乳腺浸润性筛状癌的临床病理及免疫表型

目的 探讨乳腺浸润性筛状癌（invasive cfibriform carcinoma,ICC）的临床病理及免疫表型特点。方法 收集6例ICC的临床资料,观察它们HE形态,并进行免疫组化检测,选用的-抗有CK5、CK（34βE12）、CK8、S-100蛋白、SMA、CD10、ER、PR、c-erbB-2、CgA、PCNA、E-cad。结果 本研究将ICC分为两组：经典型和混合型。它们具有以下特征：①以浸润性筛状结构占优势,细胞排列成浸润性的有棱角的岛屿状,筛孔较不规则。肿瘤细胞小,呈低或中级核级,核分裂象罕见。在多数癌巢周围有反应性纤维母细胞性间质增生。②免疫表型：肌上皮标记（S-100蛋白、SMA、CDl0）及cK（34βE12）肿瘤细胞巢均阴性,而个别肿瘤累及的TDLU周围部分肌上皮标记阳性;激素受体（ER、PR）均阳性;c-erbB-2阴性,PCNA、E-cad呈不同程度的阳性;CgA均阴性。③临床资料：经典型ICC年龄均值较混合型ICC大,肿块大小较混合型ICC小,病程较混合型ICC短,腋窝淋巴结转移少见,转移灶仍保持筛状结构。结论 ICC有其独特的组织学特征及免疫表型,是一种独立的临床病理类型。     

乳腺实性乳头状癌伴浸润性癌临床病理分析

目的探讨乳腺实性乳头状癌(solid papillary carcinoma,SPC)伴浸润性癌的临床病理特点、组织学特征和免疫表型。方法收集乳腺SPC伴浸润性癌8例,总结该组病变的临床资料,采用HE及免疫组化En Vision两步法染色检测组织病理学特征。结果乳腺SPC伴浸润性癌好发于老年女性,平均发病年龄55.5岁,其发生率约占SPC总病例的30%。肿瘤最常见的临床特征为乳腺肿块和乳头溢液,伴浸润癌常见的类型为乳腺非特殊类型癌和黏液癌,亦常伴神经内分泌分化。SPC伴浸润性癌时,浸润癌周边及其癌巢内肌上皮染色均为阴性。SPC与伴随的浸润癌区域ER、PR均阳性且阳性率较高(≥70%),HER-2均阴性,Ki-67增殖指数均≤10%。神经内分泌免疫组化标记Cg A及Syn均双阳性或单个阳性。结论 SPC可能是低级别乳头状导管原位癌的变异型,其具有进展为其他类型乳腺浸润性癌的潜能。SPC可能为伴神经内分泌分化乳腺黏液癌及非特殊类型癌原位癌阶段的病变。     

腮腺低度恶性筛状囊腺癌3例临床病理分析

目的：探讨涎腺低度恶性筛状囊腺癌( low-grade crib-riform cystadenocarcinoma, LGCCC)的临床病理特征、诊断和鉴别诊断、治疗及预后。方法对3例LGCCC的形态学和免疫表型进行分析并复习相关文献。结果(1)3例LGC-CC中2例为女性,1例为男性。年龄分别为51、60、65岁,肿物均发生在腮腺。组织学特征与乳腺不典型增生至低级别导管原位癌相似,由多个囊及邻近的导管内增生构成,囊内及导管内增生的导管上皮呈筛状、微乳头状和实性结构。(2)免疫表型：肿瘤细胞CK(AE1/AE3)、S-100均弥漫阳性, CEA、EMA部分腔内细胞阳性;癌巢周围细胞示肌上皮标志物如 p63、SMA、Calponin、CK5/6呈连续的阳性。结论LGCCC临床罕见,确诊需依靠病理学及免疫组化检查,应注意与其它良恶性肿瘤鉴别诊断。     

含有鳞状细胞癌成分的乳腺化生性癌临床病理特征

目的探讨含有鳞状细胞癌成分的乳腺化生性癌(metaplastic carcinoma with squamous cell component,MCSC)的临床病理特征和免疫表型特点。方法复习20例MCSC的临床病理资料,总结其巨检、组织学、免疫表型和预后特点。结果本组肿瘤中纯鳞状细胞癌(squamous cell carcinoma,SCC)6例、腺鳞癌(adenosquamous carcinoma,ASC)13例、癌肉瘤1例。全组平均发病年龄52·4岁,多表现为无痛性乳腺肿块。SCC和ASC腋淋巴结转移率分别为60%和66·7%。巨检45%病例呈囊性。镜下角化型SCC2例、棘层松解型1例、角化与棘层松解混合型2例、角化与梭形细胞混合型1例。ASC中的SCC成分均为角化型,腺癌成分则为浸润性导管癌,仅1例混有少量黏液癌。1例癌肉瘤含有鳞癌、腺癌和软骨肉瘤成分。进行免疫组化染色病例的SCC成分均呈CK34βE12、CK5/6、CK14和p63阳性,ER、PR阴性。5例腺癌成分呈CK34βE12灶性阳性,各有1例腺癌成分灶性表达CK14和CK5/6。CK8阳性见于所有腺癌成分,仅1例SCC成分呈灶性阳性。SMA在本组肿瘤的腺鳞两种成分均呈阴性。结论MCSC以ASC最为常见,眼观呈囊性是其特点之一。SCC成分的组织学类型和分化程度存在不同程度变异。CK14、p63和CK8作为一种组合可能有助于SCC的鉴别诊断。规范诊断标准的大样本研究将会提供更有价值的临床病理资料。     

气管腺样囊性癌3例报道并文献复习

目的 探讨气管腺样囊性癌的病理临床特征,以提高对肿瘤的认识.方法 对3例气管腺样囊性癌进行临床及组织学观察,并用免疫组化方法研究肿瘤的免疫表型.结果 气管腺样囊性癌主要发生于气管支气管,呈浸润性生长,临床症状无特征;组织学上呈筛状、管状和实性生长方式;肿瘤导管上皮表达EMA和CK8,基底细胞表达p63和SMA,肿瘤细胞还表达CD117、S-100和NSE;肿瘤发展缓慢,长期预后不佳.结论 气管腺样囊性癌是一种少见肿瘤,组织学形态、免疫组化染色及特染有助于气管腺样囊性癌的诊断及鉴别诊断.     

乳腺包裹性乳头状癌3例临床病理分析并文献复习

目的探讨乳腺包裹性乳头状癌(encapsulated papillary carcinoma,EPC)的临床病理学特征、诊断、鉴别诊断。方法收集3例乳腺EPC的临床病理资料,分析其临床病理组织学特征及免疫表型,并复习相关文献总结该肿瘤的临床病理学特征。结果 3例均为绝经后女性,年龄62~75岁,平均67岁,临床以乳腺肿块就诊。肿块均为单发,呈囊实性结节,边界清楚,有厚囊壁,内附细颗粒样或小乳头样物。该肿瘤的组织形态学以厚纤维囊壁、缺乏肌上皮的纤细乳头状结构为主要成分,在不同区域乳头分支呈筛状或实体状。肿瘤性乳头轴心及周缘的肌上皮细胞缺失是其主要形态特征。肿瘤细胞ER均强阳性,HER-2呈弱阳性,PR 2例呈阳性、1例呈阴性,Calponin、CK5/6、p63染色示肌上皮细胞在肿瘤的乳头轴心及周缘均完全缺失,肿瘤细胞Ki-67增殖指数为5%~10%。结论 EPC属于厚的纤维囊壁且囊壁肌上皮缺乏特殊亚型浸润性癌,预后较好,临床治疗与导管原位癌(ductal carcinoma in situ,DCIS)标准类似。     

乳腺恶性导管内乳头状病变28例临床病理分析

目的探讨乳腺恶性导管内乳头状病变的临床病理学特征、诊断、鉴别诊断及预后。方法回顾性分析28例乳腺恶性导管内乳头状病变的临床表现,观察其组织病理学及免疫表型特征,收集随访资料并复习相关文献。结果 28例患者均为女性,平均年龄55.7岁,主要表现为乳头溢液和乳腺肿块。组织学类型:导管内乳头状癌22例、包膜内乳头状癌2例及实性乳头状癌4例。镜检:肿瘤呈乳头状或实体状,可见纤细的纤维血管轴心。肿瘤细胞形态多一致,细胞核级别低。免疫组化标记示大部分患者肿瘤细胞ER和PR均呈强阳性,HER-2、CK5/6均呈阴性;结节内CK5/6、p63、SMA均呈阴性。实性型者部分可表达CD56、Syn、CgA。Ki-67增殖指数平均为5.3%。27例获得随访资料,随访10~79个月,患者均存活。结论乳腺恶性导管内乳头状病变好发于老年女性,组织学形态多样,诊断需结合临床、组织学形态及免疫表型,应与导管内乳头状瘤鉴别。该肿瘤具有较为惰性的生物学行为,预后较好。     

浸润性乳腺Paget病3例并文献复习

目的：探讨浸润性乳腺Paget病(invasive mammary Paget disease,invMPD)的临床病理特征。方法：回顾性分析3例浸润性乳腺Paget病的临床资料和病理资料并复习文献。结果：3例患者均有乳头糜烂,1例伴有乳头溃疡,1例同侧乳腺左侧外上象限浸润性癌,1例伴有同侧乳腺高级别导管内癌。组织学表现为具有典型的乳腺Paget病的特征,可见小的浸润灶突破基底膜,浸润真皮浅层。免疫组织化学示肿瘤细胞均表达ER、CK7、EMA;2例表达PR,2例HER-2(3+),1例HER-2(2+),Ki67从40%~60%;S-100、P63均阴性。结论：浸润性乳腺Paget病是一种罕见的肿瘤,与非浸润性乳腺Paget病(non-invasive mammary Paget disease,non-invMPD)有相似的预后。     

原发性乳腺淋巴上皮瘤样癌临床病理观察

目的观察乳腺原发性淋巴上皮瘤样癌(lymphoepithelioma-like carcinoma,LELC)的临床病理变化和免疫组化特征,以提高人们对该肿瘤的认识。方法对2例原发于乳腺的LELC的临床病理学和组织病理学特征进行观察,结合免疫表型并复习文献。结果 2例均为中年女性,临床均表现为无痛性肿块,肿瘤呈多结节状或弥漫状生长,肿瘤细胞呈卵圆形或多边形,核空泡状,核仁明显,核膜厚,间质有大量小淋巴细胞浸润。免疫表型:肿瘤细胞表达CK7、CK8/18和E-cadherin,缺乏表达ER、PR和c-erbB-2,原位分子杂交检查示EBV阴性,肿瘤细胞Ki-67增殖指数约30%。结论发生于乳腺的LELC极其少见,临床病理学特征和免疫表型与普通乳腺浸润性癌类似,病理诊断时需与乳腺发生的髓样癌和经典型霍奇金淋巴瘤进行鉴别。患者预后较好。     

乳腺腺样囊性癌18例临床病理分析

目的探讨乳腺腺样囊性癌(adenoid cystic carcinoma of the breast,ACC)的临床病理特征、免疫表型及其鉴别诊断。方法复习18例ACC的临床病理资料,观察肿瘤的组织形态学及免疫表型特点。同时对患者进行随访获取预后信息。结果 18例ACC患者均为女性,年龄29～80岁。肿瘤大体上多界限清楚,镜下呈浸润性生长,主要由筛状、管状-梁索状、实体和微囊结构组成。肿瘤成分包括腺上皮、肌上皮、基底样细胞和细胞外基质。肿瘤的腺上皮成分表达CK7、CK5/6和CD117,肌上皮成分表达SMA和p63,基底样细胞不同程度表达CK5/6、p63和CD117。随访期内有2例患者肿瘤局部复发,无患者死亡。结论 ACC是一组具有形态学异质性的肿瘤,其腺上皮、肌上皮和基底样细胞成分的免疫表型各有特点,联合运用CK7、CK5/6、p63、SMA和CD117有助于诊断与鉴别诊断。ACC预后良好,具有基底样特征的实体型ACC可能是侵袭性更强的组织学亚型。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

État de l’art : nouveaux anticoagulants et transfusion

Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.