Ozdemir Hizir, Sagris Dimitrios, Lip Gregory Y H, Abdul-Rahim Azmil H
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Internal Medicine, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
Curr Cardiol Rep. 2023 May;25(5):357-369. doi: 10.1007/s11886-023-01862-1. Epub 2023 Mar 28.
Atrial fibrillation (AF) is a major risk factor for systemic embolism and ischaemic stroke. Furthermore, AF-related strokes are associated with higher mortality, greater disability, longer hospital stays and lower rates of hospital discharge than strokes caused by other reasons. The aim of this review to summarise the existing evidence on the association of AF with ischemic stroke and provide insights on the pathophysiological mechanisms and the clinical management of patients with AF in order to reduce the burden of ischemic stroke.
Beyond Virchow's triad, several pathophysiological mechanisms associated with structural changes in the left atrium, which may precede the identification of AF, may contribute to the increased risk of arterial embolism in AF patients. Individualised thromboembolic risk stratification based on CHADS-VASc score and clinically relevant biomarkers provides essential tool towards a personalised holistic approach in thromboembolism prevention. Anticoagulation remains the cornerstone of stroke prevention moving from vitamin K antagonists (VKA) to safer non-vitamin K direct oral anticoagulants in the majority of AF patients. Despite the efficacy and safety of oral anticoagulation, still the equilibrium between thrombosis and haemostasis in AF patients remains suboptimal and future directions in anticoagulation and cardiac intervention may provide novel treatment options in stroke prevention. This review summarises the pathophysiologic mechanisms of thromboembolism, aiming the current and potential future perspectives in stroke prevention in AF patients.
心房颤动（AF）是全身栓塞和缺血性卒中的主要危险因素。此外，与AF相关的卒中与更高的死亡率、更大的残疾程度、更长的住院时间以及低于其他原因所致卒中的出院率相关。本综述旨在总结关于AF与缺血性卒中关联的现有证据，并深入探讨其病理生理机制以及AF患者的临床管理，以减轻缺血性卒中的负担。
除了魏尔啸氏三要素外，左心房结构改变相关的几种病理生理机制（可能在AF确诊之前就已存在）可能会增加AF患者发生动脉栓塞的风险。基于CHADS-VASc评分和临床相关生物标志物的个体化血栓栓塞风险分层为血栓栓塞预防的个体化整体方法提供了重要工具。在大多数AF患者中，抗凝治疗仍然是预防卒中的基石，目前正从维生素K拮抗剂（VKA）转向更安全的非维生素K直接口服抗凝剂。尽管口服抗凝治疗具有疗效和安全性，但AF患者血栓形成与止血之间的平衡仍不理想，抗凝和心脏干预的未来发展方向可能会为卒中预防提供新的治疗选择。本综述总结了血栓栓塞的病理生理机制，着眼于AF患者卒中预防的当前及潜在未来前景。
