Informations générales (source: ClinicalTrials.gov)
Registry of Patient With Antithrombotic Agents Admitted to an Emergency (RATED Registry)
Observational
University Hospital, Clermont-Ferrand (Voir sur ClinicalTrials)
janvier 2014
février 2024
29 juin 2024
Antithrombotics with antiplatelet agents, vitamin K antagonist (VKA), heparin and related
substances, and new oral anticoagulants are prescribed for arterial diseases, especially
in secondary prevention of embolic disease in carrier patients of heart valves and in
patients with fibrillation atrial, and venous diseases, in prevention and treatment.
The prescription of these treatments is increasing especially in older patients
associated with many comorbidities. Today, an estimated number of 900 000 patients under
anti-vitamin K in France, and more than 1.5 million for patients on antiplatelet agents.
Venous thromboembolism (VTE) is common in the general population with an annual incidence
of 10-18 cases per 10 000. The most severe form of VTE is represented by pulmonary
embolism with a third of cases. Even if a large literature allows for high grade
recommendations on many areas, there is still some gray areas regarding the long-term
outcomes, the early evolution and tolerance of treatment, including long-term recurrence,
the incidence of embolic sequelae with post-embolic pulmonary hypertension and
association with other cardiovascular arterial accident (acute Coronary Syndrome, Stroke,
arterial disease of the Lower Extremities ...).
The major risk of these antithrombotic is bleeding both in terms of morbidity mortality.
Despite this risk, little study focuses on the exact epidemiology of bleeding associated
with the use of antithrombotic. If the frequency of hemorrhagic stroke is low, some
populations particularly at risk of bleeding represent the majority of serious bleeding
events under VKA or anti-platelet. However, the VKA and antiplatelet agents are the first
providers of hemorrhagic serious side effects drugs when looking at all national and
international studies on the iatrogenic with in topped gastrointestinal bleeding and
intracerebral hemorrhage (mortality of about 10 to 15%).
Moreover the recent arrival of new oral anticoagulants (Apixaban rivaroxaban, dabigatran
...) should profoundly change the management of venous thromboembolism and cardioembolic
event. Because of their risk-benefit, simplicity and convenience of their prescription,
the number of patients treated with these new anticoagulants were to rise rapidly. In
addition, many patients deemed too "fragile" to be treated with VKA, should be treated
with these treatments. These new anti-Xa and anti-IIa anticoagulants already marketed or
about to be. They have the advantage over VKA: an oral way, their pharmacokinetic
characteristics, absence of biological monitoring, chemical synthesis .... If it is not
possible today to give the advantage to one or the other of these molecules, the choice
will be directed by their pharmacokinetic characteristics, their half life, their method
of disposal but also by patients co-morbidities. Although biological tests are currently
available for the monitoring of these products, therapeutic solutions for severe bleeding
does not exist: there is indeed no antidote for now, though the issue is finding a
balance between increased therapeutic benefit and bleeding risk optimization. But
hemorrhagic stroke is the most serious complications of oral anticoagulant therapy, with
substantial documentation for these events occurring under VKA but little data on those
occurring with the new oral anticoagulants (Apixaban rivaroxaban, dabigatran ...).
Etablissements
| Les établissements hors Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| CHU Clermont-Ferrand - 63003 - Clermont-Ferrand - France | Patrick LACARIN | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
- Age over 18 years
- Patient under antithrombotic agent who came in the emergency unit for any reason
- Age over 18 years
- Patient under antithrombotic agent who came in the emergency unit for any reason
-