État des lieux de la maladie des emboles de cholestérol

Cholesterol crystal embolism is a systemic pathology associated with diffuse atherosclerosis. Pathophysiology corresponds to tissue necro-inflammation secondary to arteriolar occlusion associated with microembolism from atherosclerotic plaques of large diameter arteries. The clinical presentation is heterogeneous and polymorphic. Multiple organs may be the targets, but preferential damage is skin, kidneys and digestive system. It is a serious pathology, underdiagnosed, with a poor prognosis. The risk factors for developing the disease remain the same risk factors as atheroma. The factors favouring migration of microembolism remain mainly vascular interventional procedures; easy to diagnose, they oppose spontaneous embolic migrations or secondary to the introduction of antithrombotic treatment, whose diagnosis is more difficult and the prognosis more severe. The diagnosis of the disease remains mostly a diagnosis of elimination and often refers to a bundle of clinical, biological, morphological and histologic arguments. The treatment is poorly codified and the subject of few publications. It will favour both symptomatic treatment (and mainly that of pain) and complications (high blood pressure, renal insufficiency). The aetiological support remains less consensual. The treatment of atherosclerotic plaques consists, of course, in the correction of classical cardiovascular risk factors, the introduction of a statin. It will be discussed in the implementation of surgery or angioplasty to exclude potentially responsible atherosclerotic lesions. Eviction of antithrombotic therapy should be considered in terms of the benefit–risk balance, but often in favour of maintaining it. Finally, other treatments may be proposed in a case-by-case basis, such as oral or intravenous corticosteroid therapy, colchicine or LDL aphaeresis.     

Évaluation de la connaissance des patients de leur traitement par anticoagulant oral direct (AOD)

Aim of the studyPatient's knowledge about their treatment is poor, generally speaking. New oral anticoagulants are easier to use compared to antivitamin K, and they are going to increase. This simplification can underestimate their high potential risk. We have assessed patient's knowledge about their direct oral anticoagulants.MethodsIt was a quantitative, observational, multicentric, prospective study, on 50 patients on Direct Oral Anticoagulants. They have been included from November 2015 to February 2017, in Île-de-France. They were needed to be aged more than 18 years old, whatever was: the reason of this treatment, the beginning of it, the molecule, the existence or not of antivitamin K before. Their knowledge was assessed by a survey, realised by a unique investigator. The primary outcome was to reach more than 80% good answers to the survey. Secondary outcomes were to identify factors than can influence knowledge.ResultsAmong fifty patients, nine (18%) reached a goal over or equal to 80%. They knew the name of their medicament in 58% of cases, and the indication in 72% of cases. They could identify hemorragic signs in more than 70% of cases. In case of hemorragic sign, 94% of them were going to see a doctor. Thrombosis signs were less knew. None of the factors, excepted their profession, was different in the two populations (P = 0,01).ConclusionThis study showed the few rate of patient knowing their oral anticoagulants treatment perfectly, and their need to improve it. It could make professional healthcare aware to this problematic.