[Une combinaison très rare de thrombose veineuse et artérielle chez un patient atteint du COVID 19]. / A very rare combination of venous and arterial thrombosis in a patient with COVID-19.

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. This epidemic has caused serious socio-economic problems worldwide, with a very high mortality rate. Several articles have been published in the literature showing the consequences of this disease on the human body. Among the most serious complications are venous and arterial thrombosis, which are rarely observed together in the same patient. In this article, we report an exceptional case of a patient with COVID-19 with the combination of intracardiac thrombus (left atrium) and venous thrombosis (splenic vein and portal trunk).

[Translation into French and republication of: "Home treatment for patients with cancer-associated venous thromboembolism"]. / Traduction et republication de : « Traitement à domicile des patients atteints de maladie veineuse thromboembolique associée au cancer ¼.

Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.

Full sample analysis of cerebral venous sinus thrombosis in ophthalmology inpatients.

PURPOSE: We hope that by analyzing the clinical features of cerebral venous sinus thrombosis (CVST), we can help ophthalmologists reduce misdiagnosis or delayed diagnosis. DESIGN: We evaluated 47 patients with CVST in terms of clinical manifestations. METHODS: All cases were analyzed in terms of risk factors, clinical symptoms, ophthalmic examination, imaging examination and lumbar puncture. RESULTS: The body mass indices (BMIs) of 41 patients (87.2%; 95% CI, 77.7-96.8%) were≥24, which is overweight by Chinese standards. There were 22 patients (46.8%; 95% CI, 32.5-61.1%) with BMIs≥28, who were considered obese. Thirteen were hypertensive (27.7%; 95% CI, 14.9-40.5%). The initial symptoms included blurred vision (23, 48.9%; 95% CI, 34.6-63.2%), amaurosis fugax (13, 27.7%; 95% CI, 14.9-40.5%), headache (11 patients, 23.4%; 95% CI, 11.3-35.5%), dizziness (3, 6.4%; 95% CI, -0.6-13.4%), and bilateral diplopia (3, 6.4%; 95% CI, -0.6-13.4%). There were 9 patients (9, 19.2%; 95% CI, 7.9-30.4%) with blindness, 23 patients (48.9%; 95% CI, 34.6-63.2%) with pupillary abnormalities, and 40 patients (85.1%; 95% CI, 74.9-95.2%) with papilledema. Forty-three of the 45 patients who successfully underwent a routine lumbar puncture showed high intracranial pressure (91.7%; 95.6% CI, 89.6-101.6%). Finally, two cases are reported in greater detail for illustrative purposes. CONCLUSION: The main reasons interfering with the diagnosis of CVST might be its nonspecific ocular symptoms and the physicians' clinical thought process being limited to the scope of common ophthalmological diseases.

[Maternal mortality due to venous thromboembolism in France 2016-2018]. / Mortalité maternelle par thromboembolie veineuse en France 2016­2018.

Pregnancy and the post-partum period represent a thromboembolic risk situation, with pulmonary embolism (PE) remaining one of the leading causes of direct maternal deaths in developed countries. Between 2016 and 2018 in France, twenty maternal deaths were caused by venous thromboembolic complications (VTE), yielding a Maternal Mortality Ratio (MMR) of 0.9 per 100,000 live births (95%CI 0.6-1.3), with no change compared to the periods 2013-2015 or 2010-2012. Among these 20 deaths, 1 death was related to cerebral thrombophlebitis, and the remaining 19 were due to PE. Regarding the timing of death, 2 deaths occurred after an early termination of pregnancy, 40% (8/20) during an ongoing pregnancy, and 50% (10/20) in the post-partum period. Among the 20 VTE deaths, 20% (4/20) occurred outside of a healthcare facility (at home or in a public place). Among the nineteen cases with documented BMI, seven women had obesity (37%), three times more than in the population of parturients in France (11.8%, ENP 2016). Among the nineteen PE deaths and the case of cerebral thrombophlebitis, eleven were considered preventable, six possibly preventable (35%), two probably preventable (12%), and three preventability undetermined. The identified preventability factors were inadequate care and the patient's failure to interact with the healthcare system. From the case analysis, areas for improvement were identified, including insufficient consideration of major and minor risk factors, the early initiation of appropriate prophylactic treatment, and the absence of fibrinolysis in cases of s refractory cardiac arrest due to suspected PE.

[Splanchnic vein thrombosis]. / Thromboses veineuses splanchniques.

Splanchnic vein thrombosis includes Budd-Chiari syndrome and portal vein thrombosis. These diseases share common features: (i) they are rare diseases and (ii) they can lead to portal hypertension and its complications. Budd-Chiari syndrome and portal vein thrombosis in the absence of underlying liver disease share many risk factors, the most common being myeloproliferative neoplasms. A rapid and comprehensive workup for thrombosis risk factors is necessary in these patients. Long-term anticoagulation is indicated in most patients. Portal vein thrombosis can also develop in patients with cirrhosis, and is associated with a worse course of cirrhosis. Indications for anticoagulation in patients with cirrhosis are increasing. Transjugular intrahepatic portosystemic shunt is a second-line procedure in this setting. Because of the rarity of these diseases, high-level evidence studies are rare. However, collaborative studies have provided a better understanding of their natural history and allowed to improve the management of these patients. This review focuses on the causes, diagnosis, and management of patients with Budd-Chiari syndrome, patients with portal vein thrombosis without underlying liver disease, and patients with cirrhosis and portal vein thrombosis.

[Folie à deux - Thrombosis and Infections]. / Folie à deux ­ Thrombose und Infektionen.

Folie à deux - Thrombosis and Infections Abstract: Although infections are not represented in the Revised Geneva or Wells score, they increase the risk of venous thromboembolism (VTE) similarly to the known risk factors (immobilization, major surgery, active neoplasia). This increased risk of VTE can persist for six to twelve months after infection; moreover, the more severe the infection, the higher the risk of VTE may be. In addition to VTEs, infections can promote arterial thromboembolism. For example, 20% of pneumonias are accompanied by an acute cardiovascular event (acute coronary syndrome, heart failure, atrial fibrillation). In the case of infection-associated atrial fibrillation, the CHA2DS2 VASc score remains an appropriate guide for the indication of anticoagulation.

[Human immunodeficiency virus and venous thromboembolism: Role of direct oral anticoagulants]. / Modalités du traitement de la maladie veineuse thromboembolique du patient VIH par les anticoagulants oraux directs.

Nowadays, thanks to highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection is transforming into a chronic disease. The life expectancy of people living with HIV (PWH) has increased, as well as their risk of developing several co-morbidities, in particular cardiovascular diseases. In addition, the incidence of venous thromboembolism (VTE) is increased in PWH with a 2 to 10 times higher incidence when compared to the general population. Over the last decade, direct oral anticoagulants (DOACs) have been widely used in the treatment and prevention of VTE and non-valvular atrial fibrillation. DOACs are characterized by a rapid onset of activity, a predictable response and a relatively wide therapeutic window. Nevertheless, drug interactions exist between HAART and DOACs, exposing PWH to a theoretically increased bleeding or thrombotic risk. DOACs are substrates of the transport protein P-glycoprotein and/or of isoforms of cytochromes P450 pathway, which can be affected by some antiretroviral drugs. Limited guidelines are available to assist physicians with the complexity of those drug-drug interactions. The aim of this paper is to provide an updated review on the evidence of the high risk of VTE in PWH and the place of DOAC therapy in this population.

Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft.

The most common surgical procedure for the treatment of hypothenar hammer syndrome (HHS) is resection of the pathological segment followed by arterial reconstruction using a venous bypass. Bypass thrombosis occurs in 30% of cases, with various clinical consequences, ranging from no symptoms to reappearance of the preoperative clinical symptoms. We reviewed 19 patients with HHS who underwent bypass graft, to assess clinical outcomes and graft patency, with a minimum follow-up of 12 months. Objective and subjective clinical evaluation and ultrasound exploration of the bypass were carried out. Clinical results were compared according to bypass patency. At a mean follow-up of 7 years, 47% of patients had complete resolution of symptoms; symptoms were improved in 42% of cases, and unchanged in 11%. Mean QuickDASH and CISS scores were 20.45/100 and 28/100, respectively. Bypass patency rate was 63%. Patients with patent bypass had shorter follow-up (5.7 vs 10.4 years; p = 0.037) and a better CISS score (20.3 vs 40.6; p = 0.038). There were no significant differences between groups for age (48.6 and 46.7 years; p = 0.899), bypass length (6.1 and 9.9 cm; p = 0.081) or QuickDASH score (12.1 and 34.7; p = 0.084). Arterial reconstruction gave good clinical results, with the best results in case of patent bypass. Level of evidence: IV.

[The Thromboembolism Risk with Combined Hormonal Contraceptives: Current Status and Prescribing Practice]. / Thromboembolierisiko unter kombinierten hormonellen Kontrazeptiva ­ aktueller Stand und Verschreibungspraxis.

The Thromboembolism Risk with Combined Hormonal Contraceptives: Current Status and Prescribing Practice Abstract. The use of combined hormonal contraceptives (CHC) increases not only the risk for venous thromboembolism, but also for arterial thromboembolism. The risk for thromboembolism is the same for non-oral CHC (patches, vaginal rings) as for oral CHC. Risk factors such as age >35, obesity, smoking and a positive family history need to be recognized and considered in contraceptive counselling. Elaborate information concerning risks and benefits is mandatory. This applies to first-time as well as long-term users. Careful investigation of the history is required, and the risk factors need to be re-evaluated at yearly prescription. It is also very important to inform the patients about the early symptoms of thrombosis or pulmonary embolism, so that therapy can be started immediately. Apart from these risks, CHC may have beneficial effects on organs such as the ovaries, the endometrium and the general well-being for many women. When prescribing a CHC for the first time or when changing to another preparation, one should always weigh up whether certain benefits justify prescribing a preparation with a slightly higher risk of thrombosis compared to the second-generation pill or preparations with Estradiol/Nomegestrolacetat. Women who are already using a third-generation pill or a pill with drospirenone or cyproterone acetate and feel comfortable with it do not need to switch to another preparation (provided no new risk factors have arisen). For women with increased risks, i.e. several relative contraindications or one absolute contraindication, safe alternatives to CHC include progestogen-only preparations, intrauterine devices containing copper or levonorgestrel or, after family planning has been completed, surgical methods (sterilisation/vasectomy).

[Immediate, medium- and long-term outcomes of percutaneous coronary intervention with very long drug eluting stent : An observational multicentric study]. / Les résultats immédiats, à moyen et à long terme de l'angioplastie coronaire par stent actif très long : à propos d'une étude multicentrique observationnelle.

INTRODUCTION: Very long coronary lesions account for 20% of coronary stenoses in the real world. There are few data on the effectiveness of angioplasty of these lesions with very long active stents (DES) in the literature. We conducted this study to assess the long-term outcomes of angioplasty with DES length ≥ 40 mm in a population with multiple cardiovascular risk factors. PATIENTS AND METHODS: This is a retrospective, multicenter, descriptive, and prognostic study, conducted between January 2015 and January 2020, in four Tunisian centers, including all patients who underwent angioplasty with a DES of length ≥ 40 mm with a follow-up of at least one year. The primary outcome was a combined criteria (major cardiovascular and Cerebral events: MACCE) (stroke, acute coronary syndrome, revascularization of the target lesion: TLR, cardiovascular death: CVD). RESULTS: We included 480 procedures. More than half of the patients had at least three risk factors. The prevalence of high blood pressure, diabetes and smoking were 61.1%, 56.6% and 60.4%, respectively. The treated lesions were complex: 23.54% calcified lesions, 8.75% chronic occlusions, 25% bifurcation lesions and 12.08% ostial lesions. The average length of the stents was 47.72 mm. We noted 17 cases of per-procedural complications (3.55%). The median follow-up was 35 months (extremes 1-60 months). The rate of stent thrombosis was 0.83%. The incidence of MACCE, TLR and CVD were respectively 16.25%, 8.12% and 5.2%. In multivariate analysis, diabetes (HR = 1.7, 95% CI [1.01-2.9]), dyslipidemia (HR = 2.08, 95% CI [1.3-3.3]), familial coronary artery disease (HR = 1.9, 95% CI [1.01-3.6]), left ventricle dysfunction (HR = 2.07, 95% CI [1.1-3.6]) and bifurcation lesions (HR = 1.9, 95% CI [1.2-3.14]) were the independent predictors of MACCE, while statin intake (HR = 0.38, 95% CI [0.19-0.78]) was a protective factor. CONCLUSION: Angioplasty with very long DES is associated with low levels of MACCE, TLR, stent thrombosis and CVD in our population. Therefore, it could be an interesting alternative to cardiac surgery. Randomized comparative studies of the two treatment options are needed.

[Vascular manifestations of Behcet's disease]. / Les complications vasculaires de la maladie de Behçet.

Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet.

[Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use]. / Prévention et prise en charge des thromboses associées au cancer: questions pratiques à propos de l'anticoagulation.

Cancer-associated thrombosis (CAT) is a common complication resulting from various vascular mechanisms related to cancer, antitumoral therapy and patient status, and is associated with a poor prognosis. Anticoagulants recommended for CAT treatment or prevention mainly include low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). Regarding thromboprophylaxis, a situation for which LMWH is a preferred option due to a lower risk of hemorrhage especially in patients with unresected gastro-intestinal and genito-urinary malignancies, the identification of patients at risk is a major issue. For patients with established CAT, the main issue is the choice of the most appropriate anticoagulant therapy. Because of the convenience of oral formulation, DOACs are an attractive option, and their efficacy has been shown in randomized trials. However, such studies are limited by selection biases, which make the analyzed population not representative of the real-life setting, as for instance cancers associated with a high risk of hemorrhage, or antitumoral therapies (e.g., tyrosine kinase inhibitors) known to interact with DOACs and then modifying their bioavailability. Caution associated with DOAC use is highlighted by most updated guidelines that recommend a case-by-case-based approach. The aim of the present paper is to help the oncologists make the most appropriate decision regarding the choice of anticoagulant therapy in a context of thromboprophylaxis or established CAT management in a patient with a solid tumor. The main issues are addressed through key practical questions, the answers of which are based on the current guidelines and additional published data or expert opinions.

Aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID- 19 au sein des hôpitaux militaires de Libreville et d'Akanda, Gabon / Epidemiology and clinical aspects of thrombotic manifestations during COVID-19 at the military hospitals of Libreville and Akanda, Gabon

Décrire les aspects épidémio-cliniques des manifestations thrombotiques au cours de la COVID-19 au sein des hôpitaux militaires de Libreville et Akanda, Gabon. Méthodes : Nous avons mené une étude rétrospective et descriptive multicentrique d'une durée de 7 mois, du 01er septembre 2021 au 31 mars 2022, portant sur les patients admis dans les unités de réanimation des hôpitaux d'instruction des armées de Libreville (HIAOBO) et d'Akanda (HIAA), pour COVID-19 documentée ou suspectée. Résultats : Durant la période d'étude, 167 patients ont été́ admis pour infection à SARS-CoV-2, parmi lesquels, 18 ont présentés des manifestations thromboemboliques (10,8%). La moyenne d'âge était de 54,7±6.4 ans. Il y avait une large prédominance masculine avec un sexe ratio à 2. Nous avons noté́ 9 cas d'embolie pulmonaire (50%), 5 cas d'accidents vasculaires cérébraux ischémiques (28%), 1 cas de thrombose veineuse profonde de membre inferieur (6%), 1 cas de thrombose veineuse cérébrale (6%), 1 cas de thrombose de la veine mésentérique (6%) et 1 cas de thrombose de la veine porte (6%). Les D-dimères étaient élevés chez tous les patients. Les globules blancs étaient élevés (>10000/mm3 ) chez 12 patients (67%). Les plaquettes étaient inférieures à 150000/mm3 pour 6 patients (33%). Tous les patients avaient une pneumonie à SARS-CoV-2 et la moyenne d'atteinte deslésions pulmonaires était estimée à 45%. Neuf patients étaient décédés (50%) au cours de l'hospitalisation. Conclusion : L'infection par le SARS-CoV-2 constitue vraisemblablement une prédisposition à la survenue d'un événement thrombotique. L'incidence des manifestations thrombotiques chez les patients atteints de COVID-19 reste élevée, renforçant ainsi la prescription systématique d'une anticoagulation prophylactique

[Livid Fingers after Respiratory Infection]. / Blaue Finger nach respiratorischem Infekt.

Livid Fingers after Respiratory Infection Abstract. A 53-year-old patient fell ill with SARS-CoV-2. She suffered from cough, headache and slight exertional dyspnoea. She was hospitalized for a short time as the dyspnoea increased. Two weeks after the first respiratory symptoms, the patient developed painful livid discoloration of the left terminal phalanges I-III. An occlusion of the arteria princeps pollicis and the arteria digitalis communis/propria of the left fingers II and III could be documented in the angiography. In addition to short-term lysis therapy with alteplase, the patient was therapeutically anticoagulated and received aspirin. An ilomedin (iloprost) therapy was carried out.

[Home treatment of low-risk pulmonary embolism patients : Efficacy and safety of an outpatient program including the general practitioner]. / Prise en charge ambulatoire des embolies pulmonaires à risque faible ; expérience d'une filière centrée sur le lien ville-hôpital.

AIM: Outpatient treatment (OT) of patients with low-risk pulmonary embolisms (PE) is recommended. A multidisciplinary OT program including the general practitioner (GP) has been implemented at Versailles hospital in 2019. The objectives of the study were to assess the feasibility, safety and acceptability of the program. MATERIAL AND METHODS: The feasibility of, and the inclusion criteria for OT were defined from a retrospective cohort study of PE patients carried out in 2018. In the prospective study, consecutive patients consulting in the emergency department between 2019 and 2021 with confirmed PE were eligible for OT if they had sPESI and HESTIA scores equal to 0, normal troponin and NT-pro-BNP levels, and no right ventricular dilation on imaging. PEs associated with COVID were excluded. The OT program included 4 appointments within 3 months, including 2 with the GP. Events (death, recurrence of PE or venous thromboembolism, bleeding, rehospitalisation) were collected at 3-month follow-up. RESULTS: In the retrospective study, 19% of the 138 PE patients seen in the emergency department were eligible for OT. No complication occurred at Day 90. In the prospective study, 313 consecutive patients with confirmed PE in the emergency department were included, 66 (21%) were eligible for OT. Overall, 43 patients (14%) received OT (39 eligible) and 27 patients eligible for OT were hospitalised (92% because of pulmonary infarction). At 3-month follow-up, there were no death, no recurrence of thromboembolism, and one patient has been early hospitalised for COVID; 3 female patients treated with rivaroxaban had minor bleeding (heavy menstrual bleeding). The satisfaction rate of general practitioner was 95%. CONCLUSIONS: This study confirms the feasibility and safety of our OT program for low-risk EP patients, centered on the general practitioner. It reduces the time spent in the emergency department, reduces hospitalisations and strengthens the city-hospital link for care.

[Postpartum ovarian vein thrombophlebitis: diagnosis, treatment and follow-up. Retrospective study over 10 years]. / Thrombophlébites pelviennes du post-partum : diagnostic, traitement et suivi. Etude rétrospective sur 10ans.

INTRODUCTION: Postpartum ovarian vein thrombosis (POVT) is a rare but serious postpartum complication that can be life-threatening due to its embolic and septic risks. The clinical and paraclinical diagnosis is difficult because of the non-specific signs and the absence of a gold standard for imaging. There is no consensus in the literature on the treatment and follow-up of these patients. The primary objective was to specify the clinical and paraclinical signs suggestive of POVT in order to improve the diagnostic delay. The secondary objectives were to describe the extent of POVT and the proposed immediate therapeutic management. METHODS: This was a 10-year retrospective study in a type III maternity hospital, from January 2010 to December 2019, where all patients with an imaging-confirmed diagnosis of POVT were included. We analysed the clinical and paraclinical data and the follow-up of the patients. RESULTS: We included 9 patients with a diagnostic confirmation by imaging. The mean time from first symptoms to diagnosis was 3.3 days (±3.5 days), and only 2 patients (22.2 %) had been diagnosed with POVT before imaging. All patients received curative anticoagulation and 77.8 % (n=7) received antibiotic therapy for POVT. Two patients had a complicated form, 1 with a pulmonary embolism and 1 with a urinary tract compression requiring a urinary diversion with a double J catheter. Five patients (55.6 %) had a thrombophilia check-up. CONCLUSION: The diagnosis of POVT is difficult and needs to be evoked in front of a painful symptomatology or a fever in postpartum. It can be made by ultrasound, but the injected CT scan specifying the specific search for a POVT remains the imaging examination of choice in order to confirm the diagnosis and eliminate differential diagnoses. Under curative anticoagulation and broad-spectrum antibiotic therapy, the clinical course is generally very favourable. A consultation with an internist makes it possible to define instructions for a subsequent pregnancy.

[Prevalence and etiological profiles of atypical localization venous thrombosis : A descriptive multicenter study]. / Prévalence et profils étiologiques des thromboses veineuses de localisation atypique : une étude multicentrique descriptive.

INTRODUCTION: Venous thrombosis of unusual sites is much rarer than in the lower limbs and requires a rigorous etiological approach. The objective was to describe the clinical and progressive peculiarities of unusual localization venous thrombosis as well as their etiologies. PATIENTS AND METHODS: Multicenter descriptive retrospective study of hospitalized patient records in the two large Hospital Centers, Antananarivo, Madagascar between 2017 and 2020 in which the diagnosis of unusual venous thrombosis was confirmed by imaging. RESULTS: Seventy-seven thrombosis of atypical localization were present in fifty-nine patients identified. These were 24 men and 35 women with an M/F sex ratio of 0.68. The mean age of our patients was 49.4 years (± 16.76). Thrombosis seated in the majority of cases in the portal veins (n ​​= 27), cerebral veins (n ​​= 20), vena cava (n = 10), splenic veins (n ​​= 5), upper limbs and splenomearic trunk (each n = 4), Renal vein (n = 3). Venous thrombosis had occurred following tobacco intoxication (n = 15 cases); bed rest (n = 10); surgical intervention (n = 4). The aetiological assessment revealed a neoplastic origin in 27 cases (45.77%) dominated by hepatocellular carcinoma (n = 13). the antiphospholipid antibody syndrome dominates the case of autoimmune causes (n = 4). In terms of mortality, there were no deaths during the initial hospitalization. Eight patients had died, 4 of them due to hepatocellular carcinoma, 2 after surgery, and 1 each due to kidney cancer and liver cirrhosis. The mean follow-up period was 34.03 ± 51.5 days. CONCLUSION: Unusual thrombosis, although rare, constitute a real challenge in the etiological approach. In clinical practice, the description of these thrombosis would allow us to understand their pathophysiological mechanism in order to plan the best management.

[Contribution of antiphosphatidylserine/prothrombin (anti-PS/PT) antibody detection in the diagnosis and management of antiphospholipid syndrome (APS)]. / Apport de la détection des anticorps antiphosphatidylsérine/prothrombine (aPS/PT) dans le diagnostic et la prise en charge du syndrome des antiphospholipides (SAPL).

Antiphospholipid syndrome (APS) is an autoimmune disease and one of the most common causes of acquired thrombophilia. It is characterised by the occurrence of thrombotic or obstetric events associated with the presence of persistent antiphospholipid antibodies. The diagnosis can be challenging, particularly because some biological tests can be disturbed by anticoagulant treatment or inflammation. In the recent years, new antiphospholipid antibodies, including anti-phosphatidylserine/prothrombin antibodies (anti-PS/PT), have emerged but their clinical significance and causality remain uncertain. Biologically, several studies have found a strong correlation between the presence of lupus anticoagulant (LA) and anti-PS/PT antibodies. Clinically, the presence of anti-PS/PT antibodies is associated with an increased risk of thrombosis and obstetric complications. There is also an association with thrombocytopenia, suggesting that the presence of anti-PS/PT antibodies may be associated with more severe clinical APS. Among seronegative APS patients, 6-17% of patients are positive for anti-PS/PT antibodies. This might influence the therapeutic management of patients. This article aims to provide an update on contribution of anti-PS/PT antibodies detection for the diagnosis and management of APS.

Post-traumatic cerebral venous sinus thrombosis associated with epidural hematoma: A challenging clinical situation.

Post-traumatic cerebral venous sinus thrombosis (ptCVST) is often associated with brain hemorrhage; consequently, the anticoagulation may be challenging. We report the case of a 42-year-old man who presented with post-traumatic epidural hematoma and rapidly developed transverse sinus thrombosis extending to the internal jugular vein. As the patient was asymptomatic, we decided not to use anticoagulants: close clinical and radiological monitoring was implemented. The hematoma resolved within 2 months, and the CVST diminished by the third month. Such a good outcome is not always the case in ptCVST. The present article also discusses pathophysiological mechanisms and treatment options when hematoma is associated with ptCVST.