The main objective of this study was to compare the incidence of thrombosis recurrence in these patients in case of continuation or discontinuation of anticoagulation, at the end of 3 months and after catheter has been removed. The secondary objectives were the incidence of major bleeding and death. MATERIAL AND METHODS: We conducted a retrospective cohort study including patients with a cancer and a catheter-associated upper extremity deep vein thrombosis. RESULTS: About 60 patients included, 44 stopped anticoagulation after the first 3 months and 16 continued it. The median time between catheter insertion and deep vein thrombosis was 26±83 days. Three recurrences occurred during the one-year follow-up: 2 in the group who stopped anticoagulation, with a cumulative incidence at 1 year of 4,8% (95%IC 1.2-18.1) and 1 in the group who continued anticoagulation, with a cumulative incidence at 1 year of 14.3% (95%IC 2.1-66.6). No major bleeding event occurred in anticoagulation discontinued group. The group who stopped anticoagulation was significantly associated with a lower risk of death (HR 0.21-95%IC 0.09-0.48, P<0.001). CONCLUSION: The risk of recurrence in cancer patients with a catheter-associated upper extremity deep vein thrombosis was low and statistically comparable between the group who stopped anticoagulation and the group who continued it. These results suggest that anticoagulation after the first 3 months deserves to be considered when catheter is removed.

Management of upper extremity deep vein thrombosis in Occitanie: practice assessment.

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.

[Medical residents and wound healing: A French national survey]. / Internes en médecine et cicatrisation des plaies : une étude descriptive multicentrique entre février et avril 2018.

OBJECTIVES: Around 2.5 million wounds are recorded in France, representing, in terms of cost and quality of life, a real problem of public health issue. In France, residents are among the first line personnel having to manage wounds and their complications: this study is carried out to identify the view and feelings of residents concerning their preparation and training in this field. MATERIALS AND METHODS: A questionnaire was distributed to residents throughout France. Residents' characteristics, interests and training in wound healing, training courses and opinions concerning their training were recorded. RESULTS: Seven hundred and eleven French residents answered the questionnaire, the majority of whom (79 %) had not experienced training in wound healing. The majority of residents (69 %) believe that all physicians are concerned. Training in wound management and wound healing is considered insufficient (94 %) and most (79 %) had never received any training in wound management and wound healing. Ninety-eight percent stated they needed additional training courses in wound management. CONCLUSIONS: Wound management and healing is a topic of interest to residents. Residents need more training in wound management in their curriculum to improve their practice.