[Which antithrombotic treatment should be used in the treatment of an elderly patient with chronic atrial fibrillation?]. / Quel traitement antithrombotique chez un patient âgé en fibrillation auriculaire chronique?

UNLABELLED: FREQUENCY AND CONSEQUENCES: The incidence of atrial fibrillation (AF) increases regularly with age and affects nearly 10% of persons aged over 80. The risk of thromboembolism (notably stroke) associated is enhanced the older the patient and the more cardiovascular risk factors she/he exhibits. ADVANTAGES AND RISKS OF ANTICOAGULANTS: Treatment with anticoagulants is the only treatment that has demonstrated its efficacy in reducing the risks of thromboembolism, however there is a risk of haemorrhage. IN PRACTICE: A patient with AF exhibits both a risk of thromboembolism and a risk of haemorrhage. When confronted with such patients, the practitioner must choose an antithrombotic (anticoagulant or anti-arrhythmic agent) after careful objective and individual assessment of all the risks present in a given patient.

[An aetiological survey of venous thromboembolic disease. What examinations for which patients? 104 observations]. / L'enquête étiologique dans la maladie thromboembolique veineuse. Quels examens pour quels patients? 104 observations.

OBJECTIVE: The objective of the study was to determine, depending on the risk profile of the patients and characteristics of the venous thromboembolic disease (VTED), the interest of an aetiological control in the search for a neoplasia or abnormality in haemostasis among a cohort of patients hospitalised for deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). METHOD: This was a single centre, retrospective study of 104 files of patients hospitalised over a period of 3 years for DVT and/or PE in a department of internal medicine, in an intensive care unit. The patients included must have been diagnosed with DVT and/or PE, confirmed by respectively venous Doppler, pulmonary scintigraphy and pulmonary angiography or spiralled tomodensitometry. The thromboembolic risk factors and the supplementary examinations conducted for etiological research were analysed. RESULTS: In our population, with a mean age of 71.4 years, 98 patients exhibited at least one thromboembolic risk factor. The thromboembolic episode was considered as idiopathic in 33 patients, i.e. in 31.7%. An abnormality in haemostasis was discovered in 10 patients, with a mean age of 57.5 years and 7 exhibited personal or familial past history of venous thromboembolic disease. Nine neoplasia were discovered, 4 of which were at metastatic stage. There was no significant difference in discovery of a neoplasia with regard to age, but it was more frequent in cases of seemingly idiopathic thrombosis. Anamnesis and the clinical examination suggested its existence in 6 patients. Abdominal-pelvic sonography was sufficient to orient the etiological research in 7 cases. The other examinations without clinical orientation (endoscopy, tumour markers) provided no further contribution. CONCLUSION: We feel that systemic exhaustive survey in search of the etiology of a DVT/PE in all patients is not warranted. Simple explorations--including interrogation, complete clinical examination, current biological examinations (blood count, sedimentation rate), pulmonary x-ray and abdominal-pelvic sonography--were evocative in our series. Haemostasis tests should be reserved for young patients or for those in whom thromboembolic events occur repeatedly. The more specific examinations should be set-aside for patients in whom this first assessment has not suggested an underlying carcinoma.