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【Stroke】房颤患者--仍需重视抗凝治疗
Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated
* To whom correspondence should be addressed. E-mail: david.gladstone@sunnybrook.ca.
Background and Purpose—Warfarin is the most effective stroke prevention medication for high-risk individuals with atrial fibrillation, yet it is often underused. This study examined the magnitude of this problem in a large contemporary, prospective stroke registry.
Methods—We analyzed data from the Registry of the Canadian Stroke Network, a prospective database of consecutive patients with stroke admitted to 12 designated stroke centers in Ontario (2003 to 2007). We included patients admitted with an acute ischemic stroke who (1) had a known history of atrial fibrillation; (2) were classified as high risk for systemic emboli according to published guidelines; and (3) had no known contraindications to anticoagulation. Primary end points were the use of prestroke antithrombotic medications and admission international normalized ratio.
Results—Among patients admitted with a first ischemic stroke who had known atrial fibrillation (n=597), strokes were disabling in 60% and fatal in 20%. Preadmission medications were warfarin (40%), antiplatelet therapy (30%), and no antithrombotics (29%). Of those taking warfarin, three fourths had a subtherapeutic international normalized ratio (<2.0) at the time of stroke admission. Overall, only 10% of patients with acute stroke with known atrial fibrillation were therapeutically anticoagulated (international normalized ratio 2.0) at admission. In stroke patients with a history of atrial fibrillation and a previous transient ischemic attack or ischemic stroke (n=323), only 18% were taking warfarin with therapeutic international normalized ratio at the time of admission for stroke, 39% were taking warfarin with subtherapeutic international normalized ratio, and 15% were on no antithrombotic therapy.
Conclusions—In high-risk patients with atrial fibrillation admitted with a stroke, and who were candidates for anticoagulation, most were either not taking warfarin or were subtherapeutic at the time of ischemic stroke. Many were on no antithrombotic therapy. These findings should encourage greater efforts to prescribe and monitor appropriate antithrombotic therapy to prevent stroke in individuals with atrial fibrillation.
本研究属于回顾性研究，其目的在于强调房颤患者抗凝治疗的重要性。当然，关于抗凝治疗的研究很多，另一篇文献将告诉我们心源性卒中后的抗凝治疗，有兴趣的园友可以参看下面的全文链接。
http://archneur.ama-assn.org/cgi/content/full/65.9.noc70105 本人认领，24小时未上交视为放弃，请其他战友继续。 Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated
房颤患高危险性中风抗凝治疗不足
Background and Purpose—Warfarin is the most effective stroke prevention medication for high-risk individuals with atrial fibrillation, yet it is often underused. This study examined the magnitude of this problem in a large contemporary, prospective stroke registry.
背景和目的-华法林是最有效预防房颤高风险的病人患脑卒中的药物，但它往往是使用不足。本研究这个问题当代性的，大样本的，前瞻性的中风研究 房颤患高危险性中风抗凝治疗不足
背景和目的-华法林是最有效预防房颤高风险的病人患脑卒中的药物，但它往往是使用不足。本研究这个问题当代性的，大样本的，前瞻性的中风研究 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-08-06 17:11
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