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Réactualisation de modèles épidémiologiques et application à la maladie thromboembolique veineuse

Marie-Antoinette Sevestre 1
1 TIMC-ThEMAS - Techniques pour l'Evaluation et la Modélisation des Actions de la Santé
TIMC - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525
Abstract : Venous thrombo-embolism is a heterogenous disease. Clinical presentation, prognosis vary greatly among patients and requires standardization. Using 3 epidemiological studies, we have analyzed, risk factors and diagnostic tools that are described in venous thromboembolism (VTE) and compared clinical forms. The following models have been tested: - two epidemiologic cross sectional studies of elderly patients describing risk factors and asymptomatic thrombosis detected by systematic ultrasound. Elderly patients have specific risk factors like prolonged immobilisation, dependance, age over 79 years, ulcers. The benefit of prevention is established and enhanced by a 15% rate of asymptomatic venous thromboses. Despite this, the benefit of antithrombotic compression is not proven and deserves further work. - The Optimev study, a national survey about 8256 clinical suspicions of VTE, describes risk factors and clinical description and long term follow-up for positive and negative patients. Calf vein thrombosis is the clinical form mostly prevalent (n=787). Actual analysis of clinical forms like isolated pulmonary embolism (n=130) show that mortality is close to controls in patients with PE without DVT ( 4%) whereas it is close to 13% in patients with PE with DVT; thus, the presence of DVT when diagnosis PE is of clinical importance. Deep vein thromboses and muscular thromboses are compared; they share the same risk factors and 3 month's mortality, clinical presentation is different; deep vein thromboses are more associated with swelling but less painful than muscular ones. 3 month follow-up shows that a negative ultrasound rules out VTE safely as well for in and out-patients. A clinical prediction rule for upper extremity DVT is also presented. Future works such as : 3 years follow-up, superficial venous thromboses, post thrombotic syndrome and qualification of past episodes of VTE are warranted Mots clés
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Marie-Antoinette Sevestre. Réactualisation de modèles épidémiologiques et application à la maladie thromboembolique veineuse. Sciences du Vivant [q-bio]. Université Joseph-Fourier - Grenoble I, 2010. Français. ⟨tel-00558755⟩

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