University of Miami Miller School of Medicine, Department of Neurology, 1120 NW 14th Street, Miami, FL 33136, USA.
University of Miami Miller School of Medicine, Department of Neurology, 1120 NW 14th Street, Miami, FL 33136, USA.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105599. doi: 10.1016/j.jstrokecerebrovasdis.2021.105599. Epub 2021 Feb 3.
Large vessel occlusion (LVO) strokes can in part be prevented with better atrial fibrillation (AF) stroke prevention strategies; thus we evaluated the rate of AF in patients presenting with acute LVO strokes undergoing mechanical thrombectomy (MT) and assessed patterns of oral anticoagulant (OAC) use prior to the index stroke.
We identified 347 MT cases from February 2015 to September 2018. A retrospective chart review was conducted to identify patient sociodemographics, presence of AF, use of anticoagulation, stroke severity, CHADS-VASc scores, and functional outcomes. AF was present in 161 (46%) cases. Patients with AF were older (mean 76 ± 11 years vs. 66 ± 15 years) and more likely to be female (56% vs. 46%) with higher rates of hypertension, dyslipidemia, heart failure and smoking. Of the 100 patients with known AF, 59 were not on anticoagulation prior to the index stroke. Of 39 patients with known AF on OAC, 57% were not therapeutic on warfarin and 20% were not taking prescribed direct OACs. A total of 72 (21%) thrombectomy cases were performed on patients with known AF who were not effectively anticoagulated. After multivariate adjustments, there was no significant difference in modified Rankin Scale score at discharge, in-hospital mortality, or symptomatic intracranial hemorrhage between the AF and non-AF groups.
In our study, 21% of patients with LVO stroke had known AF and were not effectively anticoagulated. Improved stroke preventive measures could potentially reduce the occurrence of stroke and avoid unnecessary procedures for patients with AF.
通过更好的心房颤动（AF）卒中预防策略，可以部分预防大血管闭塞（LVO）卒中；因此，我们评估了接受机械血栓切除术（MT）治疗的急性 LVO 卒中患者中 AF 的发生率，并评估了指数卒中前口服抗凝剂（OAC）的使用模式。
我们从 2015 年 2 月至 2018 年 9 月确定了 347 例 MT 病例。进行了回顾性病历审查，以确定患者的社会人口统计学特征、AF 的存在、抗凝治疗的使用、卒中严重程度、CHADS-VASc 评分和功能结局。161 例（46%）患者存在 AF。AF 患者年龄较大（平均 76±11 岁比 66±15 岁），更可能为女性（56%比 46%），高血压、血脂异常、心力衰竭和吸烟的发生率更高。在 100 例已知有 AF 的患者中，59 例在指数卒中前未接受抗凝治疗。在 39 例已知服用 OAC 的 AF 患者中，57%的患者服用华法林未达到治疗效果，20%的患者未服用规定的直接 OAC。在已知有 AF 且未有效抗凝的 72 例 MT 病例中。多变量调整后，AF 组和非 AF 组出院时改良 Rankin 量表评分、住院死亡率或症状性颅内出血无显著差异。
在我们的研究中，21%的 LVO 卒中患者有已知的 AF 且未得到有效抗凝。改进的卒中预防措施可能会降低卒中的发生，并避免对 AF 患者进行不必要的治疗。
