Céline Genty

French National Centre for Scientific Research, Lutetia Parisorum, Île-de-France, France

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Publications (48)109.84 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectifs Devant un épisode isolé de maladie thromboembolique veineuse (MTEV), il est usuel de rechercher un néoplasie occulte. Cependant, aucun bénéfice en termes d’amélioration de la morbi-mortalité en lien avec cette pratique n’est démontré. Nous avons cherché à isoler un sous-groupe de patient pour lequel la question du dépistage de cancer vaut encore d’être posée après un épisode de MTEV. Matériel et méthode Nous avons utilisé les données de la cohorte OPTIMEV (étude prospective multicentrique) afin de rechercher un sous-groupe de patient à haut risque de cancer après un épisode de MTEV par un modèle de Cox regroupant les caractéristiques de l’événement thrombotique chez les patients de plus de 50 ans, puis en réalisant une stratification du risque par pondération des hazard ratios (HR) significatifs et en estimant le taux de cancer selon la classe. Résultats Trois mille quatre cent douze patients avec ou sans MTEV ont été suivis 3 ans avec 4,1 % de perdus de vue ; 4,66 % [3,67–5,83] des patients avec MTEV ont présenté un cancer durant le suivi. Le HR pour les patients de plus de 50 ans est de 11,1 [2,7–45,5] (p < 0,01). Parmi eux (n = 1169), la récurrence sous traitement anticoagulant (AC) (HR 6,6 [3,2–13,6] [p < 0,01]), la récurrence après arrêt des AC (HR 3,6 [1,9–6,7] [p < 0,01]), la thrombose veineuse profonde bilatérale (HR 1,9 [1,01–3,7] [p = 0,05]) ou idiopatique (HR 1,7 [1,1–2,8] [p = 0,02]) sont significativement associées à un sur-risque de cancer, permettant de définir 3 groupes de patients à risque faible (n = 597), intermédiaire (n = 525) ou élevé (n = 47) avec respectivement un taux de cancer de 3,4 % [2,5–5,1], 8,0 % [5,8–10,6] et 21,3 % [10,7–35,7]. Discussion La recherche systématique de néoplasie après un épisode isolé de MTEV n’ayant pas montré de bénéfice en termes de survie, il ne paraît pas justifié de proposer un dépistage autre que celui habituellement recommandé adapté à l’âge et au sexe. Mais en combinant les caractéristiques de la MTEV, on peut isoler un petit groupe de patients à très haut risque pour lequel un dépistage exhaustif pourrait être proposé. Conclusion Seul un petit sous-groupe de patients à très haut risque chez les patients de plus de 50 ans devrait faire l’objet d’études complémentaires afin d’évaluer s’il existe ou non un bénéfice à modifier la politique de dépistage en vigueur du fait de cet événement thromboembolique particulier.
    Journal des Maladies Vasculaires 10/2014; 39(5):331–332. · 0.24 Impact Factor
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    ABSTRACT: Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery.
    Thrombosis Research 05/2014; · 3.13 Impact Factor
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    ABSTRACT: To determine whether the addition of spa therapy to home exercises provides any benefit over exercises and the usual treatment alone in the management of generalised osteoarthritis associated with knee osteoarthritis. This study was a post-hoc subgroup analysis of our randomised multicentre trial (www.clinicaltrial.gov: NCT00348777). Participants who met the inclusion criteria of generalized osteoarthritis (Kellgren, American College of Rheumatology, or Dougados criteria) were extracted from the original randomised controlled trial. They had been randomised using Zelen randomisation. The treatment group received 18days of spa treatment in addition to a home exercise programme. Main outcome was number of patients achieving minimal clinically important improvement at six months (MCII) (≥-19.9mm on the VAS pain scale and/or ≥-9.1 points in a WOMAC function subscale), and no knee surgery. Secondary outcomes included the "patient acceptable symptom state" (PASS) defined as VAS pain ≤32.3mm and/or WOMAC function subscale ≤31 points. From the original 462 participants, 214 patients could be categorized as having generalised osteoarthritis. At sixth month, 182 (88 in control and 94 in SA group) patients, were analysed for the main criteria. MCII was observed more often in the spa group (n=52/94 vs. 38/88, P=0.010). There was no difference for the PASS (n=19/88 vs. 26/94, P=0.343). This study indicates that spa therapy with home exercises may be superior to home exercise alone in the management of patients with GOA associated with knee OA.
    Annals of physical and rehabilitation medicine 03/2014;
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    ABSTRACT: Introduction Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery. Patients and Methods Prospective, multicentre observational cohort study of 1134 consecutive patients with coronary stents undergoing non-cardiac surgery between April 2007 and April 2009. The primary outcome measure was the occurrence of an hemorrhagic complication during the first 30 days following the surgery or intervention. Results Among the 1134 patients evaluated, 108 (9.5%) experienced a postoperative hemorrhagic complication (with a median time to occurrence of 5.3 days). These complications were considered major, involved the operative site, and required reoperation in 92 (85.2%), 92 (85.2%), and 20 (18.5%) of patients, respectively. Mortality in patients with a haemorrhagic complication was 12% (n = 13). Independent postoperative factors associated with haemorrhagic complications were identified as a high and intermediate bleeding risk procedure and the use and dose of anticoagulants. When interrupted before the procedure, resumption of antiplatelet treatment was delayed in patients developing early postoperative hemorrhagic complications. Conclusion Patients with coronary stents who undergo surgery are at high risk for hemorrhagic complications.
    Thrombosis Research 01/2014; · 3.13 Impact Factor
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    ABSTRACT: Background Isolated distal deep-vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism (PE)) represents half of all lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence. Methods Using data from the OPTIMEV study, a prospective, observational, multicentre study, we compared, three years after an index VTE event and after discontinuation of anticoagulants, i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal deep-vein thrombosis (iPDVT); ii) predictors of recurrence after iDDVT. ResultsAs compared with patients with iPDVT (n=259), patients with an iDDVT (n=490) had a lower annualized incidence of overall VTE recurrence (5.2% [3.6-7.6] vs. 2.7% (95% CI) [1.9-3.8]) respectively, p=0.02) but a similar incidence of PE recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6] respectively, p=0.83). An Age>50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, this latter being then ≥3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence. Conclusion After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than patients with iPDVT, but a similar risk of serious recurrent VTE. Age>50, unprovoked iDDVT, and number of thrombosed veins (>1) influenced the risk of recurrence and may help to define patients at significant risk of recurrence.This article is protected by copyright. All rights reserved.
    Journal of Thrombosis and Haemostasis 01/2014; · 6.08 Impact Factor
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    ABSTRACT: Introduction The diagnosis of deep vein thrombosis (DVT) in pregnant women remains a challenge for physicians. The ‘LEFt’ clinical decision rule was recently derived, that might help in estimating the pretest probability of DVT during pregnancy. Our aim was to externally validate the LEFt clinical decision rule among pregnant women included in the OPTIMEV study. Materials and Methods The OPTIMEV study is a diagnostic and epidemiologic study that included patients with suspected VTE between November 2004 and January 2006. All patients underwent standardized clinical data collection, and a bilateral whole-leg venous ultrasonography. A 3-month follow-up was performed in all patients with confirmed VTE, and in a randomly selected subsample of patients with negative diagnostic workup. Results Of the 8,256 included patients, 96 were pregnant women. A DVT was diagnosed at CUS in 9 women (9.4%). The LEFtscore was computed in all but 7 women with missing values: one point in case of left (‘L’) leg suspicion, one point for edema (‘E’) and one point if the suspicion occurred during the first trimester (‘Ft’) of pregnancy. Prevalence of confirmed DVT was as follows: 1/30 (3%) in women with no LEFt criteria, 3/35 (9%), 2/20 (10%), and 3/4 (75%) in women with 1, 2 and 3 points, respectively. Conclusions Our results confirm the ability of the LEFt rule to estimate the pretest probability of DVT. Future studies are required to prospectively validate these findings and to define the role of the rule in a diagnostic algorithm for DVT during pregnancy.
    Thrombosis Research 01/2014; · 3.13 Impact Factor
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    ABSTRACT: Background. Infections are risk factors for venous thromboembolism, especially if severe and acute. The role of chronic infections such as active tuberculosis is ill-defined, although several case reports and small series have suggested an association between tuberculosis and venous thromboembolism. Methods. Using data from the Premier Perspective(TM) database (27,659,947 admissions) we performed a multivariate analysis to assess the specific venous thromboembolism risk associated with tuberculosis. The analysis was adjusted on classical risk factors for venous thromboembolism. Results. The prevalence of venous thromboembolism among the patients with active tuberculosis was 2.07% (1.62-2.59). In a multivariate analysis model, adults with active tuberculosis had a greater risk of venous thromboembolism than those without (OR=1.55, 1.23-1.97, p<0.001), close to the previously reported risk associated with neoplasia. No particular link was found between pulmonary tuberculosis and pulmonary embolism, or between extra-pulmonary tuberculosis and deep vein thrombosis. This may suggest the preponderant role of a systemic hypercoagulable state over an intrathoracic venous compression mechanism. In-hospital mortality of patients with both active tuberculosis and venous thromboembolism (11/72, 15%) was higher than mortality of patients with only active tuberculosis (92/3413, 2.7%) or only venous thromboembolism (5062/199480, 2.5%) (p<0.001). Pulmonary embolism was more frequent in black patients, suggesting that this population, which is also more likely to suffer from tuberculosis, should be followed carefully. Conclusion. Tuberculosis must be considered as a pertinent risk factor for venous thromboembolism and should be included in thromboembolism risk evaluation as any acute and severe infection.
    Clinical Infectious Diseases 11/2013; · 9.37 Impact Factor
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    ABSTRACT: Apart from compression therapy, physical therapy has scarcely been evaluated in the treatment of chronic venous disorders (CVDs). Spa treatment is a popular way to administer physical therapy for CVDs in France, but its efficacy has not yet been assessed in a large trial. The objective was to assess the efficacy of spa therapy for patients with advanced CVD (CEAP clinical classes C4-C5). This was a single-blind (treatment concealed to the investigators) randomized, multicenter, controlled trial (French spa resorts). Inclusion criteria were primary or post-thrombotic CVD with skin changes but no active ulcer (C4a, C4b, or C5). The treated group had the usual 3-week spa treatment course soon after randomization; the control group had spa treatment after the 1-year comparison period. All patients continued their usual medical care including wearing compression stockings. Treatment consisted of four balneotherapy sessions/d, 6/7 days. Follow-up was performed at 6, 12 and 18 months by independent blinded investigators. The main outcome criterion was the incidence of leg ulcers at 12 months. Secondary criteria were a modified version of the Venous Clinical Severity Score, a visual analog scale for leg symptoms, and the Chronic Venous Insufficiency Questionnaire 2 and EuroQol 5D quality-of-life autoquestionnaires. Four hundred twenty-five subjects were enrolled: 214 in the treatment group (Spa) and 211 in the control group (Ctr); they were similar at baseline regarding their demographic characteristics, the severity of the CVD, and the outcome variables. At 1 year, the incidence of leg ulcers was not statistically different (Spa: 9.3%; 95% confidence interval [CI], 5.6-14.3; Ctr: 6.1%; 95% CI, 3.2-10.4), whereas the Venous Clinical Severity Score improved significantly in the treatment group (Spa: -1.2; 95% CI, -1.6 - -0.8; Ctr: -0.6; 95% CI, -1.0 - -0.2; P = .04). A significant difference favoring spa treatment was found regarding symptoms after 1 year (Spa: -0.03; 95% CI, -0.57 - +0.51; Ctr: +0.87; 95% CI,+0.46 - +1.26; P = .009). EuroQol 5D improved in the treatment group (Spa: +0.01; 95% CI, -0.02 - +0.04) while it worsened (Ctr: -0.07; 95% CI, -0.10 - -0.04) in the control group (P < .001). A similar pattern was found for the Chronic Venous Insufficiency Questionnaire 2 scale (Spa: -2.0; 95% CI, -4.4 - +0.4; Ctr: +2.4; 95% CI, +0.2 - 4.7; P = .008). The control patients showed similar improvements in clinical severity, symptoms, and quality of life after their own spa treatment (day 547). In this study, the incidence of leg ulcers was not reduced after a 3-week spa therapy course. Nevertheless, our study demonstrates that spa therapy provides a significant and substantial improvement in clinical status, symptoms, and quality of life of patients with advanced venous insufficiency for at least 1 year.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2013; · 3.52 Impact Factor
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    ABSTRACT: The early diagnosis of pelvic arterial haemorrhage is challenging for initiating treatment by transcatheter arterial embolization (TAE) in multiple trauma patients. We use an institutional algorithm focusing on haemodynamic status on admission and on a whole-body CT scan in stabilized patients to screen patients requiring TAE. This study aimed to assess the effectiveness of this approach. This retrospective cohort study included 106 multiple trauma patients admitted to the emergency room with serious pelvic fracture [pelvic abbreviated injury scale (AIS) score of 3 or more]. Of the 106 patients, 27 (25%) underwent pelvic angiography leading to TAE for active arterial haemorrhage in 24. The TAE procedure was successful within 3h of arrival in 18 patients. In accordance with the algorithm, 10 patients were directly admitted to the angiography unit (n=8) and/or operating room (n=2) for uncontrolled haemorrhagic shock on admission. Of the remaining 96 stabilized patients, 20 had contrast media extravasation on pelvic CT scan that prompted pelvic angiography in 16 patients leading to TAE in 14. One patient underwent a pelvic angiography despite showing no contrast media extravasation on pelvic CT scan. All 17 stabilized patients who underwent pelvic angiography presented a more severely compromised haemodynamic status on admission, and they required more blood products during their initial management than the 79 patients who did not undergo pelvic angiography. The incidence of unstable pelvic fractures was however comparable between the two groups. Overall, haemodynamic instability and contrast media extravasation on the CT-scan identified 26 out of the 27 patients who required subsequent pelvic angiography leading to TAE in 24. An algorithm focusing on haemodynamic status on arrival and on the whole-body CT scan in stabilized patients may be effective at triaging multiple trauma patients with serious pelvic fractures.
    Injury 07/2013; · 1.93 Impact Factor
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    ABSTRACT: Objective Assessment of cancer screening in the context of venous thromboembolic disease (VTE) remains controversial. We tried to characterize a population at high risk of developing cancer among patients suffering from VTE. Method We conducted a retrospective ancillary case-control study among patients with VTE who later had a positive diagnosis of cancer. We assessed the association of cancer with characteristic features of VTE and with the results for four biological markers. Results Our population included 142 patients (53% men, median age 71 years). Two years after VTE, 24 patients (17%) had cancer. Median values for D-dimers, fibrin monomers and SP-selectin were significantly higher among patients who developed cancer. Logistic regression enabled us to identify two parameters targeting patients with a high risk of cancer: bilateral venous thrombosis (OR: 4.41, 95%CI: 1.41–13.78, P = 0.01) and D-dimers superior to 3.8 μg/mL (OR: 3.68, 95%CI: 1.36–9.94, P = 0.01). The information provided by these two characteristics was additive; 58% of patients in our population who had both factors developed cancer. Conclusion Bilateral venous thrombosis and D-dimers superior to 3.8 μg/mL are highly associated with carcinoma. This result requires a prospective validation. It could be useful in limiting the screening process to the population most at risk.
    Journal des Maladies Vasculaires 05/2013; 38(3):172–177. · 0.24 Impact Factor
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    ABSTRACT: CONTEXT: Pupillary reflex dilation appears to be a reliable indicator of response to noxious stimulation even under general anaesthesia. The ability of pupillometry to detect the effects of extremity blocks during continuous infusion of opioids remains unknown. OBJECTIVE: To explore the performance of pupillometry to detect differences in pupillary reflex dilation response to a standardised noxious stimulus applied to each leg following unilateral popliteal sciatic nerve block during continuous infusion of remifentanil. DESIGN: Prospective, observational study. SETTING: University hospital anaesthesia department, between June 2010 and December 2010. PATIENTS: Twenty-four adult patients undergoing elective foot or ankle surgery under general anaesthesia who requested a peripheral nerve block. Unilateral popliteal sciatic nerve block with 0.75% ropivacaine and 1% lidocaine was performed awake. General anaesthesia was maintained with steady-state infusions of propofol and remifentanil. MAIN OUTCOME MEASURE: Video-based pupillometer was used to determine pupillary reflex dilation during tetanic stimulation (60 m, 100 Hz) applied to the skin area innervated by the sciatic nerve for 5 s after the onset of general anaesthesia. RESULTS: Sensory nerve block led to a blunted maximal pupillary reflex dilation response to noxious stimulation compared with the non-blocked leg: median (interquartile range) change from baseline 2% (1 to 4%) versus 17% (13 to 24%), respectively (P < 0.01). The differences in the response persisted throughout the 5-s stimulus and the recovery phase. CONCLUSION: These results are a proof of concept. The effects of peripheral nerve block can be detected via the measurement of pupillary reflex dilation response to noxious stimulation of the skin in patients receiving remifentanil.
    European Journal of Anaesthesiology 04/2013; · 2.79 Impact Factor
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    ABSTRACT: PURPOSE: We searched for factors independently associated with the prescription of multimodal (balanced) analgesia in mechanically ventilated critically ill patients. METHODS: In this post hoc analysis of a cohort study, 172 patients who received a combination of 1 opioid with nonopioids, that is, paracetamol and/or nefopam, (multimodal analgesia), were compared with 302 patients who received opioid only on day 2 of their stay in the intensive care unit. RESULTS: Patients given multimodal analgesia were more likely to have fewer organ failures and received fewer hypnotics compared with patients who received opioid only. They self-reported more frequently their pain level. There were no differences in the daily dose of opioids between the 2 groups. A low illness severity score, no more than 1 organ failure on day 2, the ability to self-rate pain, and a moderate-to-severe pain rated on day 2 were factors independently associated with the prescription of multimodal analgesia on day 2 (all P < .01). CONCLUSIONS: In mechanically ventilated patients, the addition of nonopioids to opioids is mostly prescribed for patients with lower illness severity scores and who are able to self-rate their pain intensity. These findings suggest that the concept of multimodal analgesia must be promoted in the intensive care unit.
    Journal of critical care 03/2013; · 2.13 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):109. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):110. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):110. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):117. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):124. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):109. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 09/2012; 37(5):262–263. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 09/2012; 37(5):266–267. · 0.24 Impact Factor

Publication Stats

411 Citations
109.84 Total Impact Points

Institutions

  • 2012–2014
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2010–2014
    • University of Grenoble
      Grenoble, Rhône-Alpes, France
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 2007–2011
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France