Atriyal fibrilasyon ve iskemik inme hastalarında antikoagülasyonun infarkt hacmi ve NIHSS skoru üzerine etkisi

Abstract

Amaç: Bu çalışmada non-valvüler atrial fibrilasyona (NVAF) bağlı kardiyoembolik inme geçiren hastaların oral antikoagülasyon (OAK) kullanımının, ilk başvuruda nöroloji uzmanı tarafından hesaplanan NIHSS (National Institute of Healt Stroke Scale (Ulusal sağlık enstitüleri inme ölçeği)) skoru ve çekilen diffüzyon manyetik rezonans görüntüleme (MRG) ’nin cm3 cinsinden semiotomatik olarak ölçülen infarkt volümünün değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Akut iskemik inme tanısı alan 101 NVAF hastası retrospektif olarak planlanan bu çalışmaya dahil edildi. Hastalar OAK ilaç kullanımına göre 4 gruba ayrıldı: OAK kullanmayanlar (grup 1), subterapötik dozda warfarin kullanan (70 yaş altı: INR≤2,0; 70 yaş üzeri: INR≤1,6 grup 2), terapötik dozda warfarin kullananlar (70 yaş altı: INR≥2,0; 70 yaş üzeri; INR≥1,6 grup 3) ve terapötik dozda Non-vitamin K oral antikoagülan (NOAK) kullanan grup 4 olmak üzere 4 gruba ayrıldı. Bulgular: İnfarkt volümü 1. grup için 22,20 cm³ medyan: (0,4-235 cm³ en düşük-en yüksek), 2. grup: 12,95 cm³ (1,3-129 cm³), 3. grup: 2,25 cm³ 0,3-89 cm³) ve 4.grup: 4,40 cm³ (0,2-293 cm³) olarak hesaplandı ve aradaki fark istatistiksel olarak anlamlıydı (p=0,039). Hesaplanan NIHSS skoru 1. grup için 9 (4-23), 2. grup: 8,5 (3-18), 3. grup: 6,5 (2-20), 4.grup 5 (1-22) olarak hesaplandı ve antikoagülasyon kullanımının NIHSS skoru üzerine etkisi istatistiksel olarak anlamlı bulundu (p=0,029). Sonuç: Antikoagülan tedavi, bu çalışmada gösterildiği gibi inme hastalarında NIHSS skorunu ve enfarktüs hacimlerini iyileştirmenin yanı sıra inmenin birincil ve ikincil önlenmesinde önemlidir.

Keywords

• Atrial fibrilasyon
• kardioembolik inme
• iskemik inme
• infarkt volümü
• NIHSS skoru

Effect of anticoagulation on infarct volume and NIHSS score in patients with atrial fibrillation and ischaemic stroke

Abstract

Purpose: The aim of this study was to evaluate the use of oral anticoagulation (OAC) in patients with cardioembolic stroke due to non-valvular atrial fibrillation (NVAF). The NIHSS (National Institute of Healt Stroke Scale) score calculated by a neurologist at initial presentation and infarct volume measured semi-automatically in cm3 by Magnetic Resonance Imaging (MRI). Materials and methods: A total of 101 NVAF patients with acute ischaemic stroke were included in this retrospective study. Patients were divided into 4 groups according to OAC drug use: Non-OAC users (group 1), subtherapeutic dose warfarin users (under 70 years of age: INR≤2.0; over 70 years of age: INR≤1.6 group 2), therapeutic dose warfarin users (under 70 years of age: INR≥2.0; over 70 years of age: INR≥1.6 group 3) and therapeutic dose Non-vitamin K oral anticoagulant (NOAC) users group 4. Results: Infarct volume was calculated as 22.20 cm³ median (0.4-235 cm³ lowest-highest) for group 1; 12.95 cm³ (1.3-129 cm³) for group 2; 2.25 cm³ (0.3-89 cm³) for group 3 and 4.40 cm³ (0.2-293 cm³) for group 4 and the difference was statistically significant (p=0.039). The calculated NIHSS score was 9 (4-23) for the group 1, 8.5 (3-18) for the group 2, 6.5 (2-20) for the group 3, 5 (1-22) for the group 4 and the effect of anticoagulation use on NIHSS score was statistically significant (p=0.029). Conclusion: Anticoagulant treatment holds importance in the primary and secondary prevention of stroke and in enhancing the NIHSS score and infarct volumes among stroke patients, as evidenced in the current study.

Keywords

• Atrial fibrillation
• cardioembolic stroke
• ischemic stroke
• infarct volume
• NIHSS score

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