| Objective: To analyze the clinical characteristics of ischemic stroke patients with non-valvular atrial fibrillation,and to observe the status of anticoagulation at present by CHA2DS2-VASc and HAS-BLED score systems,which would provide a theory to primary and secondary prevention and health knowledge education.Methods: Retrospective analysis of clinical data of 220 acute ischemic stroke patients with non-valvular atrial fibrillation from Department of neurology,the Affiliated Hospital of Southwest Medical University from 2013.8 to2015.7(named AF group for short).Enrolled 229 acute ischemic stroke patients without atrial fibrillation to a control group simultaneously(named NAF group for short).Results: 1)In AF group,121 cases were male,99 cases were female,and the gender ratio was1.22:1;The average age was(74.98 ± 8.998)years,45% patients were in the age of 70-79 years,60% were over than 75 years;The average age and female gender ratio of the AF group were higher than those of the NAF group(74.98 ± 8.998 vs.64.71 ± 11.643,P=0.000),(45%vs.34.5%,P=0.023).2)The onset symptom in AF group was hemiplegia(54.09%),followed by conscious disturbance(17.73%),dizziness(6.36%),headache(5.45%),aphasia(4.55%),articulationdisorder(4.09%),seizure(4.09%),and so on.The incidences of conscious disturbance(17.73% vs.2.62%,P<0.001)and epilepsy(4.09% vs.0.87%,P=0.027)were higher than those in NAF group.3)The rate of left atrial mural thrombus transthoracic echocardiography in patients with non-valvular atrial fibrillation was 1.82%.The proportions of patients with lesions located in internal carotid artery system,vertebral basilar artery system and both the two systems were 49.09%,19.55%,31.36%respectively.The comparisons of proportions in patients with multiple lesions(60% vs.48.91%,P=0.018),large area cerebral infarction(42.27%vs.13.97%,P<0.001)and hemorrhagic transformation(13.64% vs.1.75%,P<0.001)had significant differences in the two groups.4)The NIHSS scores at admission(13 vs.6,P<0.001)and at discharge(11 vs.5,P<0.001)in the AF group were higher than those in the NAF group.5)Patients in the AF group often had different types of complications,the proportion of patients with two or more complications was 56.82% and with three or more complications was 25.91%.Compared with patients in the NAF group,the proportions of patients with heart failure(52.27%vs.3.93%,P<0.001),coronary heart disease(45.45% vs.8.30%,P<0.001),hyperuricemia(33.64% vs.24.45%,P=0.032)and peripheral vascular disease(9.09% vs.3.06%,P=0.007)were higher in the AF group.Among them,heart failure(OR=17.645,95.0%CI=8.406-37.040,P<0.001)and coronary heart disease(OR=4.405,95.0%CI=2.393-8.106,P<0.001)were the remarkable related risk factors,and the risk degree of heart failure is higher than the coronary heart disease.6)The incidence of complications in the AF group was higher than in the NAF group(91.36% vs.62.01%,P<0.001),including respiratory tract infection(72.73% vs.32.75%,P<0.001),electrolyte disturbances(62.73%vs.32.75%,P<0.001),nutritional disorders(55.00% vs.28.38%,P<0.001),cerebral hernia(19.09% vs.2.18%,P<0.001),gastrointestinal bleeding(11.82% vs.2.62%,P=0.000),urinary tract infection(5.45%vs.1.75%,P=0.034)and epilepsy 5% vs.1.31%,P=0.025).The proportion of patients with 2 or more complications in the AF group was higher than in the NAF group(52.27% vs.14.41%,P<0.001).7)The rate of stroke recurrence(20.00%vs.7.86%,P<0.001),hospital mortality(10.00% vs.1.75%,P<0.001)and self discharge(29.09% vs.7.86%,P<0.001)in AF group were significantly higher than those in NAF group,while the average hospitalization days of patients in the AF group was shorter(10 vs.12,P=0.030).8)The proportions of low risk patients,middle risk patients and high risk patients were 1.82%,4.54%,93.64%respectively before this ischemic stroke by CHA2DS2-VASc score.In low risk patients,anticoagulation rate was 25%;In middle risk patients,anticoagulation rate was 0%,INR standard rate was 0%,the proportion of HAS-BLED score<3 points was 100%;In high risk patients,anticoagulation rate was 4.37%,the standard rate of INR was 2.43%,theproportion of HAS-BLED score<3 was 77.18%.Conclusion: 1)Ischemic stroke patients with non-valvular atrial fibrillation are mainly the elderly.The AF group tend to have more women.2)The most common symptom of ischemic stroke patients with non-valvular atrial fibrillationis is hemiplegia,and the incidence of consciousness disorder and epilepsy is higher than that of patients without atrial fibrillation.3)The rate of left atrial mural thrombus transthoracic echocardiography in ischemic stroke patients with non-valvular atrial fibrillation is low.The infarction was often at internal carotid artery system,characterd by multiple lesions,large area cerebral infarction and hemorrhagic transformation.4)Ischemic stroke patients with non-valvular atrial fibrillation more often have heart failure,coronary heart disease,hyperuricemia and the history of peripheral vascular disease,and heart failure and coronary heart disease are the remarkable related risk factors.5)Ischemic stroke patients with non-valvular atrial fibrillation have severe neurological deficits and more complications during hospitalization,especially respiratory tract infections.Ischemic stroke patients with non-valvular atrial fibrillation have bad clinical outcome,and the length of stay in hospital of patients in the AF group is shorter than those in the NAF group in the study.6)Majority of patients with atrial fibrillation in our hospital have anticoagulation indications and low bleeding risk,but the current situation of anticoagulation is inadequate at present.At the same time,thecurrent situation of anticoagulation in the low risk patients is excessive. |
PDF Full Text Request