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Objectif Les unites de soins de longue duree (USLD) presentent une population fragile, ou la prevalence des maladies cardiovasculaires est elevee, et ou le risque hemorragique, lie aux polypathologies, a l’insuffisance renale, ou au risque de chutes, est important. L’objectif principal de ce travail est d’evaluer l’adequation des prescriptions d’antithrombotiques, dans une USLD, par rapport aux recommandations actuelles. Les objectifs secondaires sont d’evaluer la qualite de la surveillance de ces traitements et en cas d’inadequation de la prescription et des recommandations, d’interroger le prescripteur en vue d’identifier des possibilites d’amelioration des prescriptions. Materiels et methodes Un releve des donnees concernant la prescription d’antithrombotiques a ete realise sur tous les patients presents dans l’USLD du CHU de Rennes entre le 16 juin et le 23 juin 2014. Ces donnees ont ete comparees aux recommandations actuelles internationales. Resultats Cent-seize patients etaient presents en USLD. La moyenne d’âge etait de 84 (± 8,5) ans. Vingt-trois patients etaient sous anticoagulant, principalement sous antivitamine K, pour une fibrillation atriale. Cinquante patients recevaient un antiplaquettaire, principalement de l’aspirine, pour un antecedent d’accident vasculaire cerebral. Sept patients recevaient a la fois un anticoagulant et un antiplaquettaire. Deux prescriptions d’anticoagulant et six prescriptions d’antiplaquettaire n’etaient pas conformes aux recommandations actuelles. Parmi les 50 patients ne recevant ni anticoagulant ni antiplaquettaire, 8 avaient une indication a un traitement antithrombotique. Au total, 16 prescriptions (14 %) etaient inadequates et ont ete modifiees (arret, ajout ou modification de traitement) ; 3 concernaient les anticoagulants et 13 les antiplaquettaires. Tous les patients sous antivitamine K beneficiaient d’un suivi par INR regulier. Plus de deux patients sur trois passaient la moitie du temps dans la fenetre therapeutique d’INR. Conclusion La majorite des prescriptions de l’USLD etaient conformes aux recommandations actuelles. Notre etude a cependant retrouve plusieurs situations ou la confrontation des prescriptions et des recommandations a entraine une modification du traitement, soulignant l’interet de la demarche. Si la gestion des anticoagulants semble bien maitrisee, notre etude montre que les situations qui ont conduit a une modification des prescriptions concernent, avant tout, les antiplaquettaires.

The authors report the case of a 24-year-old woman with paradoxical embolism of the right arm subsequent to childbirth. Patent foramen ovale was diagnosed by right cardiac catheterization and contrast echocardiography. On the basis of clinical, immunoscintigraphic and radiologic data, the pelvic region was the only possible origin of the embolic process. The main interest of this case is that arterial ischemic signs were indicative of an embolic process of pelvic origin diagnosed by scintigraphy using radiolabeled antifibrin antibody.

The authors report the case of a 30-year-old woman with Takayasu's disease revealed by acute leg ischemia and complicated by abortion during the fourth month of pregnancy. Clinically suspect lesions were confirmed by angiography showing a severe stenosis at the aorto-iliac bifurcation complicated by overlying mild ectasic lesions and a large thrombus. A total occlusion of embolic origin was noted in the right popliteal artery. An attempt to open up the thrombosis at the bifurcation led unfortunately to massive rethrombosis requiring implantation of an aorto-iliac prosthesis. Histopathological examination of the aortic surgical specimen indicated Takayasu's disease; the placenta showed multiple infarcts. The complete angiographic study revealed no arterial involvement in any other region. Five months after the initial operation, rapid development of claudication in both lower limbs suggested stenosis at the prosthesis implantation sites which was confirmed by angiography. Initiation of general corticosteroid therapy led to partial remission in less than two weeks. The unusual feature in this case was the revelation of the affection by distal arterial embolic manifestations, which have been reported only exceptionally in the literature. Moreover, isolated involvement of the aorto-iliac bifurcation constitutes a rare form of Takayasu's disease. With respect to therapy, the implantation of a prosthesis was complicated by severe stenoses of the junction zones, which is unfortunately an event in the course of this affection. The normality of biologic inflammation studies did not suggest an initial need for corticosteroid therapy, especially in the case of an isolated arterial manifestation.(ABSTRACT TRUNCATED AT 250 WORDS)