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- Title
Anticoagulant and antitrombotic therapy in stroke recurrence prevention in patients presented with atrial fibrillation - ten years experience.
- Authors
Macić-Džanković, Amra; Šubo, Anela; Polimac, Nermina; Burina, Nina; Džanković, Fuad; Pojskić, Belma
- Abstract
Introduction: atrial fibrillation (AF) is the most common arrhythmia in the elderly and potent risk factor for stroke. After the first stroke, the 5-year risk of having recurrent stroke is 20%. AF is associated with a prothrombotic state and other comorbidities and anticoagulation therapy is essential for stroke prevention in patients with AF. Objective: to determine the effect of prescribed anticoagulant or antithrombotic drugs on survival and stroke recurrence in patients presented with ischaemic stroke and atrial fibrillation. Materials and methods: the retrospective clinical study included patients diagnosed with ischemic stroke, hospitalized at the Neurology Department of the JU "Prim. Dr. Abdulah Nakaš" in Sarajevo in the period from January 1, 2001 to October 1, 2011. A total of 1134 patients with ischaemic stroke was randomly selected. Out of the total number of patients 728, aged 42 - 89 years, were presented with atrial fibrillation. Those patients were divided into two groups - Group 1 patients treated with antithrombotics (aspirin alone or in combination with clopidogrel or dipiridamole or clopidogrel alone), and Group II patients treated with OAC. INR were monitored. Results: lower survival rate was registered in the group of patients presented with stroke and concomitant atrial fibrillation. Majority of patients with AF who had repeated stroke were over 70 years of age. Only 385 of them (604 of a total of 728 survived 6 weeks follow up) received anticoagulation therapy. During further follow up period, out of a total of 604 patients, restroke occurred in 97. Two patients died due to haemorrhagic complications, and one patient, who was receiving OAC, survived haemorrhagic stroke. Conclusion: the study showed a high mortality rate in group of patients with both ischaemic stroke and atrial fibrillation. Patients over 70 presented with ischaemic stroke and atrial fibrillation had strong predictive mortality value, with no significant difference between males and females. The results showed that OAC (warfarin) reduced risk of re-stroke compared to antiplatelet therapy (aspirin alone or in combination with clopidogrel or dipiridamole or clopidogrel alone) and that there was no significant risk of bleeding in comparison with the antiplatelet therapy. These findings pointed out that common antithrombotic therapy was not optimal option for long - term treatment of patients diagnosed with both ischemic stroke and atrial fibrillation and that it could not be prescribed in this group of patients. We believe that new generation of anticoagulants will be the cornerstone in the prevention of stroke reccurance in patients with AF but with limited application in developing countries due to cost it involves.
- Publication
Medical Journal / Medicinski Žurnal, 2015, Vol 21, Issue 3, p170
- ISSN
1512-5866
- Publication type
Academic Journal