Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2009, vol. 18, nr 2, March-April, p. 141–146

Publication type: original article

Language: English

An Analysis of Primary Prophylaxis in Middle−Aged and Elderly Stroke Patients with Atrial Fibrillation

Analiza pierwotnej profilaktyki udaru u chorych z migotaniem przedsionków w średnim i podeszłym wieku

Bogusław Paradowski1,, Edyta Kowalczyk1,, Ewa Koziorowska−Gawron1,, Michał Paradowski1,, Jerzy Kamienowski2,, Andrzej Maciejak3,, Leszek Noga4,

1 Department of Neurology, Wroclaw Medical University, Wrocław, Poland

2 Department of Neurology, Marciniak Memorial Hospital, Wrocław, Poland

3 Department of Neurology, Złotoryja, Poland

4 Department of Pathophysiology, Wroclaw Medical University, Wrocław, Poland

Abstract

Background. Atrial fibrillation (AF) is the cause of about 16–18% of ischemic strokes. The authors analyzed the preventive therapy applied in middle−aged and elderly patients with AF and completed ischemic stroke treated in three wards in a large city and a smaller town in Poland and the impact of the type of primary prevention on the death rate.
Material and Methods. Patients with strokes were divided into three groups: those with a high risk (284/349 patients), an average risk (43/349 patients), and a low risk of stroke (22/349 patients) in the course of AF.
Results. In the patients with a high risk of stroke, the primary prophylaxis was an antiplatelet drug (23.6%). Only in 7.4% (21/284) of those treated was an anticoagulant (AC) administered. The manner of conducting treatment was different from that recommended by stroke experts. Statistically significantly fewer patients (5.3%) taking an AC (acenocumarol, p < 0.001) died in comparison with those who did not (30.8%). The main cause of death was extensive ischemic stroke (72.6%) and in 7.1% of the cases it was secondary bleeding to an ischemic focus.
Conclusion. Due to improper primary prophylaxis in patients with AF with a high risk of ischemic stroke, the authors recommend a simple blood test to estimate the INR of proper treatment and prophylaxis and also recommend the MMSE test for patients in the group at high risk of stroke prior to the start of anticoagulant treatment. Prophylaxes should be applied according to the recommendations of experts.

Streszczenie

Wprowadzenie. Migotanie przedsionków (AF) jest przyczyną około 16–18% udarów niedokrwiennych. Autorzy zanalizowali leczenie zapobiegawcze stosowane u osób w średnim i podeszłym wieku z migotaniem przedsionków i przebytym udarem niedokrwiennym, leczonych w trzech oddziałach w Polsce (duże miasto i miasteczko), oraz wpływ rodzaju pierwotnej prewencji udaru na śmiertelność.
Materiał i metody. Pacjenci z udarem zostali podzieleni na trzy grupy: z wysokim ryzykiem udaru (284/349 chorych), średnim – (43/349 chorych) i niskim ryzykiem udaru (22/349 chorych) w przebiegu migotania przedsionków.
Wyniki. U chorych z wysokim ryzykiem udaru jako profilaktykę pierwotną stosowano lek przeciwpłytkowy (23,6%). Tylko u 7,4% (21/284) stosowano antykoagulant (AC). Sposób prowadzenia leczenia różnił się od zaleceń ekspertów w dziedzinie leczenia udarów. Śmiertelność u chorych leczonych AC (5,3%) była mniejsza niż u chorych nieleczonych AC (30,8%), różnica była istotna statystycznie. Główną przyczyną śmierci był rozległy udar niedokrwienny (72,6%). U 7,1% chorych przyczyną śmierci było wtórne ukrwotocznienie ogniska.
Wnioski. Z powodu nieprawidłowej profilaktyki pierwotnej u chorych z AF i wysokim ryzykiem udaru autorzy zalecają proste badanie krwi, aby ocenić wskaźnik INR i skuteczność leczenia, a także przeprowadzenie testu MMSE z grupy wysokiego ryzyka udaru przed rozpoczęciem leczenia AC. Profilaktyka powinna być prowadzona według wytycznych ekspertów.

Key words

atrial fibrillation, high−risk stroke, primary preventive treatment

Słowa kluczowe

migotanie przesionków, udar wysokiego ryzyka, profilaktyka pierwotna

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