[Thrombopenia induced by heparin: treatment with Org 10172. Tolerability and efficacy]. / Thrombopénie induite par l'héparine: traitement par l'ORG 10172. Tolérance et efficacité.

OBJECTIVES: Heparin-induced thrombocytopenia is a relatively common and potentially serious adverse complication of heparin treatment. After heparin withdrawal initiation of an alternative anticoagulant is often indicated. Org 10172 or Orgaran is a mixture of several non-heparin low molecular weight glycosaminoglycans with proven antithrombotic efficacy. Unlike low molecular weight heparins, Org 10172 has a low cross reaction rate (about 10%) with the heparin-dependent antibody. METHODS: We present nine patients with heparin induced thrombocytopenia. Org 10172 was prescribed to treat or to prevent a thromboembolic event. RESULTS: Seven patients required further parenteral anticoagulant at diagnosis of heparin-induced thrombocytopenia. Org 10172 was given at prophylactic doses for three patients with a high thrombosis risk and at therapeutic doses for four patients who presented either a venous or an arterial thrombosis related to thrombocytopenia. Two patients presented heparin-induced thrombocytopenia four to six years earlier and needed a parenteral anticoagulation treatment in a post-operative period. CONCLUSION: For the nine patients, Org 10172 was a safe and effective antithrombotic treatment. However, strict monotoring of the platelet count is absolutely mandatory during Org 10172 therapy.

[Calibrated side-to-side portacaval anastomosis in the treatment of bleeding from ruptured esophageal varices. Results in 38 cirrhotic patients]. / L'anastomose porto-cave latéro-latérale calibrée dans le traitement des hémorragies par rupture de varices oesophagiennes. Résultats à propos de 38 patients cirrhotiques.

We report the clinical results of 38 calibrated side-to-side portocaval shunts performed in patients with hemorrhagic liver cirrhosis (alcoholic in 90 percent of cases). The operative mortality (at 2 months) was 10.5 percent. The rate of recurrent bleeding was 2.6 percent; hepatic encephalopathy was encountered in 16 percent (acute encephalopathy: 6.5 percent; chronic encephalopathy: 9.6 percent; this rate decreased to 3.2 percent after anastomotic narrowing). Hepatopedal portal blood flow was maintained in 74.3 percent of cases in the early postoperative period (83.3 percent since the portacaval pressure gradient was maintained at 2/3 of the initial gradient) and disappeared with time in 75 percent of cases. The survival rates at 1 and 4 years were 79.4 percent and 60 percent, respectively, for all patients (94.4 and 83.3 percent for Child A patients) with a normal social activity in 90 percent of cases. Twelve patients developed hepatocellular carcinoma. These clinical results are similar to those observed after selective shunts and suggest that the side-to-side calibrated portacaval shunt is an excellent procedure for the treatment of bleeding esophageal varices in case of failure or contraindication to endoscopic sclerotherapy or in patients with chronic ascites and good liver function.

[Marion's calibrated latero-lateral portacaval anastomosis: a truncular shunt maintaining hepatopetal portal blood flow?]. / L'anastomose porto-cave latéro-latérale calibrée de Marion: une dérivation tronculaire maintenant un flux portal hépatopète?

The authors report the hemodynamic study of 22 cases of calibrated side-to-side portacaval shunts performed in patients with liver cirrhosis. In all patients, hepatopetal portal blood flow was present before the operation. According to the data obtained by scintiangiography and angiography, hepatopetal portal flow was maintained in 70 p. 100 of the patients immediately after the operation. After one year there was a discrepancy between the results of scintiangiography and those of conventional angiography: while portal flow seemed to be hepatopetal on the scintigraphy in 11 of controlled patients, it decreased or disappeared on the angiography in 6 other controlled patients. These results are comparable to those of selective shunts and suggest that the calibrated side-to-side portacaval shunt is a valuable procedure in maintaining hepatopetal portal flow. A controlled trial would be useful to assess the place of this operation in the treatment of portal hypertension due to cirrhosis.