Laurent Bertoletti

Laurent Bertoletti
Université Jean Monnet · Faculté de Médecine

MD, PhD

About

372
Publications
43,755
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3,954
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Introduction
I'm a chest physician, working in the vascular department of the Universitary Hospital of Saint-Etienne. Fighting vascular diseases, particularly pulmonary vascular diseases, as pulmonary embolism and pulmonary hypertensions.
Additional affiliations
September 2014 - present
Centre Hospitalier Universitaire de Saint-Étienne
Position
  • Professor of Medicine - Therapeutics
November 2010 - present
Centre Hospitalier Universitaire de Saint-Étienne
Position
  • Medical Doctor
November 2009 - October 2010
University of Geneva
Position
  • Médecin Visiteur

Publications

Publications (372)
Article
Chronic obstructive pulmonary disease (COPD) is a moderate risk factor for venous thromboembolism (VTE), but neither the clinical presentation nor the outcome of VTE in COPD patients is well known. The clinical presentation of VTE, namely pulmonary embolism (PE) or deep venous thrombosis (DVT), and the outcome at 3 months (death, recurrent VTE or b...
Article
Key Points The incidence of venous thromboembolism is high in patients with a solid tumor and implanted port in the real-life practice setting. The risk factors for catheter-related thrombosis differ from those for venous thromboembolism unrelated to the catheter.
Article
Full-text available
Background Pulmonary embolism is one of the leading causes of maternal death in the Western world. Because of the low specificity and sensitivity of the d-dimer test, all pregnant women with suspected pulmonary embolism undergo computed tomographic (CT) pulmonary angiography or ventilation–perfusion scanning, both of which involve radiation exposur...
Article
Pulmonary hypertension (PH)comprises a cluster of severe conditions characterized by elevated mean pulmonary arterial pressure. While targeted therapies have been approved over the last twenty years for pulmonary arterial hypertension (PAH)and chronic-thrombo-embolic PH (CTEPH), the possible role of anticoagulant therapy as a supportive treatment P...
Article
Full-text available
Importance The prevalence of pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acutely worsening respiratory symptoms remains uncertain. Objective To determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms. Design, Setting, and Part...
Article
Objective Retrievable inferior vena cava filters (IVCF) have been developed because permanent filters have been associated with an increased risk of recurrent deep venous thrombosis. There is no data on the interactions of IVCF with the inferior vena cava (intrafilter thrombi, insertion through the venous wall) even though this may alter the course...
Article
Preliminary data and clinical experience have suggested an increased risk of abnormal uterine bleeding (AUB) in women of reproductive age treated with anticoagulants, but solid data are lacking. The TEAM-VTE study was an international, multicentre, prospective cohort study in women aged 18-50 diagnosed with acute venous thromboembolism (VTE). Menst...
Article
Importance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). Objective: To determine the clinical characteristics, short-term, and 1-year outc...
Article
Full-text available
Risk stratification is recommended for patients with pulmonary embolism (PE), and usually starts with the assessment of the hemodynamic status and the simplified Pulmonary Embolism Severity Index (sPESI). The influence of acute kidney injury (AKI) on the prognostic stratification has not been evaluated according to the “Kidney Disease: Improving Gl...
Article
Introduction The gastrointestinal (GI) tract is a frequent site of bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE). At-risk patients have not been consistently identified yet. Methods We used the RIETE registry to assess the clinical characteristics of patients developing major GI bleeding during the course of...
Article
Objective: The aim of this study was to quantify fatigue and quality of life (QoL) in people self-reporting chronic venous disease (CVD) symptoms or at risk of CVD within a large cohort representative of the French population. The relationship between self-reported physical activity and both fatigue and QoL was also investigated. We hypothesized t...
Article
Full-text available
This article aims to summarise the latest research presented at the virtual 2021 European Respiratory Society (ERS) International Congress in the field of pulmonary vascular disease. In light of the current guidelines and proceedings, knowledge gaps are addressed and the newest findings of the various forms of pulmonary hypertension as well as key...
Article
Rationale: SARS-Cov2 infection is associated with pulmonary endothelial dysfunction. There is limited data available on the outcomes of COVID-19 in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives: To describe characteristics and outcomes of patients with precapillary PH and COVI...
Article
Full-text available
Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis. Limited contemporary data exist about the utilization of each modality, including the predictors of using V/Q versus CTPA. We used the data from patients diagnosed with PE using V/Q or CTPA from 2007...
Article
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Article
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Article
Background Sex is an important factor associated with pulmonary embolism (PE) disease presentation and outcomes, which may be related to pathobiological, social, and treatment-based differences. We are seeking to illuminate sex differences in pulmonary embolism presentation, care, and outcomes using an international registry and a national US datab...
Article
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Article
11th International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC), Bergamo, ITALY, MAY 27-29, 2022
Article
Full-text available
During the past decade, emergence of direct oral anticoagulants (DOACs) has drastically improved the prevention of thrombosis. However, several unmet needs prevail in the field of thrombosis prevention, even in the DOACs' era. The use of DOACs is still constrained and the drugs cannot be administered in every clinical scenario, such as an increased...
Article
Heparins and vitamin K antagonists are the mainstay of treatment for splanchnic vein thrombosis (SVT). Rivaroxaban is a potential alternative, but data to support its use are limited. We aimed to evaluate the safety and efficacy of rivaroxaban for the treatment of acute SVT. In an international, single-arm clinical trial, adult patients with a firs...
Article
Full-text available
Pulmonary embolism is a frequent and potentially fatal disease. The major challenge of initial management lies in prognostic stratification. Since 2014, the European recommendations on the diagnosis and management of acute pulmonary embolism are based on assessing the risk stratification regarding hemodynamic status first, then on a combined risk a...
Article
Objectives: To identify patients at high risk of developing cardiovascular disease through the identification of risk factors among a large population of breast cancer women and to assess the performance of Abdel-Qadir risk prediction model score. Materials and methods: The medical records and baseline characteristics of all patients/tumors diag...
Article
Objectifs Il a récemment été mis en lumière que des lésions rénales aiguës (Acute Kidney Injury [AKI]) peuvent survenir chez près d’un tiers des patients présentant une embolie pulmonaire (EP), responsables d’un risque accru d’hémorragie et de décès toutes causes à 30 jours. Cependant, la récupération rénale après AKI chez ces patients n’est pas co...
Article
La première cause d’admission aux urgences pour effets indésirables de médicaments est l’hémorragie sous antithrombotiques. Parmi les antithrombotiques, le risque d’hémorragie est classiquement porté par les anticoagulants, mais l’exposition au traitement antiagrégant plaquettaire augmente aussi ce risque. L’association anticoagulant-antiagrégant p...
Article
Introduction & Objectifs Le dépistage et le diagnostic de l’artériopathie oblitérante des membres inférieurs (AOMI) reposent sur le calcul de l’index de pression systolique de cheville (IPSc), cette méthode étant validée et réalisée en routine par tout Médecin Vasculaire. L’IPSc est néanmoins surestimé et non fiable en cas de médiacalcose posant la...
Article
Introduction: Management of venous thromboembolic events (VTE) has been completely changed after the introduction of direct oral anticoagulants (DOAC). VTE is common in the geriatric population, but the management of DOACs remains complex because of the lack of specific data in this polymedicated fragile population. An exhaustive search of antico...
Preprint
Background Venous thromboembolism (VTE) and cancer are strongly associated. In France, evidence on patients with pancreatic, upper GI [gastrointestinal], lower GI, lung, or breast cancer-associated VTE and their hospital management is limited.Methods This longitudinal, observational, and retrospective study was based on the comprehensive hospital d...
Article
Background: Direct oral anticoagulants (DOACs) are now an option in the prevention and treatment of venous thromboembolic events (VTE) in patients with active cancer. Pharmacokinetics of DOACs are largely influenced by efflux transporters derived from ABC transporters, notably by P-glycoprotein (P-gp). Objective: The aim of this study was to ass...
Article
Full-text available
Platelets are anucleate cytoplasmic fragments derived from the fragmentation of medullary megakaryocytes. Activated platelets adhere to the damaged endothelium by means of glycoproteins on their surface, forming the platelet plug. Activated platelets can also secrete the contents of their granules, notably the growth factors contained in the α-gran...
Article
Full-text available
Background: Thromboembolic events frequently complicate the course of malignancy and represent a major cause of morbidity and mortality in cancer patients. In contrast to chemotherapy and other systemic therapies, little is known about the impact of ionizing radiations on the incidence of venous thromboembolism (VTE) in cancer patients. Methods:...
Article
Introduction: Data from clinical trials indicate that direct oral anticoagulants (DOACs) are non-inferior and safer than conventional therapy (low-molecular weight heparin followed by a vitamin K antagonist [VKA]) for treating venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism (PE). This study compared the eff...
Article
Full-text available
Pulmonary arterial hypertension (PAH) is a rare disease characterised by pulmonary vascular remodelling and elevated pulmonary pressure, which eventually leads to right heart failure and death. Registries worldwide have noted a female predominance of the disease, spurring particular interest in hormonal involvement in the disease pathobiology. Seve...
Article
Full-text available
This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European R...
Article
Full-text available
Background: Renal dysfunction influences outcomes after pulmonary embolism (PE). We aimed to determine the incremental value of adding renal dysfunction, defined by estimated glomerular filtration rate (eGFR), on top of the European Society of Cardiology (ESC) prognostic model, for the prediction of 30-day mortality in acute PE patients, which in...
Article
Background: The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting a lesser severity of illness. The clinical importance of patients with pulmonary embolism isolated to the subsegmental vessels is unknown. Objective: To determine the rate of recurrent venous thromboembolism in patients with...
Article
Introduction: Anticoagulation plays a crucial role in the treatment of splanchnic vein thrombosis (SVT), including thrombosis of the portal (PVT), mesenteric (MVT) and splenic (SpVT) veins. Rivaroxaban is a potential alternative to heparins and vitamin K antagonists (VKA) in these patients, but data to support its use are scant. Several recent guid...
Article
Full-text available
BACKGROUND: Cancer is a major risk factor for venous thromboembolism (VTE) and for all-cause mortality following a VTE event. Higher risk can be attributed to certain cancer types and to metastatic disease. Until recently the gold standard for VTE and active cancer was low molecular weight heparin (LMWH), shown to be superior to warfarin in prevent...
Article
Background Concomitant anticoagulant and antiplatelet therapy increases bleeding risk, but most data are derived from patients with atrial fibrillation. Patients with venous thromboembolism (VTE) may differ. Objective To study the management of patients diagnosed with acute VTE while receiving antiplatelet treatment. The primary outcome was the nu...
Article
Background RCT evidence has shown that direct oral anti-coagulants (DOACs) are at least as effective and safer in terms of bleeding, compared to vitamin K antagonists (VKAs) in the treatment of acute venous thromboembolism (VTE). Purpose To compare the risks of recurrent VTE and of bleeding leading to hospitalisation, in patients treated with DOAC...
Article
Background: The time-course response after a single injection of botulinum toxin (BoNT) for post-stroke spasticity is debated. We addressed this issue by conducting a systematic review and a pharmacodynamic model-based meta-analysis. Methods: We searched Medline, PeDro and Google Scholar databases up to March 2020, selecting randomized controlle...
Article
Background: Direct oral anticoagulants (DOACs) are an alternative to low-molecular-weight heparin for treating cancer-associated venous thromboembolism (VTE). Research question: Is rivaroxaban as efficient and safe as dalteparin to treat patients with cancer-associated VTE? Study design and methods: In a randomized open-label non-inferiority t...
Article
Importance: Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). Objective: To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Design, setting, and participants:...
Article
Background There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with venous thromboembolism (VTE). Many clinically important subgroups (including the elderly, those with recent bleeding, and pregnant patients) have been under-represented in clinical trials. Further, design of clinical trials i...
Article
Introduction L’utilisation concomitante d’un traitement anticoagulant et antiagrégant plaquettaire augmente le risque hémorragique. La plupart des données sont issues des patients traités pour une fibrillation auriculaire. Les patients avec une maladie thromboembolique veineuse (MTEV) peuvent être différents. Objectifs L’objectif est de décrire le...
Article
Introduction Le SARS-CoV-2, nouveau virus respiratoire, semble prédisposer à la survenue de maladie thromboembolique veineuse (MTEV). Cela s’explique par sa pathogénie particulière qui reste encore mal comprise. Des études sont nécessaires pour caractériser ces patients. Objectif L’objectif principal est de décrire les patients hospitalisés au CHU...
Article
Contexte Il y a un manque de connaissances en ce qui concerne la présentation, la prise en charge et le devenir des patients présentant une maladie thromboembolique veineuse (MTEV). De nombreux sous-groupes cliniquement pertinents (comme les personnes âgées, les hémorragies récentes et les patientes enceintes) ont été sous-représentés dans les essa...
Article
Objectifs La prise en charge de la maladie thromboembolique veineuse (MTEV) nécessite la prise en compte de la fonction rénale pour les modalités diagnostiques et thérapeutiques. Le registre RIETE a permis de produire des données importantes concernant ces interactions. Matériel et méthode Le registre RIETE est le plus grand registre clinique en c...
Article
Contexte L’incidence de la maladie veineuse thromboembolique associée au cancer est en augmentation. Les essais thérapeutiques ont permis d’évaluer les HBPM par rapport aux AVK et plus récemment les AOD par rapport aux HBPM dans cette population. Le rapport bénéfice/risque du traitement pourrait être différent sur le site du cancer. Objectifs Éval...
Article
La pandémie liée à l’apparition du SARS-CoV2 a profondément challengé les modalités d’organisation des soins, mais aussi de recherche clinique et fondamentale. D’abord compris comme un virus responsable d’une infection respiratoire, les données actuelles réorientent plutôt notre compréhension de la pathologie COVID-19 comme une infection virale, re...
Article
The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding...
Article
Introduction Thanks to the emergence of new therapeutics, prognosis and outcome of breast cancer patients (any subtype) have improved significantly. This raises the issue of the interactions and side effects related to the use of multiple drugs. Thus, to decide on a treatment the optimal benefit risk-ratio should be carefully watched as toxicities...
Article
Background Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre-specified characteristics of ACPs with a recen...
Article
Full-text available
Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acu...
Article
The effect of renal impairment (RI) on risk of bleeding and recurrent thrombosis in cancer patients treated with direct oral anticoagulants for venous thromboembolism (VTE) is undefined. We run a prespecified analysis of the randomized Caravaggio study to evaluate the role of RI as risk factor for bleeding or recurrence in patients treated with dal...
Article
Full-text available
Isolated distal deep–vein thrombosis (DVT, infra-popliteal DVT without pulmonary embolism) is a common presentation of venous thromboembolism (VTE), but was an exclusion criterion from the pivotal trials that validated the use of direct oral anticoagulants (DOACs) for VTE management. Using data from the international RIETE registry, we analyzed and...
Article
Full-text available
This study aimed to explore the validity of the use of the net clinical benefit (NCB), i.e. the sum of major bleeding and thrombotic events, as a potential surrogate for all-cause mortality in clinical trials assessing antithrombotics. Published randomized controlled trials testing anticoagulants in the prevention or treatment of venous thromboembo...
Article
Obstructive sleep apnea (OSA) is characterized by repeated episodes of intermittent hypoxia (IH) and is recognized as an independent risk factor for vascular diseases that are mediated by a multitude of mechanistic pathophysiological cascades including procoagulant factors. The pro-coagulant state contributes to the development of blood clots and t...
Article
Objectives We explored the variations in use of imaging modalities for confirming pulmonary embolism (PE) according to the trimester of pregnancy.Methods We included all pregnant patients with confirmed acute PE from RIETE, a prospective registry of patients with PE (03/2001–02/2020). Imaging modalities included computed tomography pulmonary angiog...
Article
Introduction Les acquisitions tomoscintigraphiques couplées à la TDM (TEMP/TDM) ont révolutionné l’imagerie en médecine nucléaire. Dans l’embolie pulmonaire aigue (EP), la TEMP/TDM est largement utilisée bien que nécessitant encore des validations cliniques dans des études randomisées. Beaucoup d’études s’intéressent aux améliorations des performan...
Article
Rationale: The relationship between initial treatment strategy and survival in pulmonary arterial hypertension (PAH) remains uncertain. Objectives: To evaluate long-term survival in PAH according to initial treatment strategy. Methods: Retrospective analysis of incident patients with idiopathic, heritable or anorexigen-induced PAH enrolled in the F...
Article
Full-text available
The outbreak of 2019 novel coronavirus disease (Covid-19) has deeply challenged the world population, but also our medical knowledge. Special attention has been paid early to an activation of coagulation, then to an elevated rate of venous thromboembolism (VTE) in patients hospitalized with severe COVID-19. These data suggested that anticoagulant d...
Article
3094 Background: Venous thromboembolic event (VTE) is a frequent complication of cancer, as of some classical cancer therapy, like chemotherapy and surgery. The advent of new therapies such as immunotherapy and targeted therapies has meant that new therapies may be associated with VTE. Reliable data concerning the association between ADs and VTE ar...
Article
In Reply Using a validated pulmonary embolism diagnostic algorithm based on the Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound, our study found that pulmonary embolism was diagnosed in 5.9% of patients hospitalized with COPD with acutely worsening respiratory symptoms.¹ In his let...
Poster
Full-text available
Introduction. Lower extremity chronic venous disease (CVD) is a common cause of lower extremity pain and discomfort in the adult population of Western countries. The typical self-reported symptoms of CVD are aching, cramping, fatigue, heaviness, restlessness, and swelling. Physical activity is often evoked as a non-pharmacological and non-surgical...