Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
Semin Neurol. 2021 Aug;41(4):340-347. doi: 10.1055/s-0041-1726329. Epub 2021 Apr 13.
Heart failure (HF) and stroke, two of the major causes of death worldwide, are closely associated. Although atrial fibrillation (AF), which occurs in more than half of patients with HF, is a major risk factor for stroke, there is a great deal of evidence that HF itself increases the risk of stroke independent of AF. The main mechanism of stroke appears to be thromboembolism. However, previous studies have failed to demonstrate the benefit of warfarin in patients with HF without AF, as the benefit of stroke prevention was counteracted by the increased incidence of major bleeding. Recently, researchers have identified patients with HF at a particularly high risk for stroke who may benefit from anticoagulation therapy. Based on stroke-risk prediction models, it may be possible to make better stroke prevention decisions for patients with HF. Moreover, non-vitamin K oral anticoagulants have emerged as anticoagulants with a more favorable risk-benefit profile than warfarin. Future studies on selecting high-risk patients and using more appropriate antithrombotics will lead to improved management of patients with HF.
心力衰竭（HF）和中风是全球两大主要死亡原因，二者密切相关。尽管发生在一半以上 HF 患者中的心房颤动（AF）是中风的主要危险因素，但有大量证据表明 HF 本身会增加中风风险，而不依赖于 AF。中风的主要机制似乎是血栓栓塞。然而，以前的研究未能证明 HF 患者中没有 AF 时华法林的益处，因为中风预防的益处被大出血发生率的增加所抵消。最近，研究人员发现 HF 患者中风风险特别高，可能受益于抗凝治疗。基于中风风险预测模型，可能可以为 HF 患者做出更好的中风预防决策。此外，非维生素 K 口服抗凝剂作为抗凝剂，与华法林相比具有更有利的风险效益比。未来关于选择高危患者和使用更合适的抗血栓药物的研究将改善 HF 患者的管理。
