Angiopathie amyloïde cérébrale et fibrillation atriale : le dilemme des anticoagulants (notice n° 648162)
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| fixed length control field | 04341cam a2200337 4500500 |
| 005 - DATE AND TIME OF LATEST TRANSACTION | |
| control field | 20250121183812.0 |
| 041 ## - LANGUAGE CODE | |
| Language code of text/sound track or separate title | fre |
| 042 ## - AUTHENTICATION CODE | |
| Authentication code | dc |
| 100 10 - MAIN ENTRY--PERSONAL NAME | |
| Personal name | Boutitie, Léa |
| Relator term | author |
| 245 00 - TITLE STATEMENT | |
| Title | Angiopathie amyloïde cérébrale et fibrillation atriale : le dilemme des anticoagulants |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. | |
| Date of publication, distribution, etc. | 2023.<br/> |
| 500 ## - GENERAL NOTE | |
| General note | 15 |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | Cerebral amyloid angiopathy and atrial fibrillation are two frequent comorbidities in older patients, leading to a therapeutic dilemma on the risk-benefit ratio of long-term anticoagulation. These patients both have a risk of cardioembolic complications due to atrial fibrillation, and a risk of cerebral haemorrhage from cerebral amyloid angiopathy. Since there is no therapeutic consensus, the best therapeutic strategy should be discussed during a multidisciplinary staff, based on four risk estimations: 1) the baseline risk of intracerebral haemorrhage without anticoagulation; 2) the risk of ischaemic stroke without anticoagulation; 3) the expected increase of intracerebral haemorrhage with anticoagulation; 4) the expected reduction in ischaemic stroke risk with anticoagulation. The risk of intracerebral haemorrhage varies according to the cerebral amyloid angiopathy phenotype. Patients with transient neurological episode or cortical superficial siderosis have the highest risk of intracerebral haemorrhage. Direct oral anticoagulant should be preferred to vitamin K antagonists, as the risk of intracerebral haemorrhage is lower with direct oral anticoagulants. If anticoagulation is introduced, a close clinical and radiological monitoring should be performed every 6-12 months minimum. If it has been decided not to anticoagulate, left atrial appendage occlusion should be proposed. In all situations, close blood pressure control is essential to reduce the risk of intracerebral haemorrhage. |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | L’angiopathie amyloïde cérébrale et la fibrillation atriale sont deux pathologies fréquentes chez le patient âgé, entraînant un dilemme thérapeutique : évaluer le rapport bénéfice risque de l’anticoagulation au long cours entre le risque cardio-embolique de la fibrillation atriale et le risque d’hémorragie cérébrale de l’angiopathie amyloïde. Il n’existe pas de consensus à ce sujet, et il convient de discuter, au cours d’une concertation pluridisciplinaire, de la meilleure stratégie thérapeutique à adopter, à partir de 4 questions : 1) estimation du risque d’hémorragie cérébrale sans anticoagulation ; 2) estimation du risque d’accident ischémique cérébral sans anticoagulation ; 3) estimation de l’augmentation du risque d’hémorragie cérébrale avec l’anticoagulation ; 4) estimation de la réduction du risque d’accident ischémique cérébral avec l’anticoagulation, en pondérant sur le risque de séquelles après une hémorragie intracérébrale ou un accident ischémique cérébral. Il apparait qu’il existe différents phénotypes d’angiopathie amyloïde cérébrale, certains bien plus à risque d’hémorragie cérébrale que d’autres et contre-indiquant les anticoagulants : hémosidérose corticale (en particulier disséminée) et les déficits neurologiques focaux transitoires. En cas d’introduction d’une anticoagulation, les anticoagulants oraux directs sont à privilégier (moindre risque d’hémorragie cérébrale par rapport aux AVK) avec une surveillance au minimum tous les 6-12 mois clinique et radiologique. En cas de contre-indication aux anticoagulants, une fermeture de l’auricule peut se discuter. |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | anticoagulation |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | angiopathie amyloïde cérébrale |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | personne âgée |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | fibrillation atriale |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | hémorragie cérébrale |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | cerebral amyloid angiopathy |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | anticoagulants |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | atrial fibrillation |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | cerebral hemorrhage |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | older patients |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Verny, Marc |
| Relator term | author |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Alamowitch, Sonia |
| Relator term | author |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Zerah, Lorène |
| Relator term | author |
| 786 0# - DATA SOURCE ENTRY | |
| Note | Gériatrie et Psychologie Neuropsychiatrie du Vieillissement | 21 | 1 | 2023-01-09 | p. 81-89 | 2115-8789 |
| 856 41 - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href="https://shs.cairn.info/revue-geriatrie-et-psychologie-neuropsychiatrie-du-vieillissement-2023-1-page-81?lang=fr&redirect-ssocas=7080">https://shs.cairn.info/revue-geriatrie-et-psychologie-neuropsychiatrie-du-vieillissement-2023-1-page-81?lang=fr&redirect-ssocas=7080</a> |
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