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Algengi gáttatifs og notkun warfaríns hjá sjúklingum með heiladrep eða blóðþurrðarkast í heila

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Authors
Pétur Pétursson
Sigurlaug Sveinbjörnsdóttir
Gísli Einarsson
Guðmundur Þorgeirsson
Páll Torfi Önundarson
Davíð O. Arnar,
Issue Date
2004-07-01

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Other Titles
Prevalence of atrial fibrillation and use of warfarin among patients with ischemic stroke
Citation
Læknablaðið 2004;90(7-8):561-5
Abstract
Objective: Atrial fibrillation (AF) is the most common sustained cardiac arrythmia and a significant cause of morbidity. Stroke and transient ischemic attack (TIA) are well known serious complications of AF. In the last decade, a number of studies have shown that the risk of stroke in patients with AF is reduced by anticoagulation therapy with warfarin. The aim of this study was to assess the prevalence of AF in patients with acute ischemic stroke or TIA and to look at the use of anticoagulation therapy in patients who either had a previously known AF or were diagnosed to have AF during hospitalisation for ischemic stroke or TIA. Methods: Medical records of 918 patients admitted to Landspitali University Hospital in Iceland in 1997-2000 with the diagnosis of TIA or ischemic stroke were reviewed to detect a subgroup with AF. In addition to demographic data and cardiac function studies, information was collected about other possible coexisting stroke risk factors. Results: A total of 159 patients (17%) had AF in 124 (78%) of whom the AF was previously known. In 35 patients AF was diagnosed during the hospitalisation.The majority of those patients also had at least one other risk factor for stroke. On admission, 27 patients (22%) of those with previously known AF were being treated with warfarin. In eleven (41%) the anticoagulation was subtherapeutic as the INR was found to be lower than 2,0. At discharge, 74 patients of those 131 (56%) who were alive were receiving warfarin anticoagulation. Conclusion: The prevalence of AF in patients with TIA or ischemic stroke was somewhat high in this study. AF and other risk factors for stroke were found to commonly coexist. Despite the well documented effect of warfarin in such patients, this therapy was underused for both primary and secondary stroke prevention.
Tilgangur: Gáttatif er algengasta viðvarandi hjartsláttartruflunin og getur haft afgerandi áhrif á lífs­gæði. Heiladrep er einn alvarlegasti fylgikvilli gáttatifs og fjölmargar rannsóknir á síðasta áratug sýna að draga má úr tíðni þessa fylgikvilla með warfarín blóðþynningarmeðferð. Tilgangur þessarar rannsóknar var að kanna algengi gáttatifs hjá sjúklingum með heiladrep og skammvinnt blóðþurrðarkast í heila og hvernig staðið var að blóðþynningu hjá þeim sem höfðu áður þekkt gáttatif. Efniviður og aðferðir: Upplýsinga var aflað á aftur­skyggnan hátt um alla sjúklinga sem komu á Land­spítala vegna heiladreps eða skammvinnrar blóðþurrðar í heila á fjögurra ára tímabili (1997-2000). Þessar upplýsingar höfðu verið skráðar á framvirkan kerfisbundinn hátt í Heilablóðfallsskrá. Í þessari rannsókn var litið sérstaklega á gögn sjúklinga sem jafnframt voru greindir með gáttatif, ýmist áður eða í sjúkrahúslegunni eftir heilablóðfallið. Niðurstöður: Á meðal 918 sjúklinga með heiladrep eða skammvinnna blóðþurrð í heila sem gögn voru til um reyndust 124 (13,5%) hafa þekkt gáttatif fyrir greiningu heilaáfallsins. Þrjátíu og fimm til viðbótar greindust með gáttatif í legunni og hjartsláttartruflun því til staðar hjá 159 (17%) þeirra sem greindust með heiladrep eða blóðþurrðarkast. Af þeim sem voru með þekkt gáttatif fyrir voru aðeins 27 (22%) á blóðþynningarmeðferð með warfaríni við greiningu heilaáfallsins og aðeins 16 af 27 (59%) höfðu INR gildi (International Normalized Ratio) yfir 2,0 við innlögn. Tuttugu og átta sjúklingar létust í legunni. Alls útskrifuðust 74 af 131 (56%) sjúklingi á warfarínmeðferð. Velflestir sjúklinganna höfðu að minnsta kosti einn viðbótaráhættuþátt fyrir blóðþurrðarsjúkdómi í heila auk gáttatifs. Ályktun: Gáttatif er algengt meðal sjúklinga sem fá heiladrep eða skammvinna heilablóðþurrð en margir þeirra hafa aðra áhættuþætti heila­blóð­þurrð­ar­sjúk­dóms að auki. Erfitt er því að átta sig á beinu orsakasamhengi gáttatifs og heilaáfalls hjá stórum hluta þessara sjúklinga. Niðurstöður þessarar rann­sókn­ar benda til þess að notkun warfaríns hafi ver­ið ábótavant bæði fyrir og eftir heilablóðþurrð á rann­sóknartímabilinu
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