Annales françaises de médecine d'urgence

, Volume 2, Issue 5, pp 317–322 | Cite as

Anticoagulation d’une fibrillation auriculaire aux urgences

Mise au Point / Update
  • 241 Downloads

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.

Mots clés

Fibrillation auriculaire Flutter auriculaire Anticoagulation Cardioversion Urgence 

Anticoagulation for atrial fibrillation in the emergency room

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.

Keywords

Atrial fibrillation Atrial flutter Anticoagulation Cardioversion Emergency 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Référence

  1. 1.
    Khoo CW, Lip GY (2009) Acute management of atrial fibrillation. Chest 135:849–59PubMedCrossRefGoogle Scholar
  2. 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 46:424–30PubMedCrossRefGoogle Scholar
  3. 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 31:2369–2429PubMedCrossRefGoogle Scholar
  4. 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–575SPubMedCrossRefGoogle Scholar
  5. 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 126:615–620PubMedGoogle Scholar
  6. 6.
    Stoddard MF, Dawkins PR, Prince CR, Longaker RA (1995) Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Am Heart J 129:1204–1215PubMedCrossRefGoogle Scholar
  7. 7.
    Lamas G (2012) How much atrial fibrillation is too much atrial fibrillation? N Engl J Med 366:178–180PubMedCrossRefGoogle Scholar
  8. 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 285:2864–2870PubMedCrossRefGoogle Scholar
  9. 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 56:2067–2076PubMedCrossRefGoogle Scholar
  10. 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 137:263–272PubMedCrossRefGoogle Scholar
  11. 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 138:1093–1100PubMedCrossRefGoogle Scholar
  12. 12.
    Fihn SD (1995) Aiming for safe anticoagulation. N Engl J Med 333:54–55PubMedCrossRefGoogle Scholar
  13. 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 146:857–867PubMedGoogle Scholar
  14. 14.
    Berger M, Schweitzer P (1998) Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 82:1545–1547PubMedCrossRefGoogle Scholar
  15. 15.
    Potier K, Parris R (2005) Best evidence topic report. Anticoagulation post-cardioversion of acute atrial fibrillation in the emergency department. Emerg Med J 22:275–276Google Scholar
  16. 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 123:131–136PubMedCrossRefGoogle Scholar
  17. 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 58:517–520CrossRefGoogle Scholar
  18. 18.
    Burton JH, Vinson DR, Drummond K, et al (2004) Electrical cardioversion of emergence department patients with atrial fibrillation. Ann Emerg Med 44:20–30PubMedCrossRefGoogle Scholar
  19. 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 17:408–415PubMedCrossRefGoogle Scholar
  20. 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 12:181–191PubMedGoogle Scholar
  21. 21.
    Michael JA, Stiell IG, Agarwal S, Mandavia DP (1999) Cardioversion of paroxysmal atrial fibrillation in the emergency department. Ann Emerg Med 33:379–387PubMedCrossRefGoogle Scholar
  22. 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 28:27–30PubMedCrossRefGoogle Scholar
  23. 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 27:38–46PubMedCrossRefGoogle Scholar

Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Hôpital Saint-LouisAssistance publique-hôpitaux de Paris, service des urgencesParisFrance

Personalised recommendations