Hémorragie bilatérale des surrénales sous apixaban dans le syndrome primaire des antiphospholipides

Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome.We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in 53-year-old women treated by apixaban for previous venous thromboembolism.     

Le coronarien âgé : un patient à haut risque hémorragique

Bleeding complications are frequent in coronary artery disease patients and are associated with increased mortality. Among clinical factors increasing the risk of bleeding, age appears to be a major determinant, whatever the clinical presentation (stable disease, acute coronary syndrome, PCI). Evidence of the role of age comes from the weight given to age in most existing bleedingrisk scores.     

Choc hémorragique révélant des micro-anévrismes digestifs au cours du lupus : cas clinique et revue de la littérature

Introduction

The vascular disorders in systemic lupus erythematosus (SLE) result from various mechanisms and presentations (inflammatory disease or vasculitis, atherosclerosis).

L’ulcère bulbaire hémorragique et les anti-inflammatoires non stéro?diens : quelle gravité de l’accident hémorragique ?

Introduction

Non steroidal anti inflammatory drugs (NSAIDs) are among the most prescribed and used drugs, because of their therapeutic efficacy in multiple epidemiological indication. Severity of the bleeding in the case of duodenal ulcer would be different between the group of patients taking NSAIDs and those not taking NSAIDs before bleeding complication.

Materials and methods

We propose to study the group of patients admitted for bleeding peptic ulcer (BPU) with NSAIDs and to compare it to the group without NSAIDs. Four hundred and twenty eight patients were admitted during this period for bleeding duodenal ulcer.

Results

The NSAID previous hemorrha 29.5% of patients (n=126). There was no statistically significant difference between the group taking NSAID (n=126) and NSAIDs negative (n=302) in terms of average age (45.4 vs 45 respectively). There is a clear male predominance compared in the 2 groups. There was no statistically significant difference in terms of average rate of Hte, endoscopic data (seat of the ulcer, stage Forrest, endoscopic hemostasis). The surgery was no more frequent in cases of BPU associated with NSAID Furthermore, patients who used NSAIDs had more frequent initial hemodynamic instability (4 patients vs 1, p=0.01), recurred more frequently (8.7% vs 4%, p=0.04) and there was trend to more death in the group with NSAID.

Conclusion

The episode of bleeding from peptic ulcer associated with NSAID use was more severe     

La thrombopénie induite par héparine : mise au point

Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy. It is due to the synthesis of antibodies most often directed against platelet factor 4 (FP4) modified by heparin (H). HIT is manifested by a platelet count fall, associated with a high risk of venous or arterial thrombosis. The diagnosis of HIT is based on the assessment of clinical probability (4Ts score or change in platelet count after cardiac surgery) and the demonstration of heparin-modified anti-FP4 antibodies (FP4/H). If the immunological tests are positive, functional tests should be performed. In case of suspicion of HIT, it is necessary to urgently stop heparin therapy, to perform a doppler ultrasound of the lower limbs, and to prescribe an alternative anticoagulation agent at a curative dose. Currently, danaparoid sodium and argatroban are authorized. The diagnosis and management of HIT remain complex and requires multidisciplinary collaboration.     

Allergie au latex : pertinence des mesures d’éviction

Complete latex avoidance is the most effective approach for treatment of latex allergy. Alternatives to latex gloves and other articles include chemical processes as well as synthetic rubber or other synthetic materials. These may be suited for certain uses only, depending on their respective physical properties. Global preventive strategies are based on current knowledge and a common-sense approach to minimizing latex allergy. Undue latex exposure should be reduced by the use of non-latex materials when there is little potential for contact with infectious agents. When latex is required, reduced-protein, powder-free latex gloves must be chosen. Education and information programs, improvement of ventilation procedures, frequent cleaning of contaminated areas, and training devices about latex allergy are usually recommended. However, detection of high-risk patients or workers must be discussed in relation to the background.