Olivier Sanchez

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

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Publications (117)490.65 Total impact

  • Guy Meyer, Olivier Sanchez, Benjamin Planquette
    Internal and Emergency Medicine 02/2015; · 2.35 Impact Factor
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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). · 2.30 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.
    EMC - Anestesia-Reanimación. 11/2014; 40(4).
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    ABSTRACT: Six months of treatment for VTE in patients with cancer are needed.•Be careful of a « provoked » first event (after surgery).•The recurrent rate was mainly higher during the six first months.•When anticoagulation was stopped before sixth month, the risk was eight fold higher.•After six months: no impact of the type of anticoagulation on the recurrent rate.
    Thrombosis Research 11/2014; · 2.43 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.
    EMC - Anestesia-Rianimazione. 11/2014; 19(4):1–10.
  • Revue des Maladies Respiratoires 09/2014; 31(7):661–662. · 0.49 Impact Factor
  • Olivier Sanchez, Benjamin Planquette, Guy Meyer
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    ABSTRACT: Although early pulmonary revascularization is the treatment of choice for patients with high-risk (massive) pulmonary embolism, it remains controversial in patients with intermediate-risk (submassive) pulmonary embolism until recently. Recent published data on the management of high-risk and intermediate-risk pulmonary embolism patients will be the main focus of this review.
    Current opinion in pulmonary medicine. 07/2014;
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    ABSTRACT: AIM: Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE. METHODS AND RESULTS: We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36-0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35-1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22-0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14-0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27-0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95-4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25-8.11) were significantly more frequent among patients receiving thrombolysis. CONCLUSIONS: Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage.
    European Heart Journal 06/2014; · 14.72 Impact Factor
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    ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) has been estimated to occur in 0.1-0.5% of patients who survive a pulmonary embolism (PE), but more recent prospective studies suggest that its incidence may be much higher. The absence of initial haemodynamic evaluation at the time of PE should explain this discrepancy. We performed a prospective multicentre study including patients with PE in order to assess the prevalence and to describe risk factors of CTEPH. Follow-up every year included an evaluation of dyspnea and echocardiography using a predefined algorithm. In case of suspected CTEPH, the diagnosis was confirmed using right heart catheterisation (RHC). Signs of CTEPH were searched on the multidetector computed tomography (CT) and echocardiography performed at the time of PE. Of the 146 patients analysed, eight patients (5.4%) had suspected CTEPH during a median follow-up of 26 months. CTEPH was confirmed using RHC in seven cases (4.8%; 95%CI, 2.3 - 9.6) and ruled-out in one. Patients with CTEPH were older, had more frequently previous venous thromboembolic events and more proximal PE than those without CTEPH. At the time of PE diagnosis, patients with CTEPH had a higher systolic pulmonary artery pressure and at least two signs of CTEPH on the initial CT. After acute PE, the prevalence of CTEPH appears high. However, initial echocardiography and CT data at the time of the index PE suggest that a majority of patients with CTEPH had previously unknown pulmonary hypertension, indicating that a first clinical presentation of CTEPH may mimic acute PE.
    Thrombosis and Haemostasis 06/2014; 112(3). · 5.76 Impact Factor
  • Guy Meyer, Olivier Sanchez
    European Respiratory Journal 06/2014; 43(6):1554-1555. · 7.13 Impact Factor
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    ABSTRACT: The identification of normotensive patients with acute pulmonary embolism (PE) at high risk of adverse PE-related clinical events (i.e. intermediate-risk group) is a major challenge.We combined individual patient data from six studies involving 2874 normotensive patients with PE. We developed a prognostic model for intermediate-risk PE based on the clinical presentation and the assessment of right ventricular dysfunction and myocardial injury. We used a composite of PE-related death, haemodynamic collapse or recurrent PE within 30 days of follow-up as the main outcome measure.The primary outcome occurred in 198 (6.9%) patients. Predictors of complications included systolic blood pressure 90-100 mmHg (adjusted odds ratio (aOR) 2.45, 95% CI 1.50-3.99), heart rate ≥110 beats per min (aOR 1.87, 95% CI 1.31-2.69), elevated cardiac troponin (aOR 2.49, 95% CI 1.71-3.69) and right ventricular dysfunction (aOR 2.28, 95% CI 1.58-3.29). We used these variables to construct a multidimensional seven-point risk index; the odds ratio for complications per one-point increase in the score was 1.55 (95% CI 1.43-1.68; p<0.001). The model identified three stages (I, II and III) with 30-day PE-related complication rates of 4.2%, 10.8% and 29.2%, respectively.In conclusion, a simple grading system may assist clinicians in identifying intermediate-risk PE.
    European Respiratory Journal 04/2014; · 7.13 Impact Factor
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    ABSTRACT: Purpose To report the implantation and retrieval vena cava filter success rate of the ALN filter in a the setting of a prospective randomized trial (PREPIC 2) trial filter subgroup. Materials and Methods Prepic 2 is a prospective open randomized study with a blind evaluation that compared retrievable ALN vena cava filter (ALN Implant Chirurgicaux) maintained for 3 months with no filter insertion in patients receiving anticoagulant therapy for acute symptomatic pulmonary embolism (PE) associated to deep vein thrombosis. The filter retrieval was systematically scheduled at 3 months. The primary goal of this ancillary study is to report the technical success rate of filter implantation and removal. The secondary goal is to report filter related complications. Results Between 08-2006 and 07-2012; 399 patients (median 76 years) with acute PE and no contradiction to anticoagulation were enrolled in 18 centres. 193 patients received an ALN filter after randomization in the filter arm in addition to anticoagulation therapy, using femoral (162) basilic (15) or jugular vein (16), access. Filter wasn’t implanted because of 2(1%) technical failure; 3 (1.5%) non confirmation of PE diagnosis after randomization; and 2 (1%) patients’ death before implantation. post implantation cavogram showed >15° tilting in 19 (9.8%) cases. Minor complications were observed in 20 cases (11.9%): 4 (2%) <20 mm migration; 10 (5.2%) >3 mm filters struts penetration outside the cavogram and 3 1.6%) puncture site hematoma; 5 (2.6%) tilt increase were reported. Among the 166 (92.2%) patients who were referred for extraction after 3 months (93 days [89-98]), retrieval was successfully performed in 92.2% (153). 3 (1.8%) asymptomatic filter thrombosis were observed. Failure of extraction was observed in 13 (7.8%) case, because of >15° tilt (n=9, 5.4%) or non removable fibrotic bridge to IVC n=4/2.4%. Filter removal was successfully performed in an median of 20 min [15-40]. Conclusion The ALN filter was successfully extracted in 92.2% in this multicenter experience with a little complication rate.
    SIR 2014, 3S84; 03/2014
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    ABSTRACT: IMPORTANCE D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. DESIGN, SETTINGS, AND PATIENTS A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013. INTERVENTIONS All consecutive outpatients who presented to the emergency department with clinically suspected PE were assessed by a sequential diagnostic strategy based on the clinical probability assessed using either the simplified, revised Geneva score or the 2-level Wells score for PE; highly sensitive D-dimer measurement; and computed tomography pulmonary angiography (CTPA). Patients with a D-dimer value between the conventional cutoff of 500 µg/L and their age-adjusted cutoff did not undergo CTPA and were left untreated and formally followed-up for a 3-month period. MAIN OUTCOMES AND MEASURES The primary outcome was the failure rate of the diagnostic strategy, defined as adjudicated thromboembolic events during the 3-month follow-up period among patients not treated with anticoagulants on the basis of a negative age-adjusted D-dimer cutoff result. RESULTS Of the 3346 patients with suspected PE included, the prevalence of PE was 19%. Among the 2898 patients with a nonhigh or an unlikely clinical probability, 817 patients (28.2%) had a D-dimer level lower than 500 µg/L (95% CI, 26.6%-29.9%) and 337 patients (11.6%) had a D-dimer between 500 µg/L and their age-adjusted cutoff (95% CI, 10.5%-12.9%). The 3-month failure rate in patients with a D-dimer level higher than 500 µg/L but below the age-adjusted cutoff was 1 of 331 patients (0.3% [95% CI, 0.1%-1.7%]). Among the 766 patients 75 years or older, of whom 673 had a nonhigh clinical probability, using the age-adjusted cutoff instead of the 500 µg/L cutoff increased the proportion of patients in whom PE could be excluded on the basis of D-dimer from 43 of 673 patients (6.4% [95% CI, 4.8%-8.5%) to 200 of 673 patients (29.7% [95% CI, 26.4%-33.3%), without any additional false-negative findings. CONCLUSIONS AND RELEVANCE Compared with a fixed D-dimer cutoff of 500 µg/L, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01134068.
    JAMA The Journal of the American Medical Association 03/2014; 311(11):1117-1124. · 29.98 Impact Factor
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    ABSTRACT: Rationale: Not all patients with acute pulmonary embolism (PE) have a high risk of an adverse short-term outcome. Objectives: This prospective cohort study aimed to develop a multimarker prognostic model that accurately classifies normotensive patients with PE into low and high categories of risk of adverse medical outcomes. Methods: The study enrolled 848 outpatients from the PROTECT study (derivation cohort), and 529 patients from the PREP study (validation cohort). Investigators assessed study participants for a 30-day complicated course, defined as death from any cause, haemodynamic collapse, and/or adjudicated recurrent PE. Measurements and Main Results: A complicated course occurred in 63 (7.4%) of the 848 normotensive patients with acute symptomatic PE in the derivation cohort, and in 24 patients (4.5%) in the validation cohort. The final model included the simplified Pulmonary Embolism Severity Index (sPESI), cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and lower limb ultrasound testing (CCUS). The model performed similarly in the derivation (c-index of 0.75) and validation (c-index of 0.85) cohorts. The combination of the sPESI and BNP testing showed a negative predictive value for a complicated course of 99.1% and 100% in the derivation and validation cohorts, respectively. The combination of all modalities had a positive predictive value for the prediction of a complicated course of 25.8% in the derivation cohort and 21.2% in the validation cohort. Conclusions: For normotensive patients that have acute PE, we derived and validated a multimarker model that predicts all-cause mortality, haemodynamic collapse, and/or recurrent PE within the following 30 days.
    American Journal of Respiratory and Critical Care Medicine 01/2014; · 11.04 Impact Factor
  • Guy Meyer, Olivier Sanchez, Benjamin Planquette
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    ABSTRACT: Five to 10 % of cancers are complicated by venous thromboembolism. A score is available to classify patients according to their risk of venous thromboembolism. The long-term prophylaxis is not recommended in patients with cancer, even if it reduces the incidence of thromboembolic events, due to the high number of patients to treat to prevent one event. The treatment of venous thromboembolism in cancer is based on the use of low-molecular weight heparin for at least 3months. The potential role of antithrombotic drugs in the prevention and adjuvant treatment of some cancers is being evaluated.
    La Presse Médicale 08/2013; · 1.17 Impact Factor
  • La Revue de Médecine Interne 06/2013; 34:A78–A79. · 1.32 Impact Factor
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    ABSTRACT: BACKGROUND: Assessment of pre-test probability of pulmonary embolism (PE) and prognostic stratification are two widely recommended steps in the management of patients with suspected PE. Some items of the Geneva prediction rule may have a prognostic value. We analyzed whether the initial probability assessed by the Geneva rule was associated with the outcome of patients with PE. METHODS: In a post-hoc analysis of a multicenter trial including 1,693 patients with suspected PE, the all-cause death or readmission rates during the 3-month follow-up of patients with confirmed PE were analyzed. PE probability group was prospectively assessed by the revised Geneva score (RGS). Similar analyses were made with the a posteriori-calculated simplified Geneva score (SGS). RESULTS: PE was confirmed in 357 patients and 21 (5.9%) died during the 3-month follow-up. The mortality rate differed significantly with the initial RGS group, as with the SGS group. For the RGS, the mortality increased from 0% (95% Confidence Interval: [0-5.4%]) in the low-probability group to 14.3% (95% CI: [6.3-28.2%]) in the high-probability group, and for the SGS, from 0% (95% CI: [0-5.4%] to 17.9% (95% CI: [7.4-36%]). Readmission occurred in 58 out of the 352 patients with complete information on readmission (16.5%). No significant change of readmission rate was found among the RGS or SGS groups. CONCLUSIONS: Returning to the initial PE probability evaluation may help clinicians predict 3-month mortality in patients with confirmed PE. (ClinicalTrials.gov: NCT00117169).
    Thrombosis Research 05/2013; · 2.43 Impact Factor
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    ABSTRACT: OBJECTIVES: To independently evaluate unenhanced, contrast-enhanced perfusion and angiographic MR sequences for pulmonary embolism (PE) diagnosis. METHODS: Prospective investigation, including 274 patients who underwent perfusion, unenhanced 2D steady-state-free-precession (SSFP) and contrast-enhanced 3D angiographic MR sequences on a 1.5-T unit, in addition to CTA (CT angiography). Two independent readers evaluated each sequence independently in random order. Sensitivity, specificity, predictive values and inter-reader agreement were calculated for each sequence, excluding sequences judged inconclusive. Sensitivity was also calculated according to PE location. RESULTS: Contrast-enhanced angiographic sequences showed the highest sensitivity (82.9 and 89.7 %, reader 1 and reader 2, respectively), specificity (98.5 and 100 %) and agreement (kappa value 0.77). Unenhanced angiographic sequences, although less sensitive overall (68.7 and 76.4 %), were sensitive for the detection of proximal PE (92.7 and 100 %) and showed high specificity (96.1 and 99.1 %) and good agreement (kappa value 0.62). Perfusion sequences showed lower sensitivity (75.0 and 79.3 %), specificity (84.8 and 89.7 %) and agreement (kappa value 0.51), and a negative predictive value of 84.8 % at best. CONCLUSIONS: Compared with contrast-enhanced angiographic sequences, unenhanced sequences demonstrate lower sensitivity, except for proximal PE, but high specificity and agreement. The negative predictive value of perfusion sequences was insufficient to safely rule out PE. KEY POINTS : • Unenhanced angiographic MR sequences are very specific and can identify proximal PE. • Contrast-enhanced MR angiographic sequences show high sensitivity for PE diagnosis. • A normal MR perfusion result does not exclude PE. • Inter-reader agreement is better for angiographic than perfusion MR sequences.
    European Radiology 05/2013; · 4.34 Impact Factor
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    ABSTRACT: AIMS: To assess the clinical performance of pro-B-type natriuretic peptide 1-108 (proBNP) for the prognosis of acute pulmonary embolism. METHODS: This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200™ (Bio-Rade Laboratories). Data was compared with BNP and N-terminal (NT) proBNP values. Adverse outcomes at 30days were defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. RéSULTS: ProBNP values were analysed in 549 patients, with 39 (7.1%) presenting adverse outcomes. All three natriuretic peptides were significantly elevated in these 39 patients compared with the group without adverse outcomes (BNP: p <0.001; NT-proBNP: p <0.001; proBNP: 0.044), with median proBNP values being 605pg/ml (113-1437) and 109pg/ml (30-444), respectively. Multivariate analyses revealed that proBNP significantly depended on patient age (p <0.001) and renal failure (p=0.001), with proBNP values increasing with both factors. The areas under the receiver operating curve were 0.74 (95% CI 0.69-0.79) for BNP, 0.76 (95% CI 0.72-0.80) for NT-proBNP, and 0.70 (95% CI 0.65-0.75) for proBNP, meaning that the performance of proBNP was significantly lower than that of the two other peptides (p=0.017). CONCLUSION: ProBNP, BNP, and NT-proBNP values were significantly increased in patients with adverse outcomes after acute pulmonary embolism. However, the prognostic performance of proBNP for predicting adverse versus favourable outcomes was lower than that of the other natriuretic peptides, thus limiting the clinical relevance of proBNP as a prognostic marker in pulmonary embolism.
    Thrombosis Research 04/2013; · 2.43 Impact Factor
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Publication Stats

2k Citations
490.65 Total Impact Points

Institutions

  • 2008–2014
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • University of Geneva
      • Division of Angiology and Hemostasis
      Genève, GE, Switzerland
  • 2003–2014
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Microbiologie
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Cliniques Universitaires Saint-Luc
      Bruxelles, Brussels Capital Region, Belgium
  • 2012
    • Université Paris-Sorbonne - Paris IV
      Lutetia Parisorum, Île-de-France, France
  • 2008–2012
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2006–2009
    • Centre Hospitalier Universitaire de Brest
      • Département de Médecine Interne et de Pneumologie
      Brest, Brittany, France
    • University of Lausanne
      Lausanne, Vaud, Switzerland
  • 2006–2007
    • Université Paris-Sud 11
      • Faculty of Medicine
      Orsay, Île-de-France, France