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.
