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, Annexes Annexe 1. Risques hémorragiques des actes invasifs et chirurgicaux
Risque de saignement majeur à 2 jours 2%-4% ,
, ? Remplacement valvulaire cardiaque ? Pontage coronarien ? Cure d'anévrisme de l'aorte abdominale ? Neurochirurgie, chirurgie urologique
chirurgie des varices, sphinctérotomie biliaire, dilatation ,
Risque de saignement faible à 2 jours 0%-2%) : ? Cholécystectomie ? Hystérectomie par voie abdominale ? Endoscopie gastro intestinale +/-biopsie, stent biliaire/pancréatique sans sphinctérotomie échoendoscopie sans ponction biopsie ,
Il s'agit de patient homme ou femme de moins de 65 ans avec FA idiopathique et sans facteur de risque ,
, ? Score 1 : un traitement anticoagulant oral par un AVK (INR 2-3) ou un inhibiteur direct de la thrombine (dabigatran); ou un inhibiteur du Facteur Xa oral (ex. rivaroxaban,apixaban) doit être envisagé, en se basant sur une évaluation du risque hémorragique
, ? Score ? 2 : anticoagulation par AVK (INR entre 2 et 3) ou dabigatran ou les anti Xa (rivaroxaban, apixaban) sauf contre-indication (classe I, niveau A)