Anticoagulación oral en la fibrilación auricular: ¿qué guía el uso de los nuevos fármacos? / Oral anticoagulation in atrial fibrillation: What is the guideline for using new drugs?

Objetivo: Valorar si existen diferencias entre los pacientes con fibrilación auricular (FA) en los que se inicia tratamiento en Urgencias con los anticoagulantes de acción directa (DOAC) y los antivitamina K (AVK). Método: Estudio descriptivo, observacional, prospectivo. Se seleccionaron pacientes con FA que acudieron durante un año a un servicio de urgencias hospitalarias. Resultados: Este estudio incluyó 492 pacientes con FA. Se inició anticoagulación en 189, 104 con AVK (55%) y 85 con DOAC (45%). El grupo AVK: edad media de 76,1 años, 50,9% hombres y 49,1% mujeres, con un CHA2DS2-VASc medio de 3,2±1,3 y un HAS-BLED medio de 1,9±0,8. El grupo DOAC: edad media de 73,4 años, 37,6% hombres y 63,3% mujeres, con un CHA2DS2VASc medio de 3,1±1,6 y un HAS-BLED de 1,7±0,8. Analizando los antecedentes médicos de los pacientes destacó que en el grupo AVK el 17,3% presentaba ACV previo y el 13,5% valvulopatía significativa, y en el grupo DOAC, un 7,1 y un 1,2%, respectivamente. Analizando los diferentes DOAC destacó que en el grupo de dabigatrán el 24,2% presentaba ACV previo y en el de rivaroxabán el 22,7% tenía cardiopatía isquémica. Conclusiones: Los pacientes con FA que inician tratamiento en Urgencias con AVK o con DOAC presentan un perfil similar de edad, sexo y puntuaciones CHA2DS2-VASc y HAS-BLED. Los pacientes con antecedentes de valvulopatía o cardiopatía isquémica recibieron más AVK que DOAC. Si existe antecedente de ictus el DOAC más utilizado es dabigatrán, y si existen antecedentes de cardiopatía isquémica se prefiere rivaroxabán

Objective: To assess whether there are differences between atrial fibrillation (AF) patients initiating new direct-acting oral anticoagulants (DOAC) therapy and vitamin K antagonist (VKA) therapy in an emergency service. Methods: Descriptive, observational, prospective study. We enrolled patients with AF who were visited in a hospital emergency service over one year. Results: This study included 492 patients with AF, and 189 subjects received anticoagulant therapy, 104 with VKA (55%), and 85 with DOAC (45%). The VKA group: mean age 76.1 years, male 50.9% and female 49.1%, CHA2DS2-VASc mean 3.2±1.3 points, and a HAS-BLED mean of 1.9±0.8 points. The DOAC group: mean age 73.4 years, male 37.6% and female 63.3%, CHA2DS2-VASc mean 3.1±1.6 points, and a HAS-BLED mean of 1.7±0.8 points. On analysing the medical history, 17.3% of patients in the VKA group had a previous stroke, and 13.5% significant valve disease, as well as 7.1 and 1.2% of patients, respectively, in the DOAC group. In the analysis of the DOAC types, 24.2% of patients in the dabigatran group had a previous stroke, 22.7% in the rivaroxaban group had ischaemic heart disease. Conclusions: Patients with AF who start on treatment in emergency services with VKA or with DOAC show a similar profile of age, gender, CHA2DS2-VASc score, and HAS-BLED score. The patients with a history of valvular or ischaemic heart disease received more VKA than DOAC. When the patient has a history of stroke, the DOAC more used is dabigatran, and in patients with ischaemic heart disease it is preferred to give rivaroxaban

[Oral anticoagulation in atrial fibrillation: What is the guideline for using new drugs?] / Anticoagulación oral en la fibrilación auricular: ¿qué guía el uso de los nuevos fármacos?

OBJECTIVE: To assess whether there are differences between atrial fibrillation (AF) patients initiating new direct-acting oral anticoagulants (DOAC) therapy and vitamin K antagonist (VKA) therapy in an emergency service. METHODS: Descriptive, observational, prospective study. We enrolled patients with AF who were visited in a hospital emergency service over one year. RESULTS: This study included 492 patients with AF, and 189 subjects received anticoagulant therapy, 104 with VKA (55%), and 85 with DOAC (45%). The VKA group: mean age 76.1 years, male 50.9% and female 49.1%, CHA2DS2-VASc mean 3.2±1.3 points, and a HAS-BLED mean of 1.9±0.8 points. The DOAC group: mean age 73.4 years, male 37.6% and female 63.3%, CHA2DS2-VASc mean 3.1±1.6 points, and a HAS-BLED mean of 1.7±0.8 points. On analysing the medical history, 17.3% of patients in the VKA group had a previous stroke, and 13.5% significant valve disease, as well as 7.1 and 1.2% of patients, respectively, in the DOAC group. In the analysis of the DOAC types, 24.2% of patients in the dabigatran group had a previous stroke, 22.7% in the rivaroxaban group had ischaemic heart disease. CONCLUSIONS: Patients with AF who start on treatment in emergency services with VKA or with DOAC show a similar profile of age, gender, CHA2DS2-VASc score, and HAS-BLED score. The patients with a history of valvular or ischaemic heart disease received more VKA than DOAC. When the patient has a history of stroke, the DOAC more used is dabigatran, and in patients with ischaemic heart disease it is preferred to give rivaroxaban.

[Characteristics and management of epileptic seizures in emergency department and diagnostic correlation at discharge]. / Características y manejo de las crisis epilépticas en urgencias y su correlación diagnóstica tras el ingreso.

BACKGROUND: Patients with seizures are common in the emergency department (ED), yet little is known regarding the management of these patients. This study was performed to define the demographic characteristics of patients with seizure disorders in the ED patient population and to determine final disposition, diagnostic and therapeutic activities, and to evaluate the concordance between provisional and definitive diagnosis. MATERIAL AND METHODS: We recorded prospectively all patients which were diagnosed of seizure in ED of Hospital Clínico of Zaragoza between November 1th and April 30th. Chart review was used to gather definitive diagnosis regarding these patients. RESULTS: Of the 54,022 patients who presented to the ED during the study period, 137 (0.36%) had complains related to seizures. Sixty one (44%) of these patients were admitted to the hospital. New-onset seizures were thought to be present in 60% of patients. Blood work was abnormal in 12% of patients and 48% of patients had pathological findings in neuroimaging study. False positive diagnosis was present in 33% of patients. The most important trigger of seizures in epileptic patients was tapped suddenly the antiepileptic drug treatment. CONCLUSIONS: We found a false positive diagnosis in 33% of patients, and the most important confounding pathology was sincope and stroke. High percentaje of pathological findings in neuroimaging studies were found. Electroencefalographic and toxicological studies were performed less than is recommended.

Características y manejo de las crisis epilépticas en urgencias y su correlación diagnóstica tras el ingreso / Characteristics and management of epileptic seizures in emergency department and diagnostic correlation at discharge

Introducción: las crisis convulsivas suponen un porcentaje elevado de las consultas en los servicios de urgencias, pero poco es conocido en relación al manejo y derivación de estos enfermos. El objetivo fue conocer el perfil de los pacientes que acuden a urgencias con crisis epilépticas, las medidas diagnósticas y terapéuticas, destino de los pacientes tras su valoración, así como la concordancia entre el diagnóstico inicial y definitivo de estos pacientes. Material y métodos: registramos prospectivamente todos los pacientes que acudieron al Servicio de Urgencias del Hospital Clínico de Zaragoza durante el periodo comprendido entre el 1 de noviembre del 2004 y 30 de abril del 2005 y que fueron diagnosticados de crisis comicial. Posteriormente se revisaron las historias clínicas de aquellos pacientes ingresados para determinar el diagnóstico definitivo. Resultados: de los 54.022 pacientes atendidos a urgencias, 137 (0,25%) fueron diagnosticados de crisis convulsiva, requiriendo ingreso hospitalario 61 (44%). Las crisis de novo representaron el 60% de los pacientes ingresados. Un 12% fueron secundarios a alteraciones analíticas y un 48% de los pacientes presentaron hallazgos patológicos en la neuroimagen; la falta de cumplimiento terapéutico con bajos niveles plasmáticos de fármacos fue el principal factor precipitante en los epilépticos conocidos. Los falsos positivos representaron el 33% de los diagnósticosde urgencias. Conclusiones: encontramos un tercio de errores respecto al diagnóstico de urgencias, siendo la causa más frecuente de error los síncopes y los ictus. Elevado porcentaje de diagnóstico etiológico por neuroimagen así como la escasez en la realización de electroencefalogramas y estudios toxicológicos

Background: Patients with seizures are common in the emergency department (ED), yet little is known regarding the management of these patients. This study was performed to define the demographic characteristics of patients with seizure disorders in the ED patient population and to determine final disposition, diagnostic and therapeutic activities, and to evaluate the concordance between provisional and definitive diagnosis. Material and methods: We recorded prospectively all patients which were diagnosed of seizure in ED of Hospital Clínico of Zaragoza between November 1th and April 30 th. Chart review was used to gather definitive diagnosis regarding these patients. Results: Of the 54,022 patients who presented to the ED during the study period, 137 (0.36%) had complains related to seizures. Sixty one(44%) of these patients were admitted to the hospital. New-onset seizures were thought to be present in 60% of patients. Blood work was abnormal in 12% of patients and 48% of patients had pathological findings in neuroimaging study. False positive diagnosis was present in 33% ofpatients. The most important trigger of seizures in epileptic patients was tapped suddenly the antiepileptic drug treatment. Conclusions: We found a false positive diagnosis in 33% of patients,and the most important confounding pathology was sincope and stroke.High percentaje of pathological findings in neuroimaging studies werefound. Electroencefalographic and toxicological studies were performed less than is recommended