| Abstract | Cilj istraživanja. Procijeniti usklađenost propisivanja tromboprofilaktičkog liječenja u bolesnika s nevalvularnom atrijskom fibrilacijom (nAF) prilikom prijama i otpusta s liječenja zbog ishemijskog moždanog infarkta sa smjernicama Europskog kardiološkog društva za postupanje s nAF. Metode. U presječno retrospektivno istraživanje su uključeni svi bolesnici s otpusnom dijagnozom ishemijskog moždanog infarkta i nAF koji su u razdoblju od 1. studenog 2010. do 31. prosinca 2011. godine liječeni na Klinici za neurologiju Kliničkog bolničkog centra Split. Težina tromboembolijskog (TE) rizika procijenjena je CHA2DS2-VASc sustavom, a rizik krvarenja HAS-BLED sustavom. Rezultati. U istraživanje je uključeno 327 bolesnika, 143 (44%) muškaraca i 184 (56%) žena. Prije doživljenog ishemijskog moždanog infarkta 98,2% bolesnika je pripadalo skupini velikog tromboembolijskog rizika. Od tog broja liječeno je samo 179 (55%) bolesnika: 65,5% bolesnika s acetilsalicilnom kiselinom, 30,5% varfarinom, a 4% klopidogrelom. Pritom je raniji tromboembolijski incident nezavisno korelirao s primjenom (OR 2,5; 95% CI 1,4-4,5, P=0,003), a neregulirana arterijska hipertenzija s neprimjenjivanjem (OR 0,47, 95% CI 0,25- 0,88, P=0,019) varfarina. Od 55 bolesnika koji su ishemijski moždani infarkt doživjeli unatoč primjeni varfarina, u 83,7% vrijednosti protrombinskog indeksa su bile niže od terapijskih. Smrtni ishod je zabilježen u 72 (22,2%) bolesnika; nezavisni predskazatelji smrtnosti bili su dob >75 godina (OR 1,93, 95% CI 1-3,6, P=0,039) i kongestivno popuštanje srca (OR 9,67, 95% CI 5,3-17,7, P75 godina (OR 0,53, 95% CI 0,31-0,91, P=0,22). Zaključak. Tromboprofilaktičko liječenje u bolesnika s nAF hospitaliziranih zbog ishemijskog moždanog infarkta nije bilo sukladno njihovom tromboembolijskom riziku i trenutnim smjernicama Europskog kardiološkog društva. Zabrinjavajuće je opažanje da unatoč nepostojanju kontraindikacija, 2/3 bolesnika s nAF pri otpustu s liječenja zbog ishemijskog moždanog infarkta nije dobilo preporuku za primjenu antikoagulansa. |
| Abstract (english) | Aim. Assess the concordance of the thromboprophylactic treatment in patients with nonvalvular atrial fibrillation (nAF) at the time of admission and discharge from treatment due to ischemic stroke with clinical guidelines of the European Society of Cardiology. Methods. In the cross-sectional study conducted from Novemeber 1, 2010 to December 31, 2011 were included all patients treated at the Department of Neurology University Hospital Split because of ischemic stroke associated with nAF. The index of the thromboembolic risk (TE) has been established by the CHA2DS2-VASc score, whereas the bleeding risk has been assessed by the HAS BLED score. Results: Among the 327 patients included into the research, 143 (44%) were male. Before the ischemic stroke, 98.2% of patients belonged to the group of high TE risk. Among these patients only 179 (55%) were received thromboprophylaxis: 67.5% patients acetylsalicylic acid, 30.5% warfarin, and 4% clopidogrel. Previous ischemic stroke was independently correlated with warfarin administration (OR 2.5, 95% CI 1.4-4.5, P=0.003), while poorly controlled arterial hypertension was independently correlated with warfarin non-administration (OR 0.47, 95% CI 0.25-0.88, P=0.019). 83.7% of 55 patients who experienced ischemic stroke during anticoagulant treatment, had an INR values lower than therapeutic. 72 (22.2%) patients died; independent predictors of death were age >75 years (OR 1.93, 95% CI 1-3.6, P=0.039), and congestive heart failure (OR 9.67, 95% CI 5.3-17.7, P75 years (OR 0.53, 95% CI 0.31-0.91, P=0.22) were independently correlated with warfarin non-administration. Conclusions. Tromboprophylactic treatment at the patients with nAF admitted because of ischemic stroke did not correlate with their TE risk and contemporary guidelines of the European Society of Cardiology. Worrisome is the observation that, despite of non existence of clear contraindications, two thirds of discharged ischemic stroke patients did not receive recommendation for anticoagulant therapy. |
