A. Delluc

University of Ottawa, Ottawa, Ontario, Canada

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Publications (63)128.81 Total impact

  • A. Delluc
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    ABSTRACT: Entre 20 et 50 % des patients vont développer un syndrome post-thrombotique (SPT) dans les 2 années suivant la survenue d’un épisode de thrombose veineuse profonde des membres inférieurs. Cette imprécision de l’incidence du SPT s’explique par le fait que sa définition diffère d’une étude à l’autre. Les symptômes du SPT sont en effet très divers et varient d’un simple inconfort à des manifestations plus sévères comme des douleurs chroniques des membres inférieurs, un œdème ou des modifications cutanées pouvant conduire à un ulcère. Actuellement, l’échelle de Villalta est l’outil recommandé pour évaluer si un patient présente un SPT. La physiopathologie du SPT n’est pas entièrement connue ; elle résulte probablement de l’interaction entre la détérioration des valvules veineuses par la thrombose, de la présence d’un thrombus résiduel et d’une atteinte de la microcirculation par la persistance d’une hypertension veineuse. L’identification des facteurs de risque de SPT est variable dans la littérature. Ceci est lié aux différents schémas d’étude, à la population incluse, au type de prise en charge, aux critères d’évaluation et la durée du suivi. La récidive ipsilatérale de la thrombose veineuse profonde est le facteur de risque clinique le plus souvent associé au SPT. Le risque de SPT paraît plus important lorsque la thrombose est proximale, en particulier lorsqu’elle implique la veine iliaque ou la veine fémorale commune. L’obésité, la présence d’un thrombus résiduel ou d’un reflux poplité ou une anticoagulation initiale inadéquate sont inconstamment associées à une augmentation du risque de SPT. Des marqueurs biologiques de l’inflammation (CRP) ou de la dégradation de la fibrine (D-dimères) pourraient être associés à la présence du SPT. La présence d’une anomalie au bilan de thrombophilie et les circonstances de survenue de la thrombose veineuse profonde ne semblent pas associées à la survenue du SPT. Actuellement, aucun élément clinique ou biologique n’est disponible pour clairement identifier les patients qui développeront un SPT.
    Journal des Maladies Vasculaires 10/2014; 39(5):318. · 0.24 Impact Factor
  • A Delluc, M Carrier, G Meyer, G Le Gal
    La Revue de medecine interne / fondee ... par la Societe nationale francaise de medecine interne. 08/2014;
  • A Delluc, M Carrier
    Current oncology (Toronto, Ont.). 08/2014; 21(4):163-4.
  • Aurelien Delluc, Philip S Wells
    Evidence-based medicine. 06/2014;
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    ABSTRACT: The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy. A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months. Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07-2.13). A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of "one segmental or two subsegmental mismatches" appears safe to exclude PE.
    European Journal of Nuclear Medicine 04/2014; · 4.53 Impact Factor
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    ABSTRACT: The clinical importance of tumor thrombus in patients with renal cell carcinoma is unknown. We sought to determine the long-term risk of venous thromboembolism (VTE) in patients with residual tumor thrombus post-extraction and to evaluate the impact of residual tumor thrombus on overall survival. A cohort study of patients with stage III-IV renal cell carcinoma undergoing nephrectomy was undertaken. The primary endpoint was the risk of VTE during a 2 year follow-up period. The secondary endpoint was 2 year overall survival. A total of 170 surgical renal cell carcinoma patients were included, of them 97 (57.1%) had tumor thrombus. Patients with residual tumor thrombus following surgery had a higher risk of developing VTE than those with complete tumor thrombus resection (Hazard Ratio (HR): 8.7; 95% CI: 1.7 to 43.4), and no tumor thrombus (HR: 6.5; 95% CI: 1.7 to 24.7). Patient with residual tumor thrombus did not have worse overall survival compared to those with tumor thrombus completely resected or those without tumor thrombus. The presence of residual tumor thrombus is an important risk factor for VTE among renal cell carcinoma patients This article is protected by copyright. All rights reserved.
    Journal of Thrombosis and Haemostasis 04/2014; · 6.08 Impact Factor
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    ABSTRACT: Past reports have suggested that antiphospholipid (aPL) antibodies may emerge as a response to antipsychotics treatment, as a high prevalence of aPL antibodies in antipsychotics users has been observed. However, no control group of non-medicated psychiatric patients was included in these reports. In a cross sectional study we determined the prevalence of aPL antibodies in 333 psychiatric inpatients. We compared the proportions of positive aPL antibodytests between users and non-users of antipsychotics with adjustments for potential confounders. The proportion of antipsychotics users carrying at least one aPL antibody ranged from 10·8% to 27·0% compared with 6·8% to 27·2% in non-users (P = 0·24, P = 0·24) depending on the method of detection of lupus anticoagulant (LA). The prevalence of LA detected by dilute Russell viper venom time or partial thromboplastin time-LA was not different between antipsychotics users and non-users (8·1% vs. 5·4%, P = 0·53 and 18·4% vs. 18·2%, P = 0·22), as well as the prevalence of IgM and IgG anti-β2-glycoprotein-I antibodies, IgM and IgG anti-cardiolipin antibodies(3·8% vs. 2·0%, P = 0·75, 0·0% vs. 0·0%, P = not applicable, 1·1 vs. 1·4%, P = 0·91, 2·7% vs. 3·4%, P = 0·71). In conclusion, aPL antibodies were frequently found in patients with psychiatric diseases and no significant increase in the prevalence of aPL antibodies was observed in antipsychotics users.
    British Journal of Haematology 01/2014; 164(2):272-9. · 4.94 Impact Factor
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    ABSTRACT: Background The bariatric surgical population is a particularly high risk population for VTE. It is unclear if standard (i.e. non-adjusted) thromboprophylaxis doses of low-molecular weight or unfractionated heparin provide adequate protection for obese patients undergoing bariatric surgery, or if higher doses are required. We sought to determine whether a weight based thromboprophylactic dosing regimen is safe and effective in the post-operative period for obese patients undergoing bariatric surgery. Methods A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated. Results A total of 6 studies (1 RCT, 4 cohort studies and one quasi experimental trial) containing 1,858 patients were include in the systematic review. Post bariatric surgery patients receiving weight-adjusted prophylactic doses of heparin products, had an in hospital rate of VTE of 0.54% (95% CI: 0.2 to 1.0%) compared to 2.0% (95% CI: 0.1 to 6.4%) for those that did not weight adjust doses. Rates of major bleeding were similar for both groups: 1.6% (95% CI: 0.6 to 3.0%) for patients receiving weight-adjusted dosing compared to 2.3% (95% CI: 1.1% to 3.9%) for those receiving standard doses of heparin products. Conclusions Adjusting the dose of heparin products for thromboprophylaxis post-bariatric surgery seems to be associated with a lower rate of in hospital VTE compared to a strategy of not adjusting the dose, although this did not reach statistical significance. This practice does not lead to an increase in adverse major bleeding events.
    Thrombosis Research 01/2014; · 3.13 Impact Factor
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    ABSTRACT: Introduction Patients with cancer-associated thrombosis are at a high risk of developing recurrent events despite anticoagulant therapy. Escalation of the dose of low molecular weight heparin (LMWH) has been suggested as a potential treatment option to manage these patients. We sought to confirm the benefit and risk of this management strategy in patients with recurrent cancer-associated thrombosis. Material and Methods A retrospective cohort study of consecutive cancer outpatients seen for management of a symptomatic recurrent cancer-associated thrombosis while on anticoagulation was undertaken. Objectively confirmed episodes of recurrent thrombosis were treated with either dose escalation of LMWH or initiation of therapeutic dose of LMWH in patients already anticoagulated with LMWH or vitamin K antagonist (VKA) respectively. Included patients were followed for a minimum of 3 months after the index recurrent event. Results Fifty-five cancer patients with a recurrent venous thromboembolism (VTE) despite anticoagulation were included. At the time of the recurrence, 89% of patients were on LMWH. The median time between the initial cancer-associated thrombosis to the index recurrent event was 2.3 months (range 0.1 to 30.4 months). Four patients (7.3%; 95% CI: 2.0 to 17.6%) had a second recurrent VTE during the 3-month follow-up period. Three patients (5.5%; 95% CI 1.1 to 15.1%) had major bleeding complications after dose escalation of LMWH. There were no recurrent fatal VTE or major bleeding episodes. Conclusion Escalating the dose of LMWH seems effective and safe for managing patients with recurrent cancer-associated thrombosis despite anticoagulant therapy.
    Thrombosis Research 01/2014; · 3.13 Impact Factor
  • La Revue de Médecine Interne. 01/2014;
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    ABSTRACT: Shared risk factors help explain the association between venous thromboembolism (VTE) and atherothrombosis. The potential association between insulin resistance and VTE has been poorly evaluated. Thus, we aimed to assess the association between insulin resistance and VTE in the EDITH hospital-based case-control study. Between May 2000 and December 2004, 677 patients with unprovoked VTE and their age- and sex-matched controls were included. Fasting glycaemia and insulinaemia were measured and insulin resistance was estimated with the homeostasis model assessment of insulin resistance (HOMA-IR) equation. The association between HOMA-IR and VTE was determined in non-diabetic patients in a quintile-based analysis. A total of 590 non-diabetic cases (median age 73.0 years, 255 men) and 581 non-diabetic controls (median age 72.0 years, 247 men) were analysed. There was a trend for a higher median level of HOMA-IR index in cases than in controls (1.21 [interquartile range 0.84-2.10] vs1.19 [interquartile range 0.72-2.02], p=0.08). The unadjusted analysis showed an increased risk of unprovoked VTE associated with increasing HOMA-IR (odds ratio [OR] 1.53; 95% confidence interval [CI] 1.00-2.34 for the highest quintile of HOMA-IR compared with the first quintile). Adjustment for lipid lowering drugs and antiplatelet agents use slightly modified the association (OR 1.51; 95% CI 0.97-2.34). When body mass index was added in the adjusted model, HOMA-IR was no longer associated with VTE (OR 1.08; 95% CI 0.67-1.73). Our results highlight the role of body mass index in the association between cardiovascular risk factors and VTE.
    Thrombosis and Haemostasis 06/2013; 110(3). · 5.76 Impact Factor
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    ABSTRACT: The risk of recurrent venous thromboembolism (VTE) in young women after a first oestrogen contraception associated VTE episode is unknown. This uncertainty has an impact on the decision whether to stop anticoagulant treatment. Our objective was to assess the risk of recurrent VTE in women after a first VTE episode on oestrogen contraception. This was a prospective cohort study in which we consecutively enrolled between 1992 and 2011 all women under 50years with a first objectively confirmed VTE. The incidence of recurrent VTE during follow-up after stopping anticoagulation was compared between women users and non-users of combined oral contraception (COC) at the time of index VTE. Of the 241 women aged 50 or younger seen for a first VTE and followed-up after stopping anticoagulation, there were 180 COC-users and 61 non-users. Median duration of follow-up off-anticoagulants was 66months (interquartile range: 33-103). There were 14 recurrences in COC-users and 5 cases in non-users. No significant association was found between exposure to COC and the incidence of recurrent VTE after adjustment for age or after restricting the analysis to major unprovoked VTE: incidence rate of recurrence 17.9/1,000/year (95% CI: 9.6-33.2) in women with COC as compared with 17.6/1,000/year (95% CI: 6.6-47) with an incidence ratio of 0.7 (95% CI: 0.2-2.4, p=0.59). The risk of recurrent VTE is low in young women after a first VTE. However, this risk is not significantly lower in women after a first VTE while exposed to combined oral contraception.
    Thrombosis Research 06/2013; · 3.13 Impact Factor
  • Médecine Nucléaire. 05/2013; 37(5):151.
  • Médecine Nucléaire. 05/2013; 37(5):143.
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    ABSTRACT: Ventilation-perfusion (V/Q) SPECT has been reported to improve the diagnostic performance of V/Q imaging for the diagnosis of pulmonary embolism (PE). However, only sparse data based on an objective reference test are available, and the criteria used for interpretation have varied widely. Therefore, the aim of our study was to assess the performance of V/Q SPECT using various criteria for interpretation, in comparison with a validated independent diagnostic strategy. METHODS: The SPECT study included patients for whom V/Q SPECT data were compared with the results of an independent and validated diagnostic algorithm for PE. V/Q SPECT scans were performed after intravenous injection of (99m)Tc-macroaggregated albumin and simultaneous ventilation with (81m)Kr gas. Interpretation was performed independently by 2 nuclear medicine physicians who were not aware of the clinical history, diagnostic strategy conclusion, or patient's outcome. Sensitivity, specificity, and likelihood ratios were evaluated for various combinations of mismatched defect numbers and sizes (segmental or subsegmental). Generation of receiver-operating-characteristic curves was based on the number of mismatch defects and the number of subsegmental mismatch defects or equivalent. RESULTS: Of the 249 patients who were analyzed, the diagnosis of PE was confirmed in 49 and ruled out in 200 according to the previously validated independent strategy. Of all the tested criteria, the best performance was achieved using a diagnostic cutoff of at least 1 segmental or 2 subsegmental mismatches, with sensitivity and specificity of 0.92 (95% confidence interval, 0.84-1) and 0.91 (95% confidence interval, 0.87-0.95), respectively. With a negative V/Q SPECT result, the posttest probability of PE was 0.010, 0.037, and 0.119 for a low, intermediate, and high clinical probability. With a positive V/Q SPECT result, the posttest probability of PE was 0.531, 0.814, and 0.939 for a low, intermediate, and high probability. CONCLUSION: For V/Q SPECT interpretation, a diagnostic cutoff of 1 segmental or 2 subsegmental mismatches seems best for confirming or excluding acute PE.
    Journal of Nuclear Medicine 05/2013; · 5.77 Impact Factor
  • A. Delluc, K. Lacut, D. Mottier
    La Revue de Médecine Interne. 02/2013; 34(2):69–72.
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    ABSTRACT: PURPOSE: Venous thromboembolism (VTE) is a frequent and serious problem in intensive care units (ICU). Anticoagulant treatments have demonstrated their efficacy in preventing VTE. However, when the bleeding risk is high, they are contraindicated, and mechanical devices are recommended. To date, mechanical prophylaxis has not been rigorously evaluated in any trials in ICU patients. METHODS: In this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned 407 patients with a high risk of bleeding to receive intermittent pneumatic compression (IPC) associated with graduated compression stockings (GCS) or GCS alone for 6 days during their ICU stay. The primary endpoint was the occurrence of a VTE between days 1 and 6, including nonfatal symptomatic documented VTE, or death due to a pulmonary embolism, or asymptomatic deep vein thrombosis detected by ultrasonography systematically performed on day 6. RESULTS: The primary outcome was assessed in 363 patients (89.2 %). By day 6, the incidence of the primary outcome was 5.6 % (10 of 179 patients) in the IPC + GCS group and 9.2 % (17 of 184 patients) in the GCS group (relative risk 0.60; 95 % confidence interval 0.28-1.28; p = 0.19). Tolerance of IPC was poor in only 12 patients (6.0 %). No intergroup difference in mortality rate was observed. CONCLUSIONS: With the limitation of a low statistical power, our results do not support the superiority of the combination of IPC + GCS compared to GCS alone to prevent VTE in ICU patients at high risk of bleeding.
    European Journal of Intensive Care Medicine 01/2013; · 5.17 Impact Factor
  • A Delluc, K Lacut, D Mottier
    La Revue de Médecine Interne 11/2012; · 0.90 Impact Factor
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    ABSTRACT: INTRODUCTION: Incidence and risk factors of venous thromboembolism (VTE) are well established in surgical and medical settings, but data in psychiatric units are lacking. The aim of this study was to estimate the incidence of VTE in hospitalized psychiatric patients, and to assess the risk factors for VTE in this specific population. MATERIALS AND METHODS: All consecutive adult patients, admitted for a psychiatric disorder for at least seven days in psychiatric units were considered for inclusion. Patients were evaluated for signs and symptoms of VTE during hospitalization. At Day 10, all participants were interviewed and a systematic compression ultrasonography of the lower limbs was performed. Patients were followed-up until Day 90. RESULTS: Among the 471 included patients, 449 were evaluable at Day 10, and 458 were followed-up until Day 90. Ten deep vein thromboses (DVT) were diagnosed by Day 10 leading to an incidence of VTE of 2.2% (95% CI, 1.1%-4.1%). Six additional symptomatic VTE occurred between Day 10 and Day 90, leading to a 3.5% incidence at Day 90 (95% CI, 2.0%-5.6%). The main factors associated with VTE were age, bed rest, and diagnosis of dementia. The incidence of VTE in patients aged 75 or over with a diagnosis of dementia reached 8.2% at Day 10 and 12.5% at Day 90. CONCLUSIONS: The incidence of VTE in psychiatric units appeared low. However, in older patients, especially those with dementia, the incidence of VTE increased considerably. Further studies are needed to confirm these results.
    Thrombosis Research 10/2012; · 3.13 Impact Factor
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    ABSTRACT: INTRODUCTION: Several studies have suggested that statins may lower the risk of venous thromboembolism (VTE), whereas fibrates may increase this risk. However, no studies have evaluated whether lipid-lowering drugs (LLD) use was associated with the risk of VTE recurrence. MATERIALS AND METHODS: In a prospective cohort study, we followed-up all patients who had been treated for a first unprovoked VTE event in our centre. The association between LLD exposure and risk of recurrence of VTE after discontinuation of anticoagulation was analyzed with Cox proportional hazards model with adjustment for age, sex, body mass index, site of thrombosis, antiplatelets use, and duration of anticoagulation before inclusion in the study. RESULTS: 432 patients (median age 65.5years interquartile range 45.0-75.0, 174 men) were followed up for a median of 29.5months after discontinuation of anticoagulation. Sixty patients (13.9%) had recurrent VTE. During follow-up, 48 patients (11.1%) received statins, 36 patients (8.3%) received fibrates. In multivariate analysis, the risk of recurrent VTE associated with statin exposure was 1.02 (95% confidence interval 0.36-2.91) and 2.15 (95% confidence interval 1.01-4.61) for fibrate exposure. CONCLUSION: Our results suggest an association between fibrate intake and an increased risk of recurrent VTE, whereas statin intake was not associated with recurrent VTE. Larger studies are needed to validate these results.
    Thrombosis Research 08/2012; · 3.13 Impact Factor

Publication Stats

97 Citations
128.81 Total Impact Points

Institutions

  • 2014
    • University of Ottawa
      • Department of Medicine
      Ottawa, Ontario, Canada
  • 2007–2014
    • Université de Bretagne Occidentale
      • Faculté de Médecine et des Sciences de la Santé
      Brest, Brittany, France
  • 2010–2012
    • Université de Bretagne Sud
      Lorient, Brittany, France
  • 2011
    • Centre Hospitalier Universitaire de Brest
      • Département de Médecine Interne et de Pneumologie
      Brest, Brittany, France