Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, UO Gravi Cerebrolesioni, S. Giovanni Battista Hospital, Foligno, Perugia, Italy.
Atherosclerosis. 2010 Oct;212(2):564-6. doi: 10.1016/j.atherosclerosis.2010.06.016. Epub 2010 Jun 15.
Patients with atrial fibrillation (AF) on treatment with oral anticoagulants may still suffer ischemic cerebrovascular events. The aim of this study was to evaluate the risk factors for cerebral ischemic events in warfarin-treated AF patients with an International Normalized Ratios (INR) above 1.8 on admission.
In a case-control study, cases were consecutive patients with AF who were on warfarin and who were admitted to four Italian hospitals after an acute cerebrovascular ischemic event (ischemic stroke or transient ischemic attack) with an INR above 1.8. Controls were selected from a single anticoagulation clinic and were patients with AF on adequate warfarin treatment who did not suffer cerebrovascular events.
Cases were identified among 4785 consecutive patients with an ischemic cerebral event. 148 cases (3.1%, 21 with transient ischemic events and 127 with ischemic strokes) had AF and were taking warfarin with an INR above 1.8 on admission. On multivariate analysis, diabetes (OR 3.8; 95% CI 1.09-13.82, p=0.025), hyperlipidemia (OR 4.5; 95% CI 1.11-18.23, p=0.035) and carotid/vertebral atherosclerosis on ultrasound (OR 3.0; 95% CI 1.13-8.41, p=0.028) were independent predictors for ischemic cerebral events. The use of statins was inversely correlated with an ischemic event (OR 0.1; 95% CI 0.06-0.47. p=0.001).
Carotid/vertebral atherosclerosis, diabetes and hyperlipidemia are associated with an increased risk for ischemic events in patients with AF on adequate warfarin treatment. Statins significantly reduce the risk of ischemic events.
正在服用口服抗凝剂的心房颤动（AF）患者仍可能发生缺血性脑血管事件。本研究旨在评估入院时 INR 高于 1.8 的华法林治疗 AF 患者发生脑缺血事件的危险因素。
在病例对照研究中，病例为连续接受华法林治疗的 AF 患者，在 INR 高于 1.8 后因急性缺血性脑血管事件（缺血性卒中和短暂性脑缺血发作）入住意大利的 4 家医院。对照组从单一抗凝诊所中选择，为接受适当华法林治疗且未发生脑血管事件的 AF 患者。
在 4785 例连续发生缺血性脑事件的患者中发现病例。148 例（3.1%，21 例为短暂性缺血事件，127 例为缺血性中风）患有 AF，且入院时 INR 高于 1.8 时正在服用华法林。多变量分析显示，糖尿病（OR 3.8；95%CI 1.09-13.82，p=0.025）、高脂血症（OR 4.5；95%CI 1.11-18.23，p=0.035）和超声检查发现的颈动脉/椎动脉粥样硬化（OR 3.0；95%CI 1.13-8.41，p=0.028）是缺血性脑事件的独立预测因素。他汀类药物的使用与缺血性事件呈负相关（OR 0.1；95%CI 0.06-0.47，p=0.001）。
在接受适当华法林治疗的 AF 患者中，颈动脉/椎动脉粥样硬化、糖尿病和高脂血症与缺血性事件风险增加相关。他汀类药物可显著降低缺血性事件的风险。
