A. Delluc

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (87)184.12 Total impact

  • K. Lacut · A. Delluc
    Journal des Maladies Vasculaires 09/2015; 40(5):287. DOI:10.1016/j.jmv.2015.07.033 · 0.24 Impact Factor
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    ABSTRACT: Introduction: Current clinical guidelines recommend expedited repair of hip fracture to reduce morbidity and mortality. A significant number of hip fracture patients have concomitant cardiovascular disease requiring anticoagulation. Vitamin K antagonists (VKAs), which have been traditionally used, might be associated with an increased time to surgery (TTS) and it remains unknown what effect direct oral anticoagulants (DOACs) have on this metric. Our objective is to determine how anticoagulation with a VKA or DOAC affects TTS. Materials and methods: This is a case control study comparing TTS in consecutively admitted hip fracture patients receiving either a DOAC or VKA with age- and gender-matched controls between January 1, 2010 and March 24, 2014. The primary end point is TTS, which is defined as the time elapsed from admission to surgery. Secondary end points include the rate of stroke, death, bleeding and VTE during admission. Results: Of 2258 patients, 233 were on a VKA while 27 were on a DOAC. Median TTS seems to be longer in patients receiving a DOAC or a VKA when compared to controls. (40h vs. 26.2h). The DOAC group tended to have longer median TTS when compared to the VKA groups (66.9h vs. 39.4h) There was no difference in the rate of stroke, death, bleeding and VTE during admission. Conclusions: Patients on anticoagulation prior to admission for hip fracture experienced longer delays in surgery when compared to patients not receiving anticoagulation. Patients on a DOAC experienced the longest surgical delay.
    Thrombosis Research 09/2015; DOI:10.1016/j.thromres.2015.09.017 · 2.45 Impact Factor
  • Thrombosis and Haemostasis 08/2015; 114(6). DOI:10.1160/TH15-02-0134 · 4.98 Impact Factor
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    ABSTRACT: Current diagnostic strategies for pulmonary embolism rely on the sequential use of noninvasive diagnostic tests including ventilation-perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA). V/Q scan remains criticized because of a high proportion of nondiagnostic test results, especially when the chest X-ray (CXR) is abnormal. The present study assesses whether CXR results have an impact on the conclusiveness of a noninvasive diagnostic strategy of pulmonary embolism based on the combination of pretest probability, compression ultrasonography, V/Q scan, and CTPA. Patients suspected of having pulmonary embolism were managed according to a validated diagnostic strategy. All patients underwent a CXR within 24 h of the suspicion of pulmonary embolism. CXR results were correlated to strategy conclusiveness, as assessed by the rate of required CTPA as per the diagnostic algorithm. Two hundred and twenty-three patients were retrospectively analyzed. CXRs were considered as normal in 108 (48%) patients and abnormal in 115 (52%) patients. According to the diagnostic algorithm, a CTPA was required to reach a diagnostic conclusion in 11 (10%) patients of the normal CXR group, and in 14 (12%) patients of the abnormal CXR group (P > 0.05). In this study, the presence of CXR abnormalities did not have an impact on the conclusiveness of a diagnostic strategy of pulmonary embolism based on V/Q scan. CXR abnormalities should likely not be regarded as a contraindication to the use of V/Q scan in patients with suspected pulmonary embolism.
    Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 06/2015; 26(6). DOI:10.1097/MBC.0000000000000309 · 1.40 Impact Factor
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    ABSTRACT: The aim of the study was to assess the potential interest of combining a low-dose computed tomography (ldCT) to ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) for the diagnosis of pulmonary embolism (PE). We addressed three main questions: Could ldCT be used in substitution to ventilation SPECT? Could ldCT improve the diagnostic performance of V/Q SPECT? Could ldCT provide alternative diagnoses to PE? A total of 393 patients previously analysed in a management outcome study that aimed at assessing the safety of V/Q SPECT for PE diagnosis were assessed. All patients underwent an ldCT under the same SPECT-computed tomography camera, which was not used at the time of initial interpretation. Three retrospective analyses were performed: Q SPECT combined with ldCT, V/Q SPECT combined with ldCT and ldCT only. On the basis of initial V/Q SPECT interpretation, 110 (28%) patients were positive and 283 (72%) were negative for PE.With Q SPECT-ldCT, 139 (35%) patients were positive and 254 (65%) were negative, with 55 (19%) discrepancies when compared with V/Q SPECT. Of the 283 patients with negative V/Q SPECT, 42 were positive with V/Q SPECT-ldCT, and among the 110 patients with positive V/Q SPECT 13 were negative with V/Q SPECT-ldCT. On using V/Q SPECT-ldCT, 97 (25%) patients were positive and 296 (75%) were negative, with 13 (3%) discrepancies when compared with V/Q SPECT (all had had a positive V/Q SPECT but a negative V/Q SPECT-ldCT). Finally, 67 (24%) ldCT scans showed a potential alternative diagnosis to PE. For PE diagnosis with lung SPECT, the use of ldCT in substitution to ventilation SPECT is associated with a high risk of overdiagnosis. The diagnostic value of ldCT in addition to V/Q SPECT remains unclear. Further studies are needed to determine its potential role in PE diagnosis.
    Nuclear Medicine Communications 06/2015; 36(9). DOI:10.1097/MNM.0000000000000351 · 1.67 Impact Factor
  • La Revue de Médecine Interne 06/2015; 36:A60. DOI:10.1016/j.revmed.2015.03.301 · 1.07 Impact Factor
  • Medecine Nucleaire 05/2015; 39(3):244. DOI:10.1016/j.mednuc.2015.03.135 · 0.07 Impact Factor
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    ABSTRACT: La découverte d’un souffle systolique à l’auscultation est fréquente chez l’adulte jeune militaire. En l’absence de critère clinique de bénignité de ce souffle, une échographie trans-thoracique (ETT) est réalisée dans le but de dépister les cardiopathies potentiellement responsables de mort subite. L’objectif principal de l’étude est l’évaluation dans une population spécifique de la rentabilité diagnostique de la réalisation systématique d’une ETT lors de la découverte d’un souffle systolique à l’auscultation.
    Annales de Cardiologie et d Angéiologie 02/2015; 64(2). DOI:10.1016/j.ancard.2015.01.016 · 0.30 Impact Factor
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    ABSTRACT: In this study, Pneumocystis jirovecii was detected and characterized in the air surrounding patients with Pneumocystis pulmonary colonization. Air samples were collected in the rooms of 10 colonized patients using Coriolis® μ air sampler at 1m and 5m from the patient's head. P. jirovecii DNA was amplified and genotyped in pulmonary and air samples at the mitochondrial large subunit ribosomal RNA gene. P. jirovecii DNA was detected in 5 of the 10 air samples collected at 1m and in 5 of the 10 other air samples collected at 5m. P. jirovecii genotyping was successful in 4 pairs or triplets of air and pulmonary samples. Full genotype matches were observed in 3 of the 4 pairs or triplets of air and pulmonary samples. These results provide original data supporting P. jirovecii exhalation from colonized patients and emphasize the risk of P. jirovecii nosocomial transmission from this patient population. Copyright © 2015 Elsevier Inc. All rights reserved.
    Diagnostic Microbiology and Infectious Disease 01/2015; 82(2). DOI:10.1016/j.diagmicrobio.2015.01.004 · 2.46 Impact Factor
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    ABSTRACT: Data on efficacy and safety of using low molecular weight heparin in cancer patients with catheter-related upper extremity deep vein thrombosis is scarce and the risk of recurrent venous thromboembolism after discontinuation of anticoagulation is unknown. We conducted a retrospective cohort study including consecutive cancer outpatients assessed for the management of symptomatic central venous catheter-associated proximal upper extremity deep vein thrombosis. Of 99 included patients, 89 were treated with one month of full therapeutic weight-adjusted dose of low molecular weight heparin followed by an intermediate dose. Median duration of anticoagulation was 124days (range 40 to 1849). No recurrent venous thromboembolism and two major bleeding episodes occurred during the first 3months of treatment. Eighty patients were followed-up after anticoagulation discontinuation for a median of 632days (range 6 to 2495). Central venous line was pulled in all patients in remission and in 26 of the 29 patients (89.6%) with active cancer. Five recurrences were observed during follow-up. The cumulative probability of recurrent venous thromboembolism was higher in patients whose cancer was active at the time of anticoagulation discontinuation as compared with those in remission (22.2% (95% CI: 0 to 40.6) vs. 2.3% (95% CI: 0 to 6.7)). The risk of venous thromboembolism recurrence in patients whose central venous catheter has been pulled out and cancer is in remission appears low following anticoagulation discontinuation and after a minimum of 3months of full/intermediate dose. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Thrombosis Research 12/2014; 135(2). DOI:10.1016/j.thromres.2014.11.020 · 2.45 Impact Factor
  • A. Delluc · M. Carrier · G. Meyer · G. Le Gal
    La Revue de Médecine Interne 12/2014; 35(12). DOI:10.1016/j.revmed.2014.07.007 · 1.07 Impact Factor
  • A. Delluc · G. Le Gal · D. Scarvelis · M. Carrier
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    ABSTRACT: Introduction: Thrombosis and inflammation are intimately linked. Inflammatory component of venous thromboembolism (VTE) may allow the use of FDG positron emission tomography / computed tomography (FDG PET/CT) in the detection of thrombotic process. Published studies remain limited and contradictory. We aimed at evaluating the performance of FDG PET/CT in the detection of VTE in a population of patients enrolled in a prospective study evaluating FDG PET/CT for cancer screening in etiological assessment of idiopathic VTE. Materials and methods: The first consecutive 100 patients who underwent FDG PET/CT were included. Visual and quantitative analyses of vascular axes was performed and compared with lower limb veins compression ultrasonography, lung scintigraphy and/or computed tomography pulmonary angiography. Results: Out of the 100 patients, 63 presented lobar pulmonary embolism for a total of 217 embolic sites and 62 had a deep vein thrombosis for a total of 143 thrombotic sites. Regarding pulmonary embolism, sensitivity and specificity of FDG PET/CT were 3% (95%CI: 1-6%) and 99% (95%CI: 98-100%). SUV max ratio between pulmonary embolism location and non-pathological contralateral vessel was 1.04±0.18 (p=0.7). Regarding deep vein thrombosis, sensitivity and specificity were 31% (95%CI: 24-39%) and 88% (95%CI: 81-92%). The metabolic activity was significantly higher than in contralateral vessels (p<0.001), with a SUV max ratio of 1.25±0.53, but without any significant SUVmax threshold applicable in routine practice for deep vein thrombosis diagnosis. Conclusions: FDG PET/CT is not accurate enough for the diagnosis of VTE.
    Thrombosis Research 10/2014; 135(1). DOI:10.1016/j.thromres.2014.10.008 · 2.45 Impact Factor
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    ABSTRACT: Current clinical practice guidelines all recommend the use of therapeutic doses of low molecular weight heparins (LMWH) for the initial and long-term treatment of cancer-related thrombosis. The use of vitamin-K antagonists (VKA) is acceptable if LMWH is not available. Direct oral anticoagulants (DOACs) have been shown to be comparable to conventional therapy for the acute treatment of VTE but their efficacy and safety in cancer patients remains uncertain. A systematic literature search strategy was conducted using MEDLINE, EMBASE, and the EBM reviews. Randomized controlled trials (RCTs) reporting rates of recurrent VTE and major bleeding in cancer patients were included. Relative risks (RR) (95% confidence intervals (CI)) for these outcomes were generated. A total of 9 RCTs (2310 patients) were included in our analysis. In comparison to VKA, LMWH showed a significant reduction in recurrent VTE events (RR: 0.52; 95% CI: 0.36 to 0.74) whereas DOACs did not (RR: 0.66; 95% CI: 0.39 to 1.11). LMWH was associated with a non significant increase in the risk of major bleeding (RR: 1.06; 95% CI: 0.5 to 2.23) whereas DOACs showed a non significant reduction (RR: 0.78; 95% CI: 0.42 to 1.44). Annualized risks of recurrent VTE and major bleeding among patients randomized to VKA were higher in the LMWH studies as compared to the studies assessing DOACs suggesting that a higher risk cancer population were enrolled in the LMWH studies. LMWH should be used for the treatment of acute cancer-associated thrombosis. The use DOACs cannot be supported until trials comparing them to LMWH are conducted. Copyright © 2014. Published by Elsevier Ltd.
    Thrombosis Research 10/2014; 134(6):1214-1219. DOI:10.1016/j.thromres.2014.09.039 · 2.45 Impact Factor
  • 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. DOI:10.1016/j.jmv.2014.07.022 · 0.24 Impact Factor
  • A Delluc · M Carrier · G Meyer · G Le Gal
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    A Delluc · M Carrier
    08/2014; 21(4):163-4. DOI:10.3747/co.21.2175
  • Ryma Ihadaddene · Grégoire Le Gal · Aurélien Delluc · Marc Carrier
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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 07/2014; 134(1). DOI:10.1016/j.thromres.2014.04.028 · 2.45 Impact Factor
  • Aurelien Delluc · Philip S Wells
    Evidence-Based Medicine 06/2014; 19(5). DOI:10.1136/ebmed-2014-110025

Publication Stats

189 Citations
184.12 Total Impact Points


  • 2015
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2014
    • University of Ottawa
      • Department of Medicine
      Ottawa, Ontario, Canada
  • 2013–2014
    • ESC Bretagne Brest
      Brest, Brittany, France
  • 2007–2014
    • Université de Bretagne Occidentale
      • Faculté de Médecine et des Sciences de la Santé
      Brest, Brittany, France
  • 2012
    • European University of Brittany
      Roazhon, Brittany, France
  • 2011–2012
    • Centre Hospitalier Universitaire de Brest
      • Département de Médecine Interne et de Pneumologie
      Brest, Brittany, France
  • 2010
    • Université de Bretagne Sud
      Lorient, Brittany, France