| Abstract | Cilj istraživanja
Cilj ovog istraživanja je prikazati odnos između fibrilacije atrija, cerebralnog infarkta,
intracerebralnog krvarenja, gastrointestinanog krvarenja i lijekova. Pretpostavka je da
bolesnici s fibrilacijom atrija koji su liječeni NOAK-ima imaju manje cerebralnih infarkta u
odnosu na bolesnike koji su liječeni varfarinom, acetilsalicilnom kiselinom ili nisu uopće
uzimali neki od navedenih lijekova.
Ispitanici i metode
Opservacijsko retrospektivno istraživanje provedeno je u Općoj bolnici Zadar. Obuhvaćeni su
bolesnici primljeni na bolničko liječenje u OB Zadar od 01.09.2016. do 31.08.2017. s
dijagnozama (MKB–10) I63 Cerebralni infarkt (Infarctus cerebri), I61 Intracerebralno
krvarenja i K92 Ostale bolesti probavnog sustava.
Svi bolesnici koji su u anamnezi i/ili u trenutku prijema imali fibrilaciju atrija uključeni su u
istraživanje. Uključeni su bolesnici koji su prije hospitalizacije bili na u terapiji NOAK-om,
varfarinom, acetilsalicilnom kiselinom te oni koji nisu uzimali ni jedan od navedenih lijekova.
Iz istraživanja su isključeni oni bolesnici koji u anamnezi i/ili u trenutku prijema nisu imali
fibrilaciju atrija iako su primljeni s dijagnozom cerebralnog infarkta, intracerebralnog
krvarenja ili gastrointestinalnog krvarenja.
Podatci su prikupljeni iz medicinske dokumentacije koja je dostupna elektronskim putem.
CHA2DS2-VASc score izračunat je za sve bolesnike uključene u istraživanjepomoću alata
mobilne aplikacije Mediately Baza lijekova.Statistička obrada podataka napravljena je u
Microsoft Office Excell-u i u R-u.
Istraživanje je odobrilo Etičko povjerenstvo Opće bolnice Zadar.
Rezultati
U istraživanje je uključeno 107 sudionika od kojih 78 bolesnika s dijagnozom cerebralnog
infarkta I63, 20 bolesnika s dijagnozom intracerebralnog krvarenja I61 i 9 bolesnika s
dijagnozom krvarenja iz gastrointestinalnog sustava K92. U istraživanju je ukupno 32
bolesnika koristilo varfarin u terapiji FA, 11 je koristilo neki od NOAK-a, 18 je koristilo
acetilsalicilnu kiselinu, a 46 bolesnika nije koristilo ni jedan od navedenih lijekova. Za
bolesnike koji su u terapiji imali lijek varfarin analizirani su podaci o vrijednosti INR-a. INR
prilikom prijema manji od 2 imalo je 56% bolesnika, 28% bolesnika imalo je INR u
terapijskom rasponu od 2 do 3,5, a 16% ih je imalo INR veći od 3,5.U ovom istraživanju
analizirani su također i ishodi liječenja bolesnika s obzirom na promatrane komplikacije FA
(cerebralni infark, intracerenbralno i gastrointestinalno krvarenje). Smrtni ishod tijekom
hospitalizacije zabilježen je u 25 bolesnika, a ne smrtni ishod, odnosno oporavak u 82
bolesnika. Bolesnici s intracerebralnim krvarenjem imaju veću vjerojatnost smrtnog ishoda
nego oporavka.
Zaključak
Prema rezultatima ovog rada, u kojem je ispitivanoliječenje varfarinom u prevenciji
moždanog udarabolesnika s fibrilacijom atrija, svega njih 28% je imalo optimalan učinak
lijeka. Ishodi liječenja “outcomes”, u bolesnika koji su na antikoagulacijskoj terapiji zbog
kronične FA pokazali su nezadovoljavajuću razinu kvalitete liječenja. Analizirana je
učestalost ishemijskog moždanog udara prema terapiji koju su bolesnici uzimali, ali i
nuspojava liječenja praćenjem intracerebralnih i gastrointestinalnog krvarenja, kao najčešćih
nuspojava ove terapije. Zaključak je da u uvjetima svakodnevnog rada u OB Zadar primjena
varfarina u prevenciji CVI nije opravdana zbog loše reguliranog INR-a te prednost ima
primjena NOAK-a. |
| Abstract (english) | Objectives
The aim of this study is to show the relationship between atrial fibrillation, cerebral infarction,
intracerebral bleeding, gastrointestinal bleeding and drugs. The assumption is that patients
with atrial fibrillation treated with NOAC’s have less cerebral infarction than those treated
with warfarin, acetylsalicylic acid or have not at all taken any of these drugs.
Patients and Methods
Observational retrospective study was conducted at the Zadar General Hospital. Patients were
admitted to hospital care at Zadar GH from 01.09.2016. until 31.08.2017. with diagnosis
(MKB-10) I63 Cerebral Infarction (Infarctus cerebri), I61 Intracerebral Haemorrhage and K92
Other Gastrointestinal Disorders.
All patients who had an atrial fibrillation and / or at the time of admission were involved in
the study. Patients who were used NOAC, warfarin, acetylsalicylic acid and those who did not
take any of these drugs before hospitalization were included to the study.
Patients who did not have atrial fibrillation at the history and / or at the time of admission
were excluded from the study although they were diagnosed with cerebral infarction,
intracerebral bleeding or gastrointestinal bleeding.
Data are collected from medical documentation available electronically. The CHA2DS2-VASc
score was calculated for all patients involved in the study using the Mediately Baza lijekova.
Statistical data processing is done in Microsoft Office Excell and in R.
The study was approved by the Ethics Committee of the Zadar General Hospital.
Results
The study included 107 participants, of whom 78 were diagnosed with cerebral infarction I63,
20 patients with intracerebral bleeding I61 and 9 patients with bleeding diagnoses from the
gastrointestinal tract K92. In the study, a total of 32 patients used warfarin in FA therapy, 11
used NOAC, 18 used acetylsalicylic acid, and 46 patients did not use any of these drugs. For
patients who had drug treatment with warfarin, data on INR values were analyzed. INR was
less than 2 in 56% of patients, 28% had INR in the therapeutic range of 2 to 3.5, and 16% had
INRs greater than 3.5. This study also analyzes the outcome of treating patients with regard to
the observed FA complications (cerebral infarction, intracerebral and gastrointestinal
bleeding). Mortality during hospitalization was recorded in 25 patients, recovery in 82
patients. Patients with intracerebral bleeding are more likely to experience fatal outcome than
recovery.
Conclusion
According to the results of this study, where treatment with warfarin was used to prevent
stroke in patients with atrial fibrillation, 28% of them had the optimal drug effect.The results
of treatment outcomes in patients with anticoagulant therapy due to chronic FA have shown
an unsatisfactory level of treatment quality. The incidence of ischemic stroke was evaluated
according to the therapy given by the patients, but also the side effects of treatment by
monitoring intracranial and gastrointestinal bleeding as the most common side effects of this
therapy. The conclusion is that under the conditions of daily work in Zadar General Hospital
the application of warfarin to ICV prevention is not justified because of a poorly regulated
INR and the advantage is NOAC's use. |
