[Clopidogrel and thrombopenia. A case report]. / Clopidogrel et thrombopénie. A propos d'un cas.

We report our experience with a case of isolated profound thrombocytopenia after clopidogrel (thienopyridine) administration. No adverse event such as bleeding or thrombotic event had occurred, although clopidogrel has been discontinued two weeks after the coronary artery stenting. Despite the safety of clopidogrel, this case demonstrates that clopidogrel can be associated not only with thrombotic thrombocytopenic purpura but also with isolated thrombocytopenia.

[Factors determining the improvement of effort capacity in aged patients with coronary disease during the 1st month following coronary surgery]. / Facteurs déterminant l'amélioration de la capacité à l'effort des coronariens âgés dans le premier mois suivant la chirurgie coronaire.

UNLABELLED: In order to determine the predictive factors of improvement of the physical capacity of elderly coronary patients following coronary surgery, we retrospectively analysed the data of 204 consecutive patients over the age of 65 years (181 men, 23 women, mean age: 70 +/- 4.4 years), admitted for a phase II active training programme. METHODS: The patients were divided into two groups as a function of the rate of improvement of the duration of the stress test: group A (improvement greater than or equal to 25%; n = 108) and group B (less than 25%; n = 96). Comparison of these 2 groups by multivariate analysis identified predictive factors of improvement among seven variables: age, sex, excess weight, haemoglobin, number of training sessions, duration of baseline stress test, interval between bypass graft and start of training. RESULTS: After training, the duration of the stress test and the maximal power were improved by 26.5% and 24%, respectively: 7.1 +/- 1.7 vs 8.9 +/- 2.3 minutes (p = 0.0001); 79 +/- 18.4 vs 97.8 +/- 23.7 watts (p = 0.0001). 34 (1.4%) of the 2,396 training sessions were temporarily interrupted, because of muscle fatigue in 47% of cases. Patients who had readapted before the 15th postoperative day presented fewer incidents: 4.3% vs 13.1%; NS. Only three variables appeared to be predictive of improvement of physical capacity: a duration less than 6 minutes on the baseline stress test (p = 0.0003), more than 12 training sessions (p = 0.0029) and age less than or equal to 70 years (p = 0.014). CONCLUSION: In elderly subjects undergoing coronary surgery, the improvement of physical capacity is greater the lower the baseline effort, the lower the age-group and the greater the number of training sessions. In the absence of contraindication, it appears justified to include elderly coronary patients in training programmes, even when their baseline effort level appears to be low. This training can be started by the 15th postoperative day.

[Rehabilitation of aged patients with bicycle ergometer after coronary surgery]. / Réadaptation des patients âgés sur cyclo-ergomètre au décours de la chirurgie coronaire.

This study was undertaken to assess the contraindications to rehabilitation by exercise testing on a bicycle ergometer and the tolerance of this procedure in elderly patients recovering from coronary surgery. One hundred and eighty-four patients aged over 65 years were included (Group I). The rehabilitation program consisted of exercise testing on admission period. The results were compared with those of 146 patients aged 65 or less (Group II). Twenty-six per cent of the elderly patients had a contraindications to this type of rehabilitation compared with only 4.8% in Group II. The main contraindications were extracardiac (21.7%), including infectious causes (4.3%), neuropsychiatric (3.3%), respiratory (2.7%) and rheumatological conditions (2.2%). Cardiac causes represented only 4.3% of the contraindications. In the patients undergoing the training program, the maximum power and the duration of exercise testing increased respectively from 81 +/- 17 to 97 +/- 21 watts (+21% ; p < 10(-3)) and 7 +/- 1.7 to 9 +/- 2 minutes (+28.6%, p < 10(-3)). The change in these parameters was comparable in the other group: 94.5+/- to 118 +/- 26 watts (+24.8% ; p < 10(-3)) and 8.5 +/- 1.9 to 10.9 +/- 2.4 minutes (+28.2% ; p < 10(-3)). On the other hand, the rate-pressure product decreased slightly in the elderly patients (-5.5% ; p = 0.07, compared with -13% in Group II, p = 0.001). Complications were rare: 1.6% of temporary interruption of a session (versus 0.6%). No serious complications were observed. The authors conclude that, after coronary surgery, the majority of elderly coronary patients can participate in physical training programs on bicycle ergometers without major complications. In the absence of contraindications, patients, and even elderly patients, should be encouraged to enroll for these programs after coronary bypass surgery.