A. Delluc

University of Ottawa, Ottawa, Ontario, Canada

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Publications (82)178.59 Total impact

  • [Show abstract] [Hide abstract]
    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; DOI:10.1097/MBC.0000000000000309 · 1.38 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; DOI:10.1097/MNM.0000000000000351 · 1.37 Impact Factor
  • La Revue de Médecine Interne 06/2015; 36:A60. DOI:10.1016/j.revmed.2015.03.301 · 1.32 Impact Factor
  • Medecine Nucleaire 05/2015; 39(3):244. DOI:10.1016/j.mednuc.2015.03.135 · 0.16 Impact Factor
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    ABSTRACT: Clinically discovering a systolic murmur is frequent among the young military population. When this murmur does not sound benign, a transthoracic echocardiography (TTE) is made to detect any cardiopathy, which could cause sudden cardiac death. The aim of this study was to evaluate the interest of systematic TTE in the assessment of any cardiac systolic murmur (CSM) among militaries.
    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 · 2.57 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 · 2.43 Impact Factor
  • La Revue de Médecine Interne 12/2014; DOI:10.1016/j.revmed.2014.07.007 · 1.32 Impact Factor
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    ABSTRACT: We assessed the performance of FDG PET/CT in the detection of venous thromboembolism.•The metabolic activity is significantly increased is deep vein thrombosis•Increased metabolic activity is however insufficient to diagnose DVT in routine practice.
    Thrombosis Research 10/2014; DOI:10.1016/j.thromres.2014.10.008 · 2.43 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 · 2.43 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
  • A Delluc, M Carrier
    08/2014; 21(4):163-4. DOI:10.3747/co.21.2175
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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 · 2.43 Impact Factor
  • Aurelien Delluc, Philip S Wells
    Evidence-Based Medicine 06/2014; DOI:10.1136/ebmed-2014-110025
  • La Revue de Médecine Interne 06/2014; 35:A58-A59. DOI:10.1016/j.revmed.2014.03.064 · 1.32 Impact Factor
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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; 41(10). DOI:10.1007/s00259-014-2763-1 · 5.22 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; 12(6). DOI:10.1111/jth.12580 · 5.55 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 04/2014; 133(4). DOI:10.1016/j.thromres.2014.01.021 · 2.43 Impact Factor
  • A. Delluc, K. Lacut, D. Mottier
    Archives of Cardiovascular Diseases Supplements 03/2014; 6(2):86-92. DOI:10.1016/S1878-6480(14)71481-8

Publication Stats

165 Citations
178.59 Total Impact Points

Institutions

  • 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
  • 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