Skip to main content
SpringerLink
Log in

Anticoagulation d’une fibrillation auriculaire aux urgences

Anticoagulation for atrial fibrillation in the emergency room

  • Mise au Point / Update
  • Published:
Annales françaises de médecine d'urgence

Résumé

Une composante majeure de la prise en charge d’une fibrillation auriculaire (FA) aux urgences est la prescription d’anticoagulant pour réduire le risque d’accident thromboembolique. Si une évaluation du risque thromboembolique est recommandée chez tous les patients, la prescription d’antithrombotiques doit être nuancée en fonction du risque propre à chaque patient. Ce risque varie en fonction de la durée de la FA, de facteurs de risque thromboembolique personnels, et d’une éventuelle cardioversion, spontanée ou provoquée. La prescription d’antithrombotiques doit aussi être nuancée en fonction du risque hémorragique et des préférences du patient. Le but de cette revue est de familiariser les urgentistes avec l’emploi des anticoagulants, anciens ou nouveaux, en cas de FA découverte aux urgences.

Abstract

A major component of the management of atrial fibrillation (AF) in the emergency room is the anticoagulation prescription to reduce the risk of thromboembolism. If a thromboembolic risk assessment is recommended in all patients, prescription of antithrombotic agents must be qualified according to the risk of each patient. This risk varies depending on the duration of AF, personal thromboembolic risk factors and eventual cardioversion, spontaneous or provoked. Prescription of antithrombotic must also be qualified according to the bleeding risk and patient preferences. The purpose of this review is to familiarize emergency physicians with the use of anticoagulants, old or new, in case of AF discovered in the emergency room.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Référence

  1. Khoo CW, Lip GY (2009) Acute management of atrial fibrillation. Chest 135:849–59

    Article  PubMed  CAS  Google Scholar 

  2. del Arco C, Martín A, Laguna P, Gargantilla P, Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR) (2005) Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study. Ann Emerg Med 46:424–30

    Article  PubMed  Google Scholar 

  3. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  4. You JJ, Singer DE, Howard PA, et al (2012) Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e531S–575S

    Article  PubMed  CAS  Google Scholar 

  5. Weigner MJ, Caulfield TA, Danias PG, et al (1997) Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med 126:615–620

    PubMed  CAS  Google Scholar 

  6. Stoddard MF, Dawkins PR, Prince CR, Longaker RA (1995) Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Am Heart J 129:1204–1215

    Article  PubMed  CAS  Google Scholar 

  7. Lamas G (2012) How much atrial fibrillation is too much atrial fibrillation? N Engl J Med 366:178–180

    Article  PubMed  CAS  Google Scholar 

  8. Gage BF, Waterman AD, Shannon W, et al (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870

    Article  PubMed  CAS  Google Scholar 

  9. Schirmer SH, Baumhäkel M, Neuberger HR, et al (2010) Novel anticoagulants for stroke prevention in atrial fibrillation: current clinical evidence and future developments. J Am Coll Cardiol 56:2067–2076

    Article  PubMed  CAS  Google Scholar 

  10. Lip GY, Nieuwlaat R, Pisters R, et al (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 137:263–272

    Article  PubMed  Google Scholar 

  11. Pisters R, Lane DA, Nieuwlaat R, et al (2010) A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–1100

    Article  PubMed  Google Scholar 

  12. Fihn SD (1995) Aiming for safe anticoagulation. N Engl J Med 333:54–55

    Article  PubMed  CAS  Google Scholar 

  13. Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146:857–867

    PubMed  Google Scholar 

  14. Berger M, Schweitzer P (1998) Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 82:1545–1547

    Article  PubMed  CAS  Google Scholar 

  15. Potier K, Parris R (2005) Best evidence topic report. Anticoagulation post-cardioversion of acute atrial fibrillation in the emergency department. Emerg Med J 22:275–276

    Google Scholar 

  16. Nagarakanti R, Ezekowitz MD, Oldgren J, et al (2011) Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 123:131–136

    Article  PubMed  CAS  Google Scholar 

  17. von Besser K, Mills AM (2011) Is discharge to home after emergency department cardioversion safe for the treatment of recentonset atrial fibrillation? Ann Emerg Med 58:517–520

    Article  Google Scholar 

  18. Burton JH, Vinson DR, Drummond K, et al (2004) Electrical cardioversion of emergence department patients with atrial fibrillation. Ann Emerg Med 44:20–30

    Article  PubMed  Google Scholar 

  19. Xavier Scheuermeyer F, Grafstein E, Stenstrom R et al (2010) Thirty-day outcomes of emergency department patients undergoing electrical cardioversion for atrial fibrillation or flutter. Acad Emerg Med 17:408–415

    Article  PubMed  Google Scholar 

  20. Stiell IG, Clement CM, Perry JJ, et al (2010) Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM 12:181–191

    PubMed  Google Scholar 

  21. Michael JA, Stiell IG, Agarwal S, Mandavia DP (1999) Cardioversion of paroxysmal atrial fibrillation in the emergency department. Ann Emerg Med 33:379–387

    Article  PubMed  CAS  Google Scholar 

  22. Jacoby JL, Cesta M, Heller MB, et al (2005) Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources. J Emerg Med 28:27–30

    Article  PubMed  Google Scholar 

  23. Stiell IG, Macle L, and the CCS Atrial Fibrillation Guidelines Committee (2011) Canadian Cardiovascular Society atrial fibrillation guidelines 2010: management of recent-onset atrial fibrillation and flutter in the emergency department. Can J Cardiol 27:38–46

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hôpital Saint-Louis, Assistance publique-hôpitaux de Paris, service des urgences, 1, avenue Claude Vellefaux, F-75010, Paris, France

    P. Taboulet

Authors
  1. P. Taboulet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Taboulet.

About this article

Cite this article

Taboulet, P. Anticoagulation d’une fibrillation auriculaire aux urgences. Ann. Fr. Med. Urgence 2, 317–322 (2012). https://doi.org/10.1007/s13341-012-0227-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13341-012-0227-4

Mots clés

Keywords

Search

Navigation