关键词: 脑栓塞; 心房颤动; 出血转化; 危险因素

Abstract:

Objective To observe the status of anticoagulation of patients with cerebral embolism and atrial fibrillation through congestive heart failure, hypertension, age≥75 years old (doubled), diabetes mellitus, stroke (doubled), vascular disease, aged between 65~74 years old and sex category (female)(CHA2DS2-VASc) score; to analyse the correlation of hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio (INR), age, drugs and alcohol intake (HAS-BLED) score and other clinical risk factors with hemorrhagic transformation in patients with cerebral embolism and atrial fibrillation. Methods The clinical data were analyzed retrospectively in patients with cerebral embolism andatrial fibrillation admitted in Department of Neurology in Beijing Boai Hospital from May 2012 to December 2014. The status of anticoagulation were observed in all patients who were divided into three groups with CHA2DS2-VASc score: low risk group (score=0), moderate risk group (score=1) and high risk group (score≥2). HAS-BLED score was used to analyse the difference in hemorrhagic transformation (HT) rate between low-moderate group (score=0~2) and high risk group (score≥3) and multivariate logistic regression analysis of several clinical variates was used to find clinical risk factors related to HT. Results A total of 101 patients were recruited. Before the onset of cerebral embolism of patients with atrial fibrillation, according to CHA2DS2-VASc score, the rate of anticoagulationwas 66.7% (2/3) and no patient received antiplatelet agent in low-risk group. The rate of anticoagulation and antiplatelet agent was also 16.7% (2/12) in moderate-risk group. The rate of anticoagulation was 19.8% (17/86) and antiplatelet agent was 14.0% (12/86) in high-risk group. The percentage of patients who stopped anticoagulation treatment within 1 month before the onset of cerebral embolism was 42.8% (9/21). The rate of anticoagulation was 68.3% (69/101) and antiplatelet agent was 25.7% (26/101) in all patients with atrial fibrillation after the onset of cerebral embolism. After cerebral embolism in patients with atrial fibrillation, according to HAS-BLED score, the rate of HT was 37.5% (18/48) in low-risk group, while 58.5% (31/53) in high-risk group, there was statistic signification in two groups (χ 2=4.443, P =0.035). The analysis of several clinical variates found that there was statistic signification in NIHSS score (14.86±4.486 vs 11.94±5.648, P =0.006) and HASBLED score (2.76±0.80 vs 2.21±0.96, P =0.003) between HT group and non HT group. The HT in the group with bigger volume of the infarction was 57.9% (44/76) and HT in the group of smaller volume of the infarction was 20% (5/25), which had significant difference (P =0.001). NIHSS score (OR 1.106, 95%CI 1.106~1.216, P =0.036), HAS-BLED score (OR 2.353, 95%CI 1.326~4.175, P =0.003) and the volumes of the infarction (OR 5.083, 95%CI 1.826~14.148, P =0.002) were risk factors for HT in patients with cerebral embolism and atrial fibrillation. Conclusion The rate of anticoagulant therapy is not satisfactory in patients with cerebral embolism and atrial fibrillation. HT risk could be well forecasted with HAS-BLED score in patients with cerebral embolism and atrial fibrillation. Severe neurofunction defect and bigger infarction volumes are risk factors for HT in patients with cerebral embolism and atrial fibrillation.

Key words: Cerebral embolism; Atrial fibrillation; Hemorrhagic transformation; Risk factor