Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
BMJ Case Rep. 2024 Jan 10;17(1):e258761. doi: 10.1136/bcr-2023-258761.
Primary stroke prevention in non-valvular atrial fibrillation (NVAF) is primarily with non-vitamin K oral anticoagulant (NOAC) therapy. However, 20-36% of ischaemic strokes seem to occur in patients with atrial fibrillation while already on anticoagulation. We present a case of an ischaemic stroke in an elderly female in her 70s with medical history significant for hypertension and NVAF. She had a CHA2DS2-VASc score of 3 and was on apixaban for thromboprophylaxis. She presented with neurological deficits consistent with a left middle cerebral artery stroke, confirmed via head imaging; the most likely stroke aetiology was determined to be cardioembolic in the setting of NVAF. She was treated with of her apixaban at the She displayed improved function, although with residual expressive aphasia at her 2-month neurology follow-up. Cardioembolic ischaemic stroke in NVAF despite current NOAC therapy does not have current management guidelines.
非瓣膜性心房颤动（NVAF）的主要一级卒中预防措施是使用非维生素 K 口服抗凝剂（NOAC）治疗。然而，约 20-36%的缺血性卒中似乎发生在已经接受抗凝治疗的房颤患者中。我们报告了一例 70 多岁老年女性的缺血性卒中病例，她有高血压和 NVAF 的病史。她的 CHA2DS2-VASc 评分为 3 分，并用阿哌沙班进行血栓预防。她出现了与左侧大脑中动脉卒中一致的神经功能缺损，头部影像学检查证实；在 NVAF 的情况下，最可能的卒中病因被确定为心源性栓塞。她在卒中后第 2 天停用了她的阿哌沙班。她的功能有所改善，但在 2 个月的神经科随访时仍存在表达性失语。尽管目前有 NOAC 治疗，但 NVAF 中的心源性栓塞性缺血性卒中目前没有管理指南。
