THROMBOPROPHYLAXIS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ADMITTED IN UNIVERSITY HOSPITAL SPLIT, CROATIA, DUE TO THE ISCHAEMIC STROKE IN RELATION TO THROMBOEMBOLIC AND BLEEDING RISK

Abstract

Cilj rada bio je procijeniti usklađenost propisivanja tromboproilakse u bolesnika s nevalvularnom atrijskom ibrilacijom (nAF) prigodom prijma na liječenje zbog ishemijskog moždanog infarkta sa smjernicama Europskog kardiološkog društva za tromboproilaksu u bolesnika s nAF. U presječno retrospektivno istraživanje je uključeno 327 bolesnika [143 (44 %) muškaraca] s nAF, liječenih zbog ishemijskog moždanog infarkta. Tromboembolijski (TE) rizik procijenjen je sustavom CHA2DS2-VASc, a rizik krvarenja sustavom HAS-BLED. Prije doživljenog ishemijskog moždanog infarkta 98,2 % bolesnika pripadalo je skupini velikog tromboembolijskog rizika. Od tog broja tromboproilaksu je primjenjivalo samo 179 (55 %) bolesnika: 65,5 % bolesnika primjenjivalo je acetilsalicilnu kiselinu, 30,5 % varfarin, a 4 % klopidogrel. Raniji tromboembolijski incident nezavisno je 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 % bolesnika vrijednosti protrombinskog indeksa prilikom prijama su bile niže od terapijskih.Autori zaključuju da tromboproilaksa u bolesnika s nAF hospitaliziranih zbog ishemijskog moždanog infarkta nije bila sukladna njihovom tromboembolijskom riziku i trenutnim smjernicama Europskog kardiološkog društva.Aim of the study was to assess the concordance of the thromboprophylactic treatment in patients with nonvalvular atrial ibrillation (nAF) at the time of admission due to ischemic stroke with clinical guidelines of the European Society of Cardiology. Methods: In the cross-sectional study were included 327 patients [143 (44%) males] treated 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: 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). The 83.7% of 55 patients, who experienced ischemic stroke during anticoagulant treatment, had an INR values lower than therapeutic. Conclusion: Thromboprophylaxis among 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