Olivier Sanchez

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (141)675.2 Total impact

  • Guy Meyer · Benjamin Planquette · Olivier Sanchez ·

    Current Atherosclerosis Reports 12/2015; 17(12). DOI:10.1007/s11883-015-0546-1 · 3.42 Impact Factor
  • Guy Meyer · Olivier Sanchez · David Jimenez ·

    La Presse Médicale 11/2015; DOI:10.1016/j.lpm.2015.10.009 · 1.08 Impact Factor

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    ABSTRACT: Despite the wide use of the 6 min walk distance (6MWD), no study has ever assessed its validity as a surrogate marker for haemodynamics and predictor of outcome in isolated pulmonary arterial hypertension associated with systemic sclerosis (SSc-PAH). We designed this work to address this issue. Treatment-naïve patients with SSc-PAH were prospectively included from two sources: the French PAH Network (a prospective epidemiological cohort) (n=83) and randomised clinical trials submitted for drug approval (Food and Drug Administration) (n=332). Correlations between absolute values of the 6MWD and haemodynamics at baseline, as well as between variations of 6MWD and haemodynamics during follow-up, were studied in both populations. In the French cohort, baseline cardiac output (CO) (R(2)=0.19, p=0.001) and New York Heart Association class (R(2)=0.10, p<0.001) were significantly and independently correlated with baseline 6MWD in multivariate analysis. A significant, independent, but weaker, correlation with CO was also found in the Food and Drug Administration sample (R(2)=0.04, p<0.001). During follow-up, there was no association between the changes in 6MWD and haemodynamic parameters in patients under PAH-specific treatments. In SSc-PAH, CO independently correlates with 6MWD at baseline, but accounts for a small amount of the variance of 6MWD in both study samples. This suggests that other non-haemodynamic factors could have an impact on the walk distance. Moreover, variations of 6MWD do not reflect changes in haemodynamics among treated patients. Our results suggest that 6MWD is not an accurate surrogate marker for haemodynamic severity, nor an appropriate outcome measure to assess changes in haemodynamics during follow-up in treated SSc-PAH. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Annals of the rheumatic diseases 08/2015; DOI:10.1136/annrheumdis-2015-207336 · 10.38 Impact Factor
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    ABSTRACT: The optimal duration of anticoagulation after a first episode of unprovoked pulmonary embolism is uncertain. To determine the benefits and harms of an additional 18-month treatment with warfarin vs placebo, after an initial 6-month nonrandomized treatment period on a vitamin K antagonist. Randomized, double-blind trial (treatment period, 18 months; median follow-up, 24 months); 371 adult patients who had experienced a first episode of symptomatic unprovoked pulmonary embolism (ie, with no major risk factor for thrombosis) and had been treated initially for 6 uninterrupted months with a vitamin K antagonist were randomized and followed up between July 2007 and September 2014 in 14 French centers. Warfarin or placebo for 18 months. The primary outcome was the composite of recurrent venous thromboembolism or major bleeding at 18 months after randomization. Secondary outcomes were the composite at 42 months (treatment period plus 24-month follow-up), as well as each component of the composite, and death unrelated to pulmonary embolism or major bleeding, at 18 and 42 months. After randomization, 4 patients were lost to follow-up, all after month 18, and 1 withdrew due to an adverse event. During the 18-month treatment period, the primary outcome occurred in 6 of 184 patients (3.3%) in the warfarin group and in 25 of 187 (13.5%) in the placebo group (hazard ratio [HR], 0.22; 95% CI, 0.09-0.55; P = .001). Recurrent venous thromboembolism occurred in 3 patients in the warfarin group and 25 patients in the placebo group (HR, 0.15; 95% CI, 0.05-0.43); major bleeding occurred in 4 patients in the warfarin group and in 1 patient in the placebo group (HR, 3.96; 95% CI, 0.44 to 35.89). During the 42-month entire study period (including the study treatment and follow-up periods), the composite outcome occurred in 33 patients (20.8%) in the warfarin group and in 42 (24.0%) in the placebo group (HR, 0.75; 95% CI, 0.47-1.18). Rates of recurrent venous thromboembolism, major bleeding, and unrelated death did not differ between groups. Among patients with a first episode of unprovoked pulmonary embolism who received 6 months of anticoagulant treatment, an additional 18 months of treatment with warfarin reduced the composite outcome of recurrent venous thrombosis and major bleeding compared with placebo. However, benefit was not maintained after discontinuation of anticoagulation therapy. clinicaltrials.gov Identifier: NCT00740883.
    JAMA The Journal of the American Medical Association 07/2015; 314(1):31-40. DOI:10.1001/jama.2015.7046 · 35.29 Impact Factor
  • G Meyer · B Planquette · O Sanchez ·
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    ABSTRACT: Patients with pulmonary embolism can be divided in two groups according to their risk of death or major complication: a small group of high-risk patients defined by the presence of systemic hypotension or cardiogenic shock and a large group of normotensive patients. Among normotensive patients, further risk stratification, based on clinical grounds alone or on the combination of clinical data, biomarkers, and imaging tests, allows selection of low-risk patients and intermediate-risk patients. The safety of outpatient treatment for low-risk patients has been established mainly on the basis of retrospective and prospective cohorts using different selection tools. In most studies, about 50% of the patients have been safely treated at home. Although thrombolytic therapy has a favorable benefit to risk profile in patients with high-risk pulmonary embolism, the risk of major and especially intracranial bleeding outweighs the benefits in terms of hemodynamic decompensation in patients with intermediate-risk pulmonary embolism. © 2015 International Society on Thrombosis and Haemostasis.
    Journal of Thrombosis and Haemostasis 06/2015; 13 Suppl 1(S1):S252-S258. DOI:10.1111/jth.12944 · 5.72 Impact Factor
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    ABSTRACT: Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear. To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence. Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonary embolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone with no filter implantation (control group; n = 199). Initial hospitalization with ambulatory follow-up occurred in 17 French centers. Full-dose anticoagulation for at least 6 months in all patients. Insertion of a retrievable inferior vena cava filter in patients randomized to the filter group. Filter retrieval was planned at 3 months from placement. Primary efficacy outcome was symptomatic recurrent pulmonary embolism at 3 months. Secondary outcomes were recurrent pulmonary embolism at 6 months, symptomatic deep vein thrombosis, major bleeding, death at 3 and 6 months, and filter complications. In the filter group, the filter was successfully inserted in 193 patients and was retrieved as planned in 153 of the 164 patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients (3.0%; all fatal) in the filter group and in 3 patients (1.5%; 2 fatal) in the control group (relative risk with filter, 2.00 [95% CI, 0.51-7.89]; P = .50). Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients. Among hospitalized patients with severe acute pulmonary embolism, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months. These findings do not support the use of this type of filter in patients who can be treated with anticoagulation. clinicaltrials.gov Identifier: NCT00457158.
    JAMA The Journal of the American Medical Association 04/2015; 313(16):1627-1635. DOI:10.1001/jama.2015.3780 · 35.29 Impact Factor
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    ABSTRACT: Low molecular weight heparin is recommended for the treatment of venous thromboembolism (VTE) during pregnancy. However, there are few reliable data regarding the safety of therapeutic doses of tinzaparin in this setting. The objective of this study was to assess the safety of once-daily therapeutic doses of tinzaparin for the treatment of VTE during pregnancy. A retrospective study was carried out in 3 tertiary care centres in France, from 1998 to 2009, including consecutive pregnant women who received once-daily therapeutic doses of tinzaparin (175 IU/kg/day). We analyzed 87 pregnancies in 83 women, representing a total of 13,320 patient-days of treatment. Live-birth rate was 97.8%, with one case of miscarriage (<20 weeks of gestation) and one case of intrauterine foetal death (≥20 weeks). There was no antenatal major bleeding. Major bleeding occurred in 4 women during an emergency caesarean section. No case of heparin-induced thrombocytopenia and no maternal death were reported. There was no neonatal haemorrhage and no case of congenital abnormality. VTE recurred on treatment in one patient and after treatment interruption for several days in 2 other patients. These results support the safety of once-daily tinzaparin at therapeutic dose for the treatment of VTE during pregnancy. © 2015 S. Karger AG, Basel.
    Gynecologic and Obstetric Investigation 04/2015; 79(4). DOI:10.1159/000367846 · 1.70 Impact Factor
  • G. Meyer · O. Sanchez · B. Planquette ·
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    ABSTRACT: La létalité de l’embolie pulmonaire (EP) compliquée d’état de choc varie de 25 à plus de 50 %. Dans cette circonstance, le traitement fibrinolytique réduit vraisemblablement la mortalité, ce qui semble justifier son emploi, malgré l’augmentation du risque hémorragique. En l’absence d’état de choc franc, la létalité de l’EP est beaucoup plus faible sous simple traitement anticoagulant et ne semble pas justifier l’emploi de thérapeutiques plus agressives. Des études suggèrent toutefois l’existence d’un groupe de malades à risque intermédiaire défini par une dysfonction ventriculaire droite objectivée par l’échocardiographie ou le scanner et par l’élévation de la troponine ou des peptides natriurétiques. Si la fibrinolyse diminue significativement les décompensations hémodynamiques et la mortalité liée à l’EP chez de tels malades, son emploi s’accompagne d’une augmentation sensible des complications hémorragiques graves et ne diminue pas la mortalité globale. Son emploi ne se conçoit donc que chez des malades dont l’état hémodynamique se décompense sous traitement anticoagulant et peut-être chez quelques malades jeunes sans facteur de risque hémorragique.
    Réanimation 03/2015; 24(2):98-103. DOI:10.1007/s13546-015-1039-5
  • Guy Meyer · Olivier Sanchez · Benjamin Planquette ·
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    ABSTRACT: IntroductionThrombolytic therapy is associated with faster hemodynamic, echocardiographic and angiographic improvements than heparin alone in patients with pulmonary embolism (PE) and right ventricular dysfunction, but this is obtained at the expense of an increased risk of bleeding. The use of thrombolytic therapy in patients with PE should therefore be decided on the estimation of the benefit-to-risk ratio depending both on the risk of death due to PE and to treatment-associated bleeding complications.Thrombolytic therapy induces faster angiographic and hemodynamic improvements than heparin alone in patients with PEThrombolytic treatment induces a rapid decline of pulmonary artery resistance in patients with acute PE and pulmonary hypertension. Alteplase significantly reduces mean pulmonary artery pressure and increases the cardiac index after 2 h, whereas no significant change is observed with heparin [1]. Alteplase produces an earlier reversal of right ventricular dysfunction than ...
    Internal and Emergency Medicine 02/2015; 10(3). DOI:10.1007/s11739-015-1194-8 · 2.62 Impact Factor
  • B. Planquette · D. Maurice · J. Peron · G. Mourin · A. Ferre · O. Sanchez · G. Meyer ·

  • B. Planquette · P. Chiles · J. Marsh · O. Sanchez · G. Meyer · T. Morris ·

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    ABSTRACT: For patients diagnosed with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk of developing PE-related complications within 30 days after PE diagnosis. The original Bova score study derived the model from 2,874 normotensive patients that had acute PE and participated in one of six prospective PE studies. We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban emergency department. Two clinician investigators used baseline data for the model's 4 prognostic variables to stratify patients into the three Bova risk classes (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the kappa statistic assessed inter-rater variability. The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary endpoint occurred in 91 of the 1,083 (8.4%; 95% confidence interval [CI], 6.7-10%) patients during the 30 days after the PE diagnosis. Risk class correlated with the PE-related complication rate (class I 4.4%, class II 18%, and class III 42%; ICC 0.93 [95% CI, 0.92-0.94]; kappa statistic 0.80 [P < 0.001]), in-hospital complication rate (class I 3.7%, class II 15%, and class III 37%), and 30-day PE-related mortality (class I 3.1%, class II 6.8%, and class III 10.5%). The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.
    Chest 01/2015; 148(1). DOI:10.1378/chest.14-2551 · 7.48 Impact Factor
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  • B. Planquette · A. Ferre · G. Mourin · G. Meyer · O. Sanchez ·
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    ABSTRACT: Le plus souvent asymptomatique, la maladie veineuse thromboembolique (MVTE) est fréquente (9 %) en réanimation et altère le pronostic des patients. Le risque de MVTE en réanimation est multifactoriel et inclut l’obésité. Plus de la moitié des patients de réanimation sont en surpoids et un quart est obèse (index de masse corporelle [IMC]>30 kg/m2). La thromboprophylaxie de ces patients est donc un problème quotidien. Aucune recommandation spécifique n’existe à ce jour, essentiellement du fait de l’absence d’études randomisées conduites dans cette population. Ces patients sont à haut risque de MVTE en réanimation et doivent, sauf contre-indication, bénéficier d’une prophylaxie pharmacologique. Les héparines de bas poids moléculaire (HBPM) sont les anticoagulants les mieux documentés chez le patient obèse. Il n’a été prouvé, ni en réanimation ni en chirurgie bariatrique, de bénéfice à l’adaptation de la posologie au poids. La surveillance de l’activité anti-Xa n’a pas été étudiée en réanimation. Les moyens de prévention mécanique, bas de contention veineuse ou compression pneumatique intermittente, n’ont pas fait l’objet d’études spécifiques chez le patient obèse en réanimation et sont souvent sousutilisés. Faute d’essai clinique ayant inclus des patients obèses en réanimation et comparant plusieurs modalités de prévention, il semble aujourd’hui logique de suivre les recommandations de l’American College of Chest Physicians en proposant une prophylaxie pharmacologique par HBPM. L’association d’une prévention mécanique systématique aux membres inférieurs ne peut être recommandée.
    Réanimation 01/2015; 24(1). DOI:10.1007/s13546-015-1022-1
  • B. Planquette · G. Meyer · O. Sanchez ·

    Revue des Maladies Respiratoires Actualites 12/2014; 6(4):45-50. DOI:10.1016/S1877-1203(14)70007-2
  • B Planquette · D Maurice · J Peron · G Mourin · A Ferre · O Sanchez · G Meyer ·
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    ABSTRACT: Diagnostic algorithms for pulmonary embolism (PE) have been validated in patients attending hospital emergency departments. However, general practitioners (GPs) are often the professionals of first resort for the majority of non-critical cases of PE. To evaluate the knowledge of the diagnostic algorithm for PE among GPs in France. Questionnaire-based survey of GPs with a private practice. All GPs in the study area were sent a questionnaire including several questions on the diagnosis of PE and two clinical cases scenario with suspected PE. Factors associated with knowledge of the diagnostic algorithm were analysed by univariate and multivariate analyses. Five-hundred and eight questionnaires were distributed and 155 (30.5%) were available for analysis. Only 55% of the GPs did know about clinical scores for the assessment of clinical probability of PE and 42% of the GPs were aware that clinical probability is needed to interpret the result of D-dimer testing. Forty GPs (26%) gave valid responses to both clinical cases, 54 GPs (35%) had one valid case out of the two and 61 (39%) gave invalid responses to both clinical cases. Participation in specific training on PE was significantly associated with valid responses to the two clinical cases in multivariate analysis (p<0.017). The majority of GPs were unaware of the diagnostic algorithm for PE. Clinical probability was rarely assessed and knowledge about D-dimers was poor. Specific training on PE and greater awareness of clinical probability scores may promote knowledge of PE algorithm diagnosis. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    European Journal of Internal Medicine 12/2014; 26(1). DOI:10.1016/j.ejim.2014.11.005 · 2.89 Impact Factor
  • M. Dres · A. Ferre · O. Sanchez ·
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    ABSTRACT: La enfermedad pulmonar obstructiva crónica (EPOC) es un grave problema de salud pública, tanto por la morbilidad y la mortalidad como por los costes que genera. Debido a las comorbilidades frecuentes (sobre todo cardiovasculares), el tratamiento debe ser multidisciplinario. La evolución de la enfermedad incluye episodios agudos que agravan el pronóstico a largo plazo y que, en los casos más graves, comprometen el pronóstico vital. El tratamiento sintomático de las descompensaciones ha sido objeto de numerosas recomendaciones que, en su mayoría, se basan en estudios heterogéneos cuyo punto más controvertido sigue siendo la corticoterapia sistémica. En cambio, los broncodilatadores por inhalación han demostrado ser eficaces. Tratar el factor etiológico de la descompensación es primordial: el factor más frecuente es una infección respiratoria. El uso de los antibióticos está ampliamente extendido, pero debe limitarse a las neumonías o a las exacerbaciones de la EPOC con otra infección añadida en los pacientes de los estadios GOLD (global initiative for chronic obstructive lung disease) más graves (estadios definidos en función del volumen espiratorio máximo en el primer segundo [VEMS]). Existen varios trabajos relativos a la determinación de la concentración de biomarcadores para guiar la prescripción de la antibioticoterapia, pero hasta ahora ninguno de ellos se recomienda de rutina. En lo que se refiere a las descompensaciones más graves que justifican la hospitalización en cuidados intensivos, la disponibilidad de la ventilación no invasiva desde hace más de dos décadas ha modificado el tratamiento y el pronóstico. Debe seguir siendo el método de asistencia ventilatoria de elección, respetando las indicaciones y las contraindicaciones para no retrasar, llegado el caso, el comienzo de la ventilación invasiva. La experiencia de los equipos que usan estas técnicas garantiza su eficacia. Por último, después de la fase aguda, habrá que pensar en el seguimiento, los medios de prevención de las exacerbaciones y, si fuera necesario, la rehabilitación respiratoria en el contexto de un tratamiento general y multidisciplinario.
    11/2014; 40(4). DOI:10.1016/S1280-4703(14)68954-4
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    European Heart Journal 11/2014; 35(43):3033-3073. DOI:10.1093/eurheartj/ehu283 · 15.20 Impact Factor
  • M. Dres · A. Ferre · O. Sanchez ·
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    ABSTRACT: La broncopneumopatia cronica ostruttiva (BPCO) è un problema importante di salute pubblica sia per la morbilità e la mortalità che per i costi sanitari che essa genera. Tenuto conto delle frequenti comorbilità (in particolare cardiovascolari), la gestione deve essere multidisciplinare. L’evoluzione di questa malattia è costellata di episodi acuti che aggravano la prognosi a lungo termine e che, nei casi più gravi, mettono in gioco la prognosi vitale. Il trattamento sintomatico degli scompensi è stato oggetto di numerose raccomandazioni basate, per la maggior parte, su degli studi disomogenei, il cui elemento più dibattuto resta quello dei corticosteroidi sistemici. Viceversa, i broncodilatatori per via inalata hanno dimostrato la loro efficacia. Il trattamento del fattore eziologico dello scompenso è fondamentale: il fattore più frequente è un’infezione respiratoria. L’utilizzo degli antibiotici è ampiamente diffuso, ma deve limitarsi ai casi di polmoniti o di riacutizzazioni di BPCO con sovrainfezione nei pazienti agli stadi GOLD (global initiative for chronic obstructive lung disease) più gravi (stadi definiti in funzione del volume espiratorio massimo durante il primo secondo [VEMS]). Diversi lavori si interessano ai dosaggi di bioindicatori per orientare la prescrizione della terapia antibiotica; nessuno è consigliato di routine a tutt’oggi. A proposito degli scompensi più gravi che giustificano un ricovero in terapia intensiva, l’avvento della ventilazione non invasiva da più di due decenni ha trasformato la gestione e la prognosi di questi pazienti. Essa deve restare la metodica di assistenza ventilatoria di elezione, sempre rispettando le sue indicazioni e controindicazioni per non ritardare l’instaurazione di una ventilazione invasiva, in caso di necessità. L’esperienza delle equipe che praticano queste tecniche è garanzia della loro efficacia. Infine, dopo la fase acuta, occorrerà pensare all’implementazione di un follow-up e dei mezzi di prevenzione delle esacerbazioni e, all’occorrenza, a una riabilitazione respiratoria nel quadro di una gestione globale e multidisciplinare.
    11/2014; 19(4):1–10. DOI:10.1016/S1283-0771(14)68865-4

Publication Stats

3k Citations
675.20 Total Impact Points


  • 2007-2015
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Université Paris-Sud 11
      • Faculty of Medicine
      Orsay, Île-de-France, France
  • 2005-2014
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Microbiologie
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2009
    • Centre Hospitalier Universitaire de Brest
      • Département de Médecine Interne et de Pneumologie
      Brest, Brittany, France
  • 2006
    • University of Lausanne
      Lausanne, Vaud, Switzerland
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      Créteil, Île-de-France, France
  • 1998
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France