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The Study of Preventing Ischemic Stroke in Patients with Atrial Fibrillation

Author: FanShangHua
Tutor: XieRuiMan
School: Fudan University
Course: Neurology
Keywords: AF stroke warfarin anticoagulation
CLC: R541.75
Type: Master's thesis
Year: 2011
Downloads: 25
Quote: 0
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Abstract


Atrial fibrillation (AF) is the most common form of irregular heart beat. AF is caused by the abnormal heart rhythm which involves the two chambers of the atria of the heart. The name is derived from the quivering or shaking of the muscles of the heart in the atria. Stroke is considered to be the most significant morbidity in patients with AF. The prevalence of stroke in AF patients was much more serious year after year. Warfarin is the most important anticoagulant for stroke prevention. But it is underused in China. The objective of this study is to investigate the pattern of anticoagulation in patients with AF.All 480 patients with AF were investigated (289 males and 191 females, mean age 68.9±13 years old) and the 236 of all cases were followed-up successfully through phone calls in this retrospective cohort study.All consecutive patients (more than 18 years old and confirmed AF with EKG) were included in the study. The mean CHADS2 score of all cases was 1.60±1.33 and the CHADS2 score in the 381 of all cases (79.37%) was greater than or equal 1. The anti-thrombotic therapy was used in the 448 of all cases (93.3%) and the warfarin was used in the 210 of all cases. The INR was tested simultaneously in the 182 of 210 patients with warfarin. A non-lethal embolic stroke was found in the 4 of 236 cases (1.7%) and the 29 of 236 cases (12.3%) were died in the followed-up study. The warfarin of oral anticoagulation was used in the 54 of 207 survived patients (26.1%) continuously and the INR was tested in the 53 of 54 cases (98.1%) regularly. Then the aspirin was used in the 85 of 207 survived patients (41.1%) to prevent stroke and the clopidogrel was only used in the 5 of 207 survived cases (2.4%).The study showed that the important of anticoagulation therapy was not understood in the patients with AF clinically and the anticoagulation therapy was not taken even if the CHADS2 score was high. The warfarin is the most effective oral anticoagulation clinically but there is underused among AF patients. Although there is less effective anticoagulation in the aspirin than that in the warfarin, it is prone to use the asprin among AF patients clinically. The dose of aspirin is low for patients with AF (<300mg) and the effective anticoagulation is unable to achieve. There is high probability of use in the combination therapy of aspirin and clopidogrel clinically. The INR were not tested in some AF patients with warfarin therapy simultaneously. The high morbidity of stroke and mortality might be considered as a result of underused of warfarin in patients with AF clinically.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Arrhythmia > Atrial fibrillation and atrial flutter
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