Kocaman Gülşen, Dürüyen Hümeyra, Koçer Abdulkadir, Asil Talip
Department of Neurology, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey.
Department of Neurology, Medeniyet University Faculty of Medicine, İstanbul, Turkey.
Noro Psikiyatr Ars. 2015 Jun;52(2):139-144. doi: 10.5152/npa.2015.7499. Epub 2015 Jun 1.
Disabilities due to stroke lead to a serious individual and socioeconomic burden. In this presented hospital-based study, we aimed to evaluate recurrent ischemic stroke (RIS) characteristics and the sufficiency of secondary prevention regarding the most common modifiable risk factors.
The records of patients with a diagnosis of ischemic stroke between November 2009 and November 2011 in our unit were retrospectively investigated.
Ninety-one (18%) out of 500 patients with ischemic stroke had RIS. Hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia, atrial fibrillation, and smoking were found in 88%, 43%, 36%, 30%, 11%, and 14% of the patients, respectively. Thirty-eight percent of the patients had more than two risk factors. While 14% of the hypertensive patients did not use antihypertensive medications, antihypertensive treatment was insufficient in 39% of those who already used antihypertensive medications. Twenty-three percent of the patients received no prophylactic agents. Sixty percent of the patients with a history of atrial fibrillation were on oral anticoagulant therapy (warfarin), and the international normalized ratio was <2.0 in 73% of them. Of the diabetic patients, 87% had an HgbA1C level above 6%. The LDL level was higher than 100 mg/dL in 72% of the patients.
The incidence of RIS and risk factors in our retrospective study was compatible with the results of those in literature. Secondary prophylactic treatment and modification of risk factors in the stroke patients were not satisfactory. The improvement of the patients' adherence to treatment is also very important in addition to the optimal treatment and follow-up strategy for decreasing the incidence of RIS. A multidisciplinary outpatient model of stroke care may be beneficial for decreasing the incidence of RIS.
中风导致的残疾会给个人和社会经济带来沉重负担。在这项基于医院的研究中，我们旨在评估复发性缺血性中风（RIS）的特征以及针对最常见可改变风险因素的二级预防的充分性。
回顾性调查了2009年11月至2011年11月期间在我院诊断为缺血性中风的患者记录。
500例缺血性中风患者中有91例（18%）发生了RIS。分别有88%、43%、36%、30%、11%和14%的患者患有高血压、糖尿病、缺血性心脏病、高脂血症、心房颤动和吸烟。38%的患者有两种以上风险因素。14%的高血压患者未使用抗高血压药物，在已使用抗高血压药物的患者中，39%的患者抗高血压治疗不足。23%的患者未接受预防性药物治疗。有房颤病史的患者中，60%接受口服抗凝治疗（华法林），其中73%的患者国际标准化比值<2.0。在糖尿病患者中，87%的患者糖化血红蛋白水平高于6%。72%的患者低密度脂蛋白水平高于100mg/dL。
我们回顾性研究中RIS的发生率和风险因素与文献报道的结果相符。中风患者的二级预防性治疗和风险因素的改善并不理想。除了采取最佳治疗和随访策略以降低RIS的发生率外，提高患者的治疗依从性也非常重要。多学科门诊中风护理模式可能有助于降低RIS的发生率。
