학술논문
Antiplatelet and anticoagulant therapies in hereditary hemorrhagic telangiectasia: A large French cohort study (RETROPLACOTEL).
Document Type
Academic Journal
Author
Grobost V; Service de Médecine Interne, Clermont-Ferrand University Hospital, CHU Estaing, 63000 Clermont-Ferrand, France. Electronic address: vgrobost@chu-clermontferrand.fr.; Hammi S; Department of Internal Medicine, Angers University Hospital, 49100 Angers, France.; Pereira B; Biostatistics Unit, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France.; Guilhem A; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France.; Duffau P; Bordeaux University Hospital, Internal Medicine and Clinical Immunology Department, Université de Bordeaux, CNRS ImmunoConcEpT UMR 5164, 33000 Bordeaux, France.; Seguier J; Département de Médecine Interne, Marseille University Hospital, 13000 Marseille, France.; Parrot A; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie et Centre de Compétence de la Maladie de Rendu Osler, Hôpital Tenon, 75020 Paris, France.; Gautier G; Nantes Université, Nantes University Hospital, Department of Internal and Vascular Medicine, 44000 Nantes, France.; Alric L; Internal Medicine-Digestive Medicine, CHU Rangueil Toulouse 3 University, 31000 Toulouse, France.; Kerjouan M; Service de Pneumologie, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France.; Le Guillou X; Medical Genetics Department, University Hospital of Poitiers, 86000 Poitiers, France.; Simon D; Service de Médecine Interne, CHU Charles Nicolle, 76000 Rouen, France.; Chaussavoine L; Centre Hospitalier Universitaire de Caen Normandie, Service de Médecine Vasculaire, 14000 Caen, France.; Rondeau-Lutz M; Service de Médecine Interne, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67 091 Strasbourg cedex, France.; Leguy-Seguin V; Department of Internal Medicine, CHU François Mitterrand, 21000 Dijon, France.; Delagrange L; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France.; Lavigne C; Department of Internal Medicine, Angers University Hospital, 49100 Angers, France.; Maillard H; Department of Internal Medicine and Clinical Immunology, Referral Centre for rare systemic autoimmune diseases for North and North-West France (CeRAINO), CHU Lille, 59000, Lille, France.; Dupuis-Girod S; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France.
Source
Publisher: Pergamon Press Country of Publication: United States NLM ID: 0326377 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-2472 (Electronic) Linking ISSN: 00493848 NLM ISO Abbreviation: Thromb Res Subsets: MEDLINE
Subject
Language
English
Abstract
Background: It is unclear whether hereditary hemorrhagic telangiectasia (HHT) patients can tolerate antithrombotic therapies (AT) including antiplatelet (AP) and/or anticoagulant (AC) agents.
Objectives: Primary endpoint was tolerance to AT in HHT. Secondary endpoints were to identify factors associated with major bleeding events (MBE) and premature discontinuation of AT.
Methods: Retrospective multicenter study in French national HHT Registry patients exposed to AT.
Results: We included 126 patients with 180 courses of AT. Median follow-up was 24 [11-52] months. Mean age was 65.6 ± 13.1 years. The first 3 months of AT exposure had an increased risk of hospitalization for hemorrhage (p < 0.001) and transfusions (p < 0.001). MBE (n = 63) occurred more frequently in the first 3 months of AT exposure (p < 0.001). Premature discontinuation of AT occurred in 61 cases. Rate of premature discontinuation was 29 % under both AP and AT therapy but significantly higher under dual AP therapy (n = 4/7, 57 % p = 0.008). Risk factors for MBE were: age ≥ 60 years (HR 2.34 [1.12;4.87], p = 0.023), prior hospitalization in the 3 months before starting AT for hemorrhage (HR 3.59 [1.93;6.66], p < 0.001) or transfusion (HR 3.15 [1.61;6.18], p = 0.001), previous history of gastro-intestinal bleeding (HR 2.71 [1.57;4.65], p < 0.001) or MBE (HR 4.62 [2.68;7.98], p < 0.001). Frequency of MBE did not differ between groups except for a higher risk in the dual AP group (HR 3.92 [1.37;11.22], p = 0.011).
Conclusion: Tolerance of AC or AP therapy was similar in HHT population but not dual AP therapy. We identified risk factors for MBE occurrence or premature discontinuation under AT.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Only one author have potential conflict of interest: L. Chaussavoine with ASPEN, Léo Pharma, Bayer Healthcare.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Objectives: Primary endpoint was tolerance to AT in HHT. Secondary endpoints were to identify factors associated with major bleeding events (MBE) and premature discontinuation of AT.
Methods: Retrospective multicenter study in French national HHT Registry patients exposed to AT.
Results: We included 126 patients with 180 courses of AT. Median follow-up was 24 [11-52] months. Mean age was 65.6 ± 13.1 years. The first 3 months of AT exposure had an increased risk of hospitalization for hemorrhage (p < 0.001) and transfusions (p < 0.001). MBE (n = 63) occurred more frequently in the first 3 months of AT exposure (p < 0.001). Premature discontinuation of AT occurred in 61 cases. Rate of premature discontinuation was 29 % under both AP and AT therapy but significantly higher under dual AP therapy (n = 4/7, 57 % p = 0.008). Risk factors for MBE were: age ≥ 60 years (HR 2.34 [1.12;4.87], p = 0.023), prior hospitalization in the 3 months before starting AT for hemorrhage (HR 3.59 [1.93;6.66], p < 0.001) or transfusion (HR 3.15 [1.61;6.18], p = 0.001), previous history of gastro-intestinal bleeding (HR 2.71 [1.57;4.65], p < 0.001) or MBE (HR 4.62 [2.68;7.98], p < 0.001). Frequency of MBE did not differ between groups except for a higher risk in the dual AP group (HR 3.92 [1.37;11.22], p = 0.011).
Conclusion: Tolerance of AC or AP therapy was similar in HHT population but not dual AP therapy. We identified risk factors for MBE occurrence or premature discontinuation under AT.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Only one author have potential conflict of interest: L. Chaussavoine with ASPEN, Léo Pharma, Bayer Healthcare.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)