Sadeghi Roxana, Parsa Mahjoob Mohammad, Asadollahi Marjan, Abbasi Zahra
Associate Professor of Interventional Cardiology, Cardiovascular Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acta Biomed. 2015 Sep 14;86(2):162-9.
Despite controllable nature of atrial fibrillation in most patients, it increases the risk of atrial thrombosis leading to ischemic stroke. The researchers assessed the underlying risk factors for brain stroke and also major bleeding in patients with ischemic stroke and atrial fibrillation.
Among 900 patients hospitalized with the diagnosis of ischemic brain stroke between 2013 and 2014, 100 patients had atrial fibrillation that included into this cross-sectional study. The risk of stroke and major bleeding was assessed using CHA2DS2-VASc and HAS-BLED risk scores, respectively; but new stroke was not considered.
Of 900 patients with evidences of ischemic stroke, 100 had atrial fibrillation with an overall prevalence of 11.1%. Mean CHA2DS2-VASc score was 4.35 ± 1.76 that the total score was ≥ 2 points in 93% of subjects showing necessity to anticoagulation therapy in 93% of the patients before recent stroke. Mean HAS-BLED score was 2.83 ± 1.30 that was ≥ 3 in 61% indicating risk of bleeding in 61% of all patients. 31% of the patients had previous history of atrial fibrillation, but only less than half of them (51%) were under treatment with warfarin, and also the measured INR was lower than the therapeutic range in 95.5% of individuals on warfarin therapy. In-hospital mortality was reported in 9% of all study subjects. The main determinants of early mortality included history of stroke, renal failure, presence of coronary artery disease, acetylsalicylic acid use, and Clopidogrel use. The analysis using the ROC curve showed that both CHA2DS2-VASc score (AUC = 0.788) and HAS-BLED score (AUC = 0.960) could strongly predict in-hospital mortality.
The patients with atrial fibrillation hospitalized with ischemic stroke showed an important absolute risk of further stroke and early mortality. Despite substantiated advantages of warfarin prophylaxis, its limited application is still very common.
尽管大多数患者的房颤具有可控性，但它会增加心房血栓形成的风险，进而导致缺血性中风。研究人员评估了缺血性中风和房颤患者中风及大出血的潜在危险因素。
在2013年至2014年间因缺血性脑卒中标明诊断而住院的900例患者中，100例患有房颤，这些患者被纳入这项横断面研究。分别使用CHA2DS2-VASc和HAS-BLED风险评分评估中风和大出血的风险；但未考虑新发中风。
在900例有缺血性中风证据的患者中，100例患有房颤，总体患病率为11.1%。CHA2DS2-VASc评分的平均值为4.35±1.76，93%的受试者总分≥2分，这表明在近期中风前93%的患者有必要进行抗凝治疗。HAS-BLED评分的平均值为2.83±1.30，61%的患者≥3分，这表明所有患者中有61%有出血风险。31%的患者有房颤病史，但其中只有不到一半（51%）接受华法林治疗，而且在接受华法林治疗的个体中，95.5%的患者测得的国际标准化比值（INR）低于治疗范围。所有研究对象中有9%报告了住院死亡率。早期死亡的主要决定因素包括中风病史、肾衰竭、冠状动脉疾病的存在、使用阿司匹林和使用氯吡格雷。使用ROC曲线分析表明，CHA2DS2-VASc评分（AUC=0.788）和HAS-BLED评分（AUC=0.960）都能强烈预测住院死亡率。
因缺血性中风住院的房颤患者显示出进一步中风和早期死亡的重要绝对风险。尽管华法林预防有确凿的优势，但其应用有限的情况仍然非常普遍。
Zotero 插件