Ferro José M
Stroke Unit, Department of Neurology, Hospital de Santa Maria, Faculdade de Medicina de Lisboa, Lisbon, Portugal.
Lancet Neurol. 2003 Mar;2(3):177-88. doi: 10.1016/s1474-4422(03)00324-7.
Embolism of cardiac origin accounts for about one fifth of ischaemic strokes. Strokes due to cardioembolism are in general severe and prone to early recurrence. The risk of long term recurrence and mortality are high after a cardioembolic stroke. Cardioembolism can be reliably predicted on clinical grounds but is difficult to document. MRI, transcranial doppler, echocardiogram, Holter monitoring, and electrophysiological studies increase our ability to identify the source of cardioembolism. Non-valvular atrial fibrillation is the commonest cause of cardioembolic stroke. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Alternatives to oral anticoagulation in this setting include safer and easier to use antithrombotic drugs and definitive treatment of atrial fibrillation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke.
心源性栓塞约占缺血性卒中的五分之一。心源性栓塞所致的卒中通常病情严重，且易于早期复发。心源性栓塞性卒中后长期复发及死亡风险很高。心源性栓塞可基于临床依据可靠预测，但难以证实。磁共振成像（MRI）、经颅多普勒、超声心动图、动态心电图监测及电生理研究提高了我们识别心源性栓塞来源的能力。非瓣膜性心房颤动是心源性栓塞性卒中最常见的病因。尽管口服抗凝治疗具有巨大的预防潜力，但对于有发生心源性栓塞危险因素且无抗凝治疗禁忌证的心房颤动患者，接受持续口服抗凝治疗的不到一半。在此情况下，口服抗凝治疗的替代方法包括更安全、使用更简便的抗血栓药物以及对心房颤动进行确定性治疗。现有证据不支持对急性心源性栓塞性卒中进行常规即时抗凝治疗。
