Indications, Efficacité et Coût de la Thrombolyse en Réanimation au Mali

RESUMEIntroduction. La thrombolyse est moyen de reperfusion d’un evenement thromboembolique notamment quand elle est administree dans les premieres heures de la symptomatologie. Le but de notre travail etait d’evaluer les indications, l’efficacite et le cout de notre schema de thrombolyse par rapport au protocole standard. Methodes. Etude prospective transversale sur 06 mois, incluant tous les patients admis en reanimation pour urgence cardiovasculaire thrombotique majeure et neurovasculaire : syndrome coronarien aigu (SCA), embolie pulmonaire (EP) massive, accident vasculaire cerebral ischemique (AVCI) et thrombolyses selon notre protocole a base d’association Alteplase (un flacon de 50 mg) et  heparine sodique avec relais par Rivaroxaban 20mg (Xarelto). Le TCA pour adaptation therapeutique de l’heparine. Resultats. Parmil les 71 patients eligibles, nous avons collige 61 patients donc 37 pour SCA, 14 EP grave et 10 AVCI soit 82,43%. La classe modale etait de [41-50]. Le sexe feminin a represente 62%. Une prise en charge apres 12 heures a ete observee chez 55,7% des patients. La duree moyenne de sejour etait de 5+/-3 jours. Nous avons observe 5 deces dont 4 cas d’EP massive. La coronarographie a ete realisee chez 18 patients avec une repermeabilisation parfaite chez 17, et un stente. Les principaux incidents ont ete domines par l’hematurie, l’hypotension arterielle ; nous avons observe un cas d’hematome intracerebral avec des suites simples. Le principal facteur de risque de mortalite commun aux pathologies etait le retard de prise en charge. Le cout moyen de prise en charge selon notre protocole etait de 525 000F CFA contre 1 400 000 F CFA selon le protocole standard. Conclusion. L’analyse cout-avantages est favorable a notre protocole par rapport au protocole standard. En effet, nous avons relativement peu de complications graves (hemorragiques) et  un cout nettement inferieur.ABSTRACTIntroduction: Thrombolysis: a means of reperfusion of a thromboembolic event, especially when it is administered in the first hours of symptoms. We initiated this work with the aim of evaluating the effectiveness of our thrombolysis regimen compared to the standard protocol. Materials and methods: This was a prospective cross-sectional study carried out over 06 months. Including all patients admitted to intensive care for a major thrombotic and neurovascular cardiovascular emergency (ACS, massive EP, DALY) and thrombolysed according to our protocol protocol, which used the combination of Alteplase (a 50 mg vial) and heparin sodium with relay by Rivaroxaban 20mg (xarelto). TCA for therapeutic adaptation of heparin. Results: We collected 61/71 patients, therefore 37 for ACS, 14 severe PE and 10 DALYs, ie 82.43%. The modal class was [41-50]. The female sex represented 62%. Management after 12 hours was observed in 55.7% of patients. The average length of stay was 5 +/- 3 days. We observed 5 deaths including 4 cases of massive PE. Coronary angiography was performed in 18 patients with perfect repermeability in 17, and 1 stent. The main incidents were dominated by hematuria, low blood pressure; we observed a case of intracerebral hematoma with simple consequences. The main risk factor for mortality common to the pathologies was the delay in treatment. The average cost of care according to our protocol was 525,000 CFA francs against 1,400,000 CFA francs according to the standard protocol. Conclusion: A cost-benefit analysis in our protocol is justified by the direct benefits observed, which are in fact estimated from the results. Our protocol is justified by the excellent result with fewer serious complications (hemorrhagic) but at a lower cost.