Recurrent ischemic stroke in patients with atrial fibrillation: frequency, heterogeneity, prevention
https://doi.org/10.21518/2307-1109-2020-2-7-16
Abstract
Introduction. For the prevention of recurrent ischemic stroke (IS) in patients with atrial fibrillation (AF), oral anticoagulants (OAC) are considered a priority. The comorbidity of AF patients raises a discussion about the non-alternative feasibility and exceptional clinical efficacy of OAC. The validity of the choice of a specific antithrombotic agent can be assessed using a dynamic assessment of the causes of the first and recurrent stroke in patients with AF.
Aim. To assess the frequency recurrent IS and quality of medicament prevention therapy in patients with AF depend on heterogeneity of stroke leading pathogenetic mechanism.
Materials and methods. The data from the register of 200 patients with IS and AF were analyzed. 55 (27.5%) patients suffered recurrent IS (24 (43,6%) men, 31 (56,4%) women, mean age 72,3 ± 10,2 years). The pathogenetic subtype of recurrent IS was determined, including a retrospective assessment of the pathogenetic subtype of a previous IS. We studied the presence and nature of antithrombotic therapy (ATT) preceding a second stroke.
Results. The first IS was due to cardiogenic embolism in 36.4% of patients, the atherothrombotic subtype occurred in 18.2%, and the lacunar subtype in 34.5% of patients. Embolic stroke from an undetermined source (ESUS) - in 10.9% of patients. OACs were prescribed only to 31.7% of patients, antiplatelet agents - to 14.6% of patients, 53.7% of patients did not receive ATT. The leading pathogenetic subtype of recurrent stroke was cardiogenic embolism (70.7%), the frequency of lacunar stroke decreased (4.9%), and the frequency of atherothrombotic stroke remained unchanged. In 14 patients with recurrent stroke, AF was first detected, including all patients with ESUS.
Conclusion. The proportion of recurrent stroke in patients with AF is 27.5%. Compared with the first stroke, recurrent stroke in patients with AF is characterized by an increase in the proportion of cardiogenic embolism up to 70.7%, which is due to the insufficient prescription of OAC, which must be recommended, including for patients with non-cardioembolic subtypes of stroke.
About the Authors
L. A. Geraskina
Research Center of Neurology
Russian Federation
Russian Federation
Liudmila A. Geraskina - Dr. of Sci. (Med.), Leading Researcher of the Laboratory of Cardioneurology of the Department of Neurology No. 2, Research Center of Neurology.
80, Volokolamskoe Shosse, Moscow, 125367.
M. M. Alieva
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Muslimat M. Alieva - Postgraduate student of the Department of Nervous Diseases and Neurosurgery named after Yu.S. Martynov of the Medical Institute, Peoples' Friendship University of Russia.
6, Miklukho-Maklai St., Moscow, 117198.
A. V. Fonyakin
Research Center of Neurology
Russian Federation
Russian Federation
Andrey v. Fonyakin - Dr. of Sci. (Med.), Professor, Leading Researcher , Head of the Laboratory of Cardioneurology of the Department of Neurology No. 2, Research Center of Neurology.
80, Volokolamskoe Shosse, Moscow, 125367.
M. Yu. Maximova
Research Center of Neurology
Russian Federation
Russian Federation
Marina Yu. Maximova - Dr. of Sci. (Med.), Professor, Head of the Department of Neurology No. 2, Research Center of Neurology.
80, Volokolamskoe Shosse, Moscow, 125367.
N. I. Garabova
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Naida I. Garabova - Cand. of Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery named after Yu.S. Martynov of the Medical Institute, Peoples' Friendship University of Russia.
6, Miklukho-Maklai St., Moscow, 117198.
M. G. Burzhunova
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Madina G. Burzhunova - Assistant Professor of the Department of Nervous Diseases and Neurosurgery named after Yu.S. Martynov of the Medical Institute, Peoples' Friendship University of Russia.
6, Miklukho-Maklai St., Moscow, 117198.
References
1. Wolf P.A., Abbott R.D., Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22(8):983-988. doi: 10.1161/01.str.22.8.983.
2. Perera K.S., Vanassche T., Bosch J., Swaminathan B., Mundl H., Giruparajah M. et al. Global Survey of the Frequency of Atrial Fibrillation - Associated Stroke: Embolic Stroke of Undetermined Source Global Registry. Stroke. 2016;47(9):2197-2202. doi: 10.1161/STROKEAHA.116.013378.
3. Kernan W.N., Ovbiagele B., Black H.R., Bravata D.M., Chimowitz M.I., Ezekowitz M.D. et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-2236. doi: 10.1161/STR.0000000000000024.
4. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-1678. doi: 10.1093/europace/euw295.
5. Hart R.G., Pearce L.A., Miller V.T., Anderson D.C., Rothrock J.F., Albers G.W., Nasco E. Cardioembolic vs. noncardioembolic strokes in atrial fibrillation: frequency and effect of antithrombotic agents in the stroke prevention in atrial fibrillation studies. Cerebrovasc Dis. 2000;10(1):39-43. doi: 10.1159/000016023.
6. Nakamura A., Kuroda J., Ago T., Hata J., Matsuo R., Arakawa S. et al. Causes of Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation. Cerebrovasc Dis. 2016;42(3-4):196-204. doi: 10.1159/000445723.
7. Yang P.S., Pak H.N., Park D.H., Yoo J., Kim T.H., Uhm J.S. et al. Non-cardioembolic risk factors in atrial fibrillation-associated ischemic stroke. PLoS One. 2018;13(7):e0201062. doi: 10.1371/journal.pone.0201062.
8. Kamel H., Okin P.M., Elkind M.S., Iadecola C. Atrial fibrillation and Mechanisms of Stroke; Time for a New Model. Stroke. 2016;47(3):895-900. doi: 10.1161/STROKEAHA.115.012004.
9. Wang Z., Korantzopoulos P., Liu T. Carotid Atherosclerosis in Patients with Atrial Fibrillation. Curr Atheroscler Rep. 2019;21(12):55. doi: 10.1007/s11883-019-0808-4.
10. Becattini C., Dentali F., Camporese G., Sembolini A., Rancan E., Tonello C. et al. Carotid atherosclerosis and risk for ischemic stroke in patients with atrial fibrillation on oral anticoagulant treatment. Atherosclerosis. 2018;271:177-181. doi: 10.1016/j.atherosclerosis.2018.02.004.
11. Suslina Z.A., Pyradov M.A. (eds.). Stroke: diagnosis, treatment, prevention. Moscow: MEDpress-inform; 2009. 288 p. (In Russ.) Available at: https://istina.msu.ru/publications/book/28705885/.
12. Hart R.G., Catanese L., Perera K.S., Ntaios G., Connolly S.J. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke. 2017;48(4):867-872. doi: 10.1161/STROKEAHA.116.016414.
13. Tanashyan M.M. Hemostasis, hemorheology and athrombogenic activity of the vascular wall in angioneurology. Annaly klinicheskoy i eksperimental'noy nevrologii = Annals of Clinical and Experimental Neurology. 2007;1(2):29-33. (In Russ.) Available at: http://annaly-nevrologii.com/ru/2016/09/22/gemostaz-gemoreologiya-i-atrombogennaya-aktivnost-sosudis-toj-stenki-v-angionevrologii/#pll_switcher.
14. Khurshid S., Trinquart L., Weng L.C., Hulme O.L., Guan W., Ko D. et al. Atrial Fibrillation Risk and Discrimination of Cardioembolic From Noncardioembolic Stroke. Stroke. 2020;51(5):1396-1403. doi: 10.1161/STROKEAHA.120.028837.
15. Marini C., De Santis F., Sacco S., Russo T., Olivieri L., Totaro R., Carolei A. Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-Based Study. Stroke. 2005;36(6):1115-1119. doi: 10.1161/01.STR.0000166053.83476.4a.
16. Shang L., Zhao Y., Shao M., Sun H., Feng M., Li Y. et al. The association of CHA2DS2-VASc score and carotid plaque in patients with non-valvular atrial fibrillation. PLoS One. 2019;14(2):e0210945. doi: 10.1371/journal.pone.0210945.
17. Evans A., Perez I., Yu G., Kalra L. Should Stroke Subtype Influence Anticoagulation Decisions to Prevent Recurrence in Stroke Patients With Atrial fibrillation? Stroke. 2001;32(12):2828-2832. doi: 10.1161/hs1201.099520.
18. Boussier M.G. Antithrombotic agents in the prevention of ischemic stroke. Cerebrovasc Dis. 2009;27(Suppl. 3):12-19. doi: 10.1159/000209261.
Review
For citations:
Geraskina L.A., Alieva M.M., Fonyakin A.V., Maximova M.Yu., Garabova N.I., Burzhunova M.G. Recurrent ischemic stroke in patients with atrial fibrillation: frequency, heterogeneity, prevention. Aterotromboz = Atherothrombosis. 2020;(2):7-16. (In Russ.) https://doi.org/10.21518/2307-1109-2020-2-7-16
Views:
2327
This work is licensed under a Creative Commons Attribution Attribution-NonCommercial-NoDerivs License.
Email this article 