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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Left Atrial Enlargement and Anticoagulation Status in Patients with Acute Ischemic Stroke and Atrial Fibrillation
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Left Atrial Enlargement and Anticoagulation Status in Patients with Acute Ischemic Stroke and Atrial Fibrillation

机译：急性缺血性卒中和心房颤动患者的左心房扩大和抗凝状态

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Background: Despite anticoagulation therapy, ischemic stroke risk in atrial fibril-lation (AF) remains substantial. We hypothesize that left atrial enlargement (LAE) is more prevalent in AF patients admitted with ischemic stroke who are therapeutic, as opposed to nontherapeutic, on anticoagulation. Methods: We included consecutive patients with AF admitted with ischemic stroke between April 1, 2015, and December 31, 2016. Patients were divided into two groups based on whether they were therapeutic (warfarin with an international normalized ratio 2.0 or non-vitamin K oral anticoagulant with uninterrupted use in the prior 2 weeks) versus nontherapeutic on anticoagulation. Univariable and multivariable models were used to estimate associations between therapeutic anticoagulation and clinical factors, including CHADS2 score and LAE (none/mild versus moderate/severe). Results: We identified 225 patients during the study period; 52 (23.1%) were therapeutic on anticoagulation. Patients therapeutic on anticoagulation were more likely to have a larger left atrial diameter in millimeters (45.6 +/- 9.2 versus 42.3 +/- 8.6, P = .032) and a higher CHADS2 score (2.9 +/- 1.1 versus 2.4 +/- 1.1, P = .03). After adjusting for the CHADS2 score, patients who had a stroke despite therapeutic anticoagulation were more likely to have moderate to severe LAE (odds ratio, 2.05; 95% confidence interval, 1.01-4.16). Conclusion: LAE is associated with anticoagulation failure in AF patients admitted with an ischemic stroke. This provides indirect evidence that LAE may portend failure of anticoagulation therapy in patients with AF; further studies are needed to delineate the significance of this association and improve stroke prevention strategies.
机译：背景：尽管进行了抗凝治疗，房颤患者发生缺血性卒中的风险仍然很大。我们假设左心房扩大（LAE）在接受抗凝治疗（而非非非治疗）的缺血性卒中AF患者中更为普遍。方法：我们纳入了2015年4月1日至2016年12月31日期间因缺血性卒中入院的连续性房颤患者。根据患者是否接受治疗（国际标准化比率为2.0的华法林或前2周不间断使用的非维生素K口服抗凝剂）和非治疗性抗凝剂，将患者分为两组。单变量和多变量模型用于评估治疗性抗凝与临床因素之间的关联，包括CHADS2评分和LAE（无/轻度与中度/重度）。结果：我们在研究期间确定了225名患者；抗凝治疗52例（23.1%）。接受抗凝治疗的患者更可能有较大的左心房直径（毫米）（45.6+/-9.2对42.3+/-8.6，P=0.032）和较高的CHADS2评分（2.9+/-1.1对2.4+/-1.1，P=0.03）。调整CHADS2评分后，尽管进行了治疗性抗凝治疗，但中风患者更可能出现中重度LAE（优势比，2.05；95%置信区间，1.01-4.16）。结论：LAE与缺血性卒中AF患者抗凝失败有关。这为LAE可能预示房颤患者抗凝治疗失败提供了间接证据；需要进一步的研究来阐明这种关联的重要性，并改进中风预防策略。

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