Amélioration de la prise en charge précoce des accidents vasculaires cérébraux au CHU de Brest (à partir d'une étude de 55 patients consécutifs thrombolysés par voie intraveineuse.)

Objectif : optimiser la prise en charge précoce des accidents vasculaires cérébraux (AVC). Méthode : nous avons étudié 55 patients entre novembre 2004 et avril 2009, Les données ont été recueillis à partir d'un protocole prospectif de thrombolyse des infarctus cérébraux (IC) et de données informatisées du Service d'Aide Médicale et d'Urgence SAMU 29. Résultats : cette méthode montre l'hétérogénéité de prise en charge des patients atteints d'IC thrombolysés en IV de 2004 à 2009 sans diminution des délais d'imagerie ou de début du traitement depuis l'ouverture de l'UNV, Ces résultats ont permis de cibler les défaillances et nous ont orienté dans la réalisation de procédures écrites telles qu'elles sont recommandées par la Haute Autorité de Santé (HAS) en collaboration avec les acteurs de la filière. Conclusion : ces procédures écrites devraient permettre d'évaluer régulièrement et prospectivement la performance de l'organisation de la filière neurovasculaire.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Stroke with atrial fibrillation or atrial flutter: a descriptive population-based study from the Brest stroke registry

International audienceIn the 1990s, epidemiological studies estimated the prevalence of stroke caused by atrial fibrillation (AF) at about 15 %. Given the aging population, there is a rise in the number of AF patients. AF prevention guidelines based on clinical practice and the literature have been published and updated since 2001. Implementation seems to have an impact on the prescription of vitamin K antagonist (VKA). During the last 20 years, few population-based studies have focused on the prevalence of atrial arrhythmia (AA) in patients with stroke. The objective of the present prospective study, using data from 2008, was to evaluate the prevalence of AA (atrial fibrillation/flutter) in patients with stroke and the impact of implementing AF guidelines. The prevalence of AA was studied in patients diagnosed with stroke from January 1 to December 31, 2008 in the population-based Stroke Registry of Brest, France (total population, 363,760 according to the 2008 census, with 295,553 aged 15 years or older). Guidelines implementation was assessed in terms of antithrombotic therapy (VKA, antiplatelet agent, none), and the CHADS2 (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack). 851 cases of stroke were identified. The prevalence of AA was 31.7 % (n = 264), and increased with age from < 20 % in patients aged 45 to 54 years to nearly 50 % in patients ≥ 85 years. In patients with AA, 231 strokes were ischemic, 28 hemorrhagic and 5 undetermined. At time of stroke, AA was known in 207 patients (78.4 %). 54 of the 152 patients with CHADS2 score ≥ 2 (35.5 %) were treated with VKA; this proportion decreased with age: 50 % between 50 and 74 years, 43.8 % between 75 and 84 years, and 25 % at 85 years and older. The prevalence of AA in the population-based Brest Stroke Registry in 2008 was higher than that reported by studies conducted 20 years ago. Despite publication of AF prevention guidelines, VKA prescription and use in elderly patients were significantly low