Anticoagulation therapy usage in atrial fibrillation patients and its relation to ischemic stroke severity

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Monika Šerelytė1, Džonardas Šleiteris2, Antanas Vaitkus2

1 Lithuanian University of Health Science, Academy of Medicine, Faculty of Medicine

2Department of Neurology, Kaunas Clinics, Hospital of Lithuanian University of Health Sciences

Abstract

Background: Atrial fibrillation (AF) is one of the most common clinically significant cardiac arrythmias (CA) and a major modifiable factor associated with increased risk of acute ischemic stroke (AIS) and peripheral embolism.

Aim: investigate anticoagulation therapy (AT) usage in atrial fibrillation patients and its relation to ischemic stroke severity.

Methods: Retrospective study involved participants older than 18 years old, first AIS in life, AF, AT anamnesis, CHA2DS2VASc, National institutes of health stroke severity (NIHSS) scales results. Statistical analysis was performed by using SPSS statistics software package, Microsoft Excel 2010 and Microsoft Word 2010 programs.

Results: 67 cases, 26 (38.8%) men and 41 (61.2 %) women with AF and AIS diagnosis. AF first time in life 2 (3%), persistent AF 2 (3%), paroxysmal AF 19 (28.4%), permanent AF 44 (65.6 %) diagnosed cases. AT was applied by 11 (16.4 %), but 56 (83.6 %) cases AT was not used. AIS risk: moderate CHA2DS2VASc result in 59 (80.6%), severe in 3 (4.48 %) cases had AT indications and mild risk in 5(7.46 %) cases had no AT indications. There were no group differences between AT and no – AT cases, except CHA2DS2VASc was higher in women (p = 0.002). CHA2DS2VASc women mean 4.07 SD 1.77, men mean 2.65 SD 1.65. Some non – parametrical correlation was found: age to CHA2DS2VASc (r=- 0,389; p= 0.001), CHA2DS2VASc to NIHSS before (r=- 0.313; p=0.01) CHA2DS2VASc to NIHSS after thrombolysis (r=- 0.357; p= 0.003) and CHA2DS2VASc to glycaemia (r=- 0.34; p =0.005).

Conclusions:  More than half AF patients did not use anticoagulation therapy. We did not find any AIS severity statistically relevant differences between AF patient with or without AT. This study shows only tendencies that AT in AF remains still challenging in AIS prevention.

Keywords: acute ischemic stroke, atrial fibrillation, anticoagulants, therapy