Leckey R, Aguilar E G, Phillips S J
Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
Can J Cardiol. 2000 Apr;16(4):481-5.
To examine the use of warfarin in patients with atrial fibrillation (AF) admitted to hospital because of stroke or transient ischemic attack; and to describe the outcome of AF-associated stroke.
Review of the medical records of patients, identified from a prospective registry, admitted from January 1, 1994 through December 31, 1996.
Tertiary care teaching hospital.
AF was present in 92 of 722 (13%) patients at the time of admission. Only eight of 60 (13%) patients with ischemic stroke who were known to be in AF before their stroke were taking warfarin. The in-hospital case-fatality ratio for AF patients was more than double that of patients in sinus rhythm (21% versus 9%, respectively, P=0.001). AF patients were less likely to be discharged home (31% versus 59%, P=0.005). Of the 68 AF patients who survived, 74% left hospital taking warfarin. No warfarin-treated patient experienced intracranial bleeding while in hospital or during follow-up.
Patients with AF had more severe strokes than patients in sinus rhythm. A small proportion of patients with known AF were taking warfarin at the time of hospitalization. Bleeding complications were infrequent. Broader implementation of guidelines for the management of AF is justified to reduce the frequency of stroke in this group of patients.
研究因中风或短暂性脑缺血发作入院的心房颤动（AF）患者使用华法林的情况；并描述与AF相关的中风的结局。
回顾从1994年1月1日至1996年12月31日期间前瞻性登记中确定的患者的病历。
三级医疗教学医院。
722例患者中有92例（13%）入院时存在AF。已知中风前处于AF的60例缺血性中风患者中只有8例（13%）正在服用华法林。AF患者的院内病死率是窦性心律患者的两倍多（分别为21%和9%，P = 0.001）。AF患者出院回家的可能性较小（31%对59%，P = 0.005）。在存活的68例AF患者中，74%出院时服用华法林。没有接受华法林治疗的患者在住院期间或随访期间发生颅内出血。
AF患者的中风比窦性心律患者更严重。一小部分已知患有AF的患者在住院时正在服用华法林。出血并发症很少见。为降低该组患者中风的发生率，有理由更广泛地实施AF管理指南。
