Perfil clínico y satisfacción con el tratamiento anticoagulante en pacientes con fibrilación auricular no valvular atendidos en consultas de medicina interna y neurología de España / Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain

Objetivo. Determinar el perfil clínico, el manejo del tratamiento anticoagulante y la satisfacción relacionada con la anticoagulación en pacientes con fibrilación auricular no valvular atendidos en consultas de neurología o medicina interna de España. Pacientes y métodos. Estudio prospectivo, transversal y multicéntrico en el que se incluyó a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenían de consultas de neurología, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenían más hipertensión, diabetes, insuficiencia cardíaca, insuficiencia renal y arteriopatía periférica. Los pacientes atendidos en neurología tenían más antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones más altas fueron en neurología. El 56,1% tomaba antagonistas de la vitamina K, lo que era más común en medicina interna. El porcentaje de tiempo en rango terapéutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfacción con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurología, y mayor con los anticoagulantes orales de acción directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clínico de los pacientes con fibrilación auricular atendidos en neurología o medicina interna, todos presentaban múltiples comorbilidades y un riesgo tromboembólico elevado. A pesar de que el control del índice internacional normalizado fue pobre, el anticoagulante oral más empleado fueron los antagonistas de la vitamina K. La satisfacción con el tratamiento anticoagulante oral fue alta (AU)

Aim. To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. Patients and methods. Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. Results. 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. Conclusions. Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high (AU)

Implicación de la cocaína en la patología vascular cerebral / Involvement of cocaine in cerebral vascular pathology

Objetivo. Describir la implicación de la cocaína en la patología vascular cerebral en pacientes jóvenes. Pacientes y métodos. Es un estudio descriptivo del papel de la cocaína en pacientes con ictus agudo menores de 50 años ingresados en el servicio de neurología durante cuatro años. Se analizan 18 pacientes con niveles de cocaína positivos en el momento del ingreso y 79 pacientes con niveles negativos. Se recogen y analizan distintas variables que definen el perfil de riesgo vascular, características del ictus y morbimortalidad asociada a éstos. Resultados. Se obtiene un predominio de varones y mayor proporción de factores de riesgo vascular no significativa en el grupo control (55,6% frente a 64,6%). El grupo de consumidores presenta de manera significativa una menor edad media (35,2 ± 8,9 frente a 41,5 ± 7,7 años), mayor consumo de tóxicos (tabaco, alcohol y cannabis), hiperCKemia (27,8% frente a 5,1%) y trastorno psiquiátrico (16,7% frente a 3,8%) (p < 0,05). Predomina el subtipo de ictus isquémico en territorio anterior para ambos grupos. Hay una clara tendencia a la normalidad de las pruebas complementarias, mayor índice de complicaciones (33,3% frente a 15,2%) y mortalidad (11,1% frente a 3,8%) en los consumidores (p > 0,05). Conclusiones. La cocaína es un factor de riesgo que hay que tener en cuenta en adultos jóvenes, asociado a ictus a edades más tempranas de lo habitual, con tendencia a la normalidad de las pruebas complementarias y una mayor morbimortalidad hospitalaria (AU)

Aim. To describe the involvement of cocaine in cerebral vascular pathology in young patients. Patients and methods. The work consists in a descriptive study of the role of cocaine in patients with acute stroke under the age of 50 years admitted to the neurology service over a period of four years. Eighteen patients with positive levels of cocaine on admission and 79 patients with negative levels were analysed. Different variables that define the profile of vascular risk, characteristics of the stroke and the morbidity and mortality associated to them are collected and analysed. Results. Males were predominant and there was a non-significant higher proportion of vascular risk factors in the control group (55.6% versus 64.6%). The group of consumers presented a significantly lower mean age (35.2 ± 8.9 versus 41.5 ± 7.7 years), higher consumption of toxic substances (tobacco, alcohol and cannabis), hyperCKemia (27.8% versus 5.1%) and psychiatric disorders (16.7% versus 3.8%) (p < 0.05). The ischaemic stroke in the anterior territory subtype was predominant in both groups. There was a clear tendency towards normality in complementary tests and a higher rate of complications (33.3% versus 15.2%) and mortality (11.1% versus 3.8%) among consumers (p > 0.05). Conclusions. Cocaine is a risk factor that must be taken into account in young adults: it is associated to stroke at earlier ages than is considered normal, with a tendency towards normality in complementary tests and a higher rate of hospital morbidity and mortality (AU)

[Involvement of cocaine in cerebral vascular pathology]. / Implicación de la cocaína en la patología vascular cerebral.

AIM: To describe the involvement of cocaine in cerebral vascular pathology in young patients. PATIENTS AND METHODS: The work consists in a descriptive study of the role of cocaine in patients with acute stroke under the age of 50 years admitted to the neurology service over a period of four years. Eighteen patients with positive levels of cocaine on admission and 79 patients with negative levels were analysed. Different variables that define the profile of vascular risk, characteristics of the stroke and the morbidity and mortality associated to them are collected and analysed. RESULTS: Males were predominant and there was a non-significant higher proportion of vascular risk factors in the control group (55.6% versus 64.6%). The group of consumers presented a significantly lower mean age (35.2 ± 8.9 versus 41.5 ± 7.7 years), higher consumption of toxic substances (tobacco, alcohol and cannabis), hyperCKemia (27.8% versus 5.1%) and psychiatric disorders (16.7% versus 3.8%) (p < 0.05). The ischaemic stroke in the anterior territory subtype was predominant in both groups. There was a clear tendency towards normality in complementary tests and a higher rate of complications (33.3% versus 15.2%) and mortality (11.1% versus 3.8%) among consumers (p > 0.05). CONCLUSIONS: Cocaine is a risk factor that must be taken into account in young adults: it is associated to stroke at earlier ages than is considered normal, with a tendency towards normality in complementary tests and a higher rate of hospital morbidity and mortality.