Tiphaine Belleville

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

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Publications (4)0.3 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Elderly patients of 80 years and above are commonly frail, due to substantial comorbid conditions and numerous medications. Managing elderly patients receiving vitamin K antagonists (VKA) is challenging because those patients are at high risk of both thrombosis and bleeding. Special considerations on the choice of the VKA drug, dosing and monitoring have to be taken into account in the elderly in order to avoid over-anticoagulation and to minimize the haemorrhagic risk which consequences may be dramatic or fatal in this age group. In these patients, INR monitoring is crucial, especially at the start of treatment. The use of dosing algorithms specifically developed for elderly patients allows to decrease over-anticoagulation during the initiation period. INR has to be monitored more frequently in case of acute illness or in case of modification of the associated drugs. Patient information and education are of great importance, even in geriatric patients and has been shown to improve the quality of anticoagulation. Even though the use of direct oral anticoagulants is currently expanding, prescribing VKA in elderly patients in whom the prevalence of severe renal insufficiency remains up to date.
    Annales de biologie clinique. 04/2014; 72(2):185-192.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2011; 32.
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    ABSTRACT: Les patients âgés, souvent polypathologiques et polymédiqués sont des sujets fragiles à haut risque hémorragique. Il existe des spécificités pour le choix, le maniement et la surveillance des antivitamine-K qu’il convient de ne pas méconnaître pour éviter les surdosages et limiter le risque d’une hémorragie dont les conséquences peuvent être dramatiques voire fatales dans cette tranche d’âge. Chez ces patients, les antivitamine-K impliquent une surveillance accrue de l’INR (International Normalized Ratio), notamment en début de traitement. Le recours à des schémas posologiques spécifiques du sujet âgé permet de limiter les surdosages pendant cette période. L’INR doit être contrôlé en cas d’affection intercurrente aiguë ou lors de toute modification du traitement médicamenteux. L’éducation thérapeutique est importante, même dans la population gériatrique: la qualité de l’information retentit sur la qualité de l’équilibre du traitement par antivitamine K. Les nouveaux anticoagulants par voie orale, avec une marge thérapeutique plus large, sont attendus avec un grand intérêt. Elderly patients are commonly frail, due to a lot of comorbid conditions and numerous medications. These patients are at high risk of bleeding when treated with vitamin K antagonist (VKA). Special considerations on the choice of VKA drug, dosing and monitoring have to be taken into account in the elderly in order to avoid over-anticoagulation and to minimize the haemorrhagic risk which consequences may be dramatic or fatal in this age group. In these patients, INR monitoring is crucial, especially at the start of treatment. The use of dosing algorithms specifically developed for elderly patients allows to decrease over-anticoagulation during the initiation period. INR has to be monitored more frequently in case of acute illness or in case of modification of the associated drugs. Patient education is of great importance, even in geriatric patients and has been shown to improve the quality of anticoagulation. New oral anticoagulants with a wider therapeutic index seem to be of great interest. Mots clésantivitamine K–anticoagulant oral–sujet âgé–INR–éducation thérapeutique Keywordsvitamin K antagonist–oral anticoagulant–elderly–INR–patient education
    Bio Tribune Magazine 01/2010; 35(1):10-14.
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    ABSTRACT: We report a case of Hodgkin's lymphoma in a patient aged 75, presenting with acute cardiopulmonary insufficiency, hospitalized in a geriatrics ward. The deterioration of his general condition and the discovery of several lymph nodes led us to perform an aspiration of a lymph node and a bone marrow biopsy. Reed-Sternberg cells, pathognomonic of Hodgkin's disease were identified on the smears and biopsy sections. Due to the poor condition of the patient, it was decided not to treat with chemotherapy. The diagnostic approach and treatment strategy of Hodgkin's disease are summarized in this paper, especially the particular features of the disease in the elderly.
    Annales de biologie clinique 69(3):319-24. · 0.30 Impact Factor

Publication Stats

0.30 Total Impact Points

Institutions

  • 2010
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France