Akutni ishemijski moždani udar kod bolesnika sa atrijalnom fibrilacijom : kliničke karakteristike i ishod

Abstract

Cilj: Atrijalna fibrilacija (AF) predstavlja nezavisni faktor koji pet puta povećava rizik od nastanka akutnog ishemijskog moždanog udara (AIMU). Takodje, ona predstavlja i značajan prediktor lošeg ishoda AIMU. Ciljevi ove doktorske disertacije su bili: (i) utvrdjivanje kratkoročnog morbiditeta i mortaliteta kod bolesnika sa AF i AIMU; (ii) sagledavanje uticaja različitih faktora rizika (odredjivanjem vrednosti CHADS2, CHA2DS2-VASc i HAS-BLED skora pri prijemu) na težinu kliničke slike i ishod bolesti; (iii) utvrdjivanje efekta trombolitičke terapije ali i rane antikoagulantne terapije na ishod bolesti kod pacijenata sa AF i AIMU. Metodologija: Izvršena je analiza prospektivno prikupljenih podataka o 131 bolesniku sa AF i AIMU lečenim na Odeljenju urgentne neurologije, Klinike za neurologiju, Kliničkog centra Srbije u periodu 01.01.2009. – 01.06.2012. godine. U studiju za ovu disertaciju, a u cilju analize efekta primenjene trombolitičke terapije na ishod bolesti, bilo je uključeno i 115 bolesnika sa AIMU druge etiologije koji su u istom periodu bili lečeni intravenskom trombolizom na Odeljenju urgentne neurologije KCS, kao i 585 bolesnika sa AIMU (AF uzrokovanih i non-AF uzrokovanih) koji su u istom periodu lečeni trombolitičkom terapijom na Odeljenju neurologije, Univerzitetske bolnice „Roger Salengro“ u Lille-u, Francuska. Kod svih bolesnika je sproveden detaljan dijagnostički postupak koji je podrazumevao: postavljanje dijagnoze AIMU na prijemu (na osnovu anamneze i kliničkih kriterijuma) koja je potom verifikovana sprovedenim neuroimidžingom (non-kontrastni CT snimak). Takodje, svim bolesnicima je pri prijemu uzeta krv za kompletnu analizu, meren arterijski pritisak, radjen EKG i potom su pacijenti priključivani na kontinuirani EKG monitoring tokom hospitalizacije...

Purpose: Atrial fibrillation (AF) is an independent risk factor for acute ischemic stroke which increases the stroke risk by five-fold. In addition, it is also a significant predictor of stroke’s poor outcome. The research goals of this doctoral dissertation were: (i) to determine short-term morbidity and mortality in patients with AF and acute ischemic stroke; (ii) to analyze the impact of different risk factors (by determination of baseline CHADS2, CHA2DS2- VASc and HAS-BLED score values) on the clinical characteristics and stroke outcome; (iii) to determine the efficiency of thrombolytic therapy (IVT) and early anticoagulation on outcome in patients with AF-associated stroke. Methodology: Analysis of prospectively collected data on 131 patients with AF and acute ischemic stroke treated at the Emergency neurology department, Clinical Centre of Serbia in the period 01.01.2009. - 01.06.2012. was performed. For the purpose of this dissertation, in order to analyze the efficiency of IVT in stroke outcome, 115 patients with stroke of other etiology that were treated with IVT at the same period at Emergency neurology department, Clinical Centre of Serbia were also included, as well as 585 stroke patients (AF-associated and non-AF-associated) treated with IVT in the Neurology department of University hospital “Roger Salengro” in Lille, France. In all patients a detailed diagnostic procedure was performed at admission: the stroke diagnosis was made based on anamnesis and clinical criteria, and it was then verified by neuroimaging (non - contrast CT scan). Afterwards, blood was taken from all patients for a complete analysis, blood pressure was measured and an ECG at admission was performed which was then followed by continuous ECG monitoring during hospitalization...