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.

Impacto clínico de las nuevas estrategias en anticoagulación oral para la fibrilación auricular / Clinical impact of new approaches to oral anticoagulation therapy in atrial fibrillation

Objetivo: Describir el tratamiento anticoagulante recibido por los pacientes con fibrilación auricular (FA) ingresados en un área de observación (AO) de un servicio de urgencias hospitalario (SUH) así como el grado de adecuación del mismo a las indicaciones de los protocolos de la American Heart Association (AHA) de 2001 y 2006 y el impacto que tiene en los porcentajes de adecuación el cambio de indicación que ha existido durante este periodo. Método: Estudio observacional, prospectivo y sin intervención. Se incluyeron pacientes ingresados en el AO con el diagnóstico principal de FA durante un período de 3 años consecutivos. Se recogieron los datos clínicos generales y de la FA más relevantes y el tratamiento anticoagulante-antiagregante prescrito al alta del AO. Se comprobó el grado de adecuación de dicho tratamiento a ambos protocolos de la AHA y el porcentaje de cambios en las indicaciones que ha supuesto el cambio de indicación de las guías. Resultados: Se incluyeron 789 pacientes (edad media 67 años, 52% mujeres): 90 (12%)correspondieron a FA crónica, 262 (33%) a primeros episodios y 436 (55%) a FA paroxísitica. De los 185 pacientes con primer episodio de FA dados de alta del AO, 61 de ellos lo fueron con tratamiento anticoagulante. De éstos, 52 fueron dados de alta con FA controlada (100% bien descoagulados según ambas guías) y 9 en ritmo sin usal (100%bien descoagulados según las guías de 2001, pero 55% según las guías de 2006). Delos 370 pacientes con FA paroxística dados de alta, fueron descoagulados 167 (el 45%)cuando según las guías de 2001 debieran haberlo sido el 54% (un 9% más de lo realizado en el AO) y según las de 2006 un 28% (un 17% menos de lo realizado en el AO).Conclusión: La prescripción de anticoagulantes en la FA en urgencias no se ajusta estrictamente a lo recomendado en las guías de la AHA, si bien los cambios en los (..) (AU)

Objective: To describe the oral anticoagulation therapy received by patients with atrial fibrillation (AF) admitted in an Emergency Department Observation Unit (OU) and to determine the adjusting degree of this therapy to the indications included in the American Heart Association (AHA) protocols 2001 and 2006, and also the impact that it has in the adjusting percentage of the indication change that has existed during this period. Method: Observational, prospective and no interventional trial. Patients admitted in an OU diagnosed of AF for a 3 years consecutive period were included. General clinical data were taken and from the most relevant AF and from the anticoagulant-antiplatelet treatment prescribed when the patients were discharged from the OU. The adjusting degree of this treatment was checked to both AHA protocols and the change percentage in the indications that has implied the indication change of these guides. Results: 789 patients were included (average age 67 years, 52% women): 90 (12%) corresponding to chronic AF, 262(33%) to first episodes and 436 (55%) to paroxystic AF. From 185 patients with AF first episode discharged from de OU,61 were prescribed with anticoagulant therapy. From these, 52 were discharged with controlled AF (100% welldecoagulated, according to both guides) and 9 with sinusal rate (100% well decoagulated according to the 2001guides, but 55% according to the 2006 guides). From the 370 patients with paroxystic AF discharged, 167 (45%) weredecoagulated, although according to the 2001 guides should have been 54% (9% more than carried out in the OU) and according to the 2006 guides 28% (17% less than carried out in the OU).Conclusion: Anticoagulant prescription in AF in an Emergency Department doesn’t adjust exactly to recommended in AHA guides, although the criteria changes produced in those make possible a change from an under treatment situationto another one of overtreatment (AU)

[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.