[Pharmacological Thromboprophylaxis in Acutely Ill Hospitalized Medical Patients]. / Thromboprophylaxie pharmacologique chez les patients hospitalisés pour une affection médicale aiguë.

Venous thromboembolic events (VTE) occur in approximately 50% of cases during or following hospitalization; VTE are a major cause of morbidity and mortality. Thromboprophylaxis for 6 to 14 days with heparins or fondaparinux has been demonstrated to be effective in VTE prevention in patients hospitalized for acute medical illnesses and reduced mobility. Nevertheless, the level of recommendation has been gradually downgraded as the benefit has been mainly demonstrated on the basis of systematic imaging diagnosed events. Direct oral anticoagulants have been assessed only as an extended prophylaxis, and are currently not recommended in medical thromboprophylaxis. Assessing the risk of VTE and bleeding in medical patients is complex. VTE and bleeding risk assessment scores were constructed but have not been validated. In order to improve the adequacy of prescriptions for thromboprophylaxis, the impact of different interventions has been the subject of several studies but these yielded varying results. The aim of this review is to analyze the indications for thromboprophylaxis in a medical setting with the latest available data.

Educational diagnosis of patients under oral anticoagulant therapy: Development of a 4-category patient profiling score based on a retrospective study and prospective analysis.

BACKGROUND: Oral anticoagulants are used in numerous pathologies and their consumption is growing. However, to prevent their occurrence, their use should be supervised and the patients educated. Patients vary in understanding and compliance. Therefore, it seems necessary to standardize educational diagnosis with a patient profiling score to adapt therapeutic education to the individual patient profile. METHOD: A retrospective study based on observation of consecutive patients treated by an oral anticoagulant therapy and involved in a therapeutic education program conducted between October 2014 and December 2015. A 12-item questionnaire distinguished 4 profiles based on the educational diagnosis. In a prospective double-blind study including consecutive patients with an indication to anticoagulants and admitted to the Internal Medicine department of the Louis-Mourier Hospital (AP-HP, University of Paris), the patient's profile defined by a clinician using the questionnaire was compared to the one defined by the Therapeutic Education Leader after standardized educational diagnosis. RESULTS: The questionnaire was tested prospectively in 53 patients, 26 of which had also a complete therapeutic education by the TEP leader. In any case, the assessment assisted by the questionnaire succeeded in identifying the patient profile, as determined by the therapeutic education specialist. CONCLUSION: The present questionnaire helps identify different patient profiles and therefore standardize educational diagnosis. The perspective is to adapt therapeutic education to individual patient profile, with the objective to improve compliance.

Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis.

International academic and regulatory guidelines consistently recommend the long-term use of low-molecular-weight heparins (LMWHs) as the standard for the treatment of cancer-associated thrombosis (CAT). However, both physicians and patients are reluctant to follow established guidelines. Insufficient compliance with treatment recommendations among care physicians represents a loss of opportunity for patients at very high risk of recurrence of venous thromboembolism (VTE) and death. Few data are available regarding adherence to CAT clinical practice guidelines. Based on published data, we aimed to review the gap between guidelines and practice to draw a more precise picture of current practice in order to precisely identify the extent to which patient management is currently lacking with respect to treatment guidelines. Published observational studies, registries and surveys on cancer-associated VTE treatment were reviewed. In spite of evidence from randomized controlled trials (RCTs) showing the usefulness of long-term LMWH, only approximately 50% of patients are managed according to established guideline recommendations. Patient profiles and co-morbidities influence compliance with standard guidelines. A better knowledge of physician and patient-related factors that influence therapeutic decisions may improve the implementation of clinical practice guidelines. Efficient awareness programs including a multidisciplinary approach are necessary to implement guidelines aimed at optimizing the therapeutic management of cancer-associated VTE.

PO-13 - Production of a functional thrombopoietin by a human ovarian cancer cell line.

INTRODUCTION: Hemostatic abnormalities are frequently noticed in patients with malignant diseases. These complications include platelets disorders. The role of platelets in cancer extends beyond thrombocytosis and thrombosis, and also platelets promote cancer growth and metastatic dissemination. In the physiology, platelet production is regulated by thrombopoietin, which is mainly secreted by the liver. We, previously, reported that thrombopoietin could be secreted by the ovarian adenocarcinoma cell line, OVCAR-3. AIM: Our main purpose is to analyze the gene expression of thrombopoietin in ovarian cancer cells and to assess its functionality. MATERIALS AND METHODS: The thrombopoietin gene expression in ascitic cells from patients with ovarian carcinomatosis, as well as, in three cancer cell lines, including OVCAR-3 cells, performed using reverse transcription PCR, real-time PCR and gene sequencing, Normal human ovary and liver tissues are used as controls. The functionality of thrombopoietin on the basis of the viability of a thrombopoietin-dependent cell line (Ba/F3) using a co-culture method. RESULTS: Similarly to liver and ovary tissues, all cancer cells lines express the three TPO-1 (full length TPO), TPO-2 (12bp deletion) and TPO-3 (116pb deletion) variants. By flow cytometry, we show that thrombopoietin production by OVCAR-3 could be increased when cells are stimulated by activated protein C. Lastly, Our results confirm that activated protein C may act, in a paracrine fashion, to boost thrombopoietin production. CONCLUSIONS: We report, for the first time, that thrombopoietin secreted by ovarian cancer cells is functional. Hence, thrombopoietin produced by tumor cells may have a direct effect on thrombocytosis/thrombosis occurrence in patients with ovarian cancer.