服用非维生素K口服抗凝剂的房颤患者缺血性卒中的发生:原因和预防策略

IF 6 1区 医学 Q1 CLINICAL NEUROLOGY Journal of Stroke Pub Date : 2023-05-01 DOI:10.5853/jos.2022.03552
Oh Young Bang, Kyoung-Min Park, Dong Seop Jeong
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引用次数: 2

摘要

心房颤动(AF)是心脏栓塞性中风的主要原因,通常是致命的或致残的。预防卒中是房颤管理的关键,而非维生素K口服抗凝剂(NOACs)抗凝治疗是房颤管理预防卒中的主要手段。由于NOAC处方在世界范围内激增,在接受NOAC治疗的房颤患者中发生急性缺血性卒中是临床实践中越来越重要的问题。此外,这些患者的复发风险较高,比既往未接受抗凝治疗的房颤患者高出50%以上。在NOAC治疗期间,必须仔细评估以确定缺血性中风的可能原因。鉴别心房颤动无关的卒中和证明合并心脏疾病/全身性凝血功能障碍对这些患者很重要,并可能改善其治疗结果。此外,确保适当的剂量和良好的NOAC治疗依从性也很重要。心脏栓塞,尽管有充分的抗凝治疗且没有其他原因,是最常见和最具挑战性的并发症,因为在治疗方案中使用抗凝剂或添加抗血小板并不能降低卒中复发的风险,并且没有针对这种特殊情况的指南。这篇综述文章旨在介绍关于房颤的流行、原因和二级预防策略的最新数据,特别关注非药物方法,以及在NOAC治疗下发生缺血性卒中的房颤患者的相关病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Occurrence of Ischemic Stroke in Patients With Atrial Fibrillation Receiving Non-Vitamin K Oral Anticoagulants: Causes and Prevention Strategies.

Atrial fibrillation (AF) is a leading cause of cardioembolic stroke, which is often fatal or disabling. Prevention of stroke is crucial in AF management, and anticoagulation with non-vitamin K oral anticoagulants (NOACs) is the mainstay of AF management for stroke prevention. Because NOAC prescriptions have been surging worldwide, the development of acute ischemic stroke in patients with AF who receive NOAC treatment is an increasingly important issue in clinical practice. Moreover, these patients show a high risk of recurrence, with more than a 50% higher risk, than do patients with AF and no prior anticoagulation therapy. Careful evaluation is mandatory to determine possible causes of ischemic stroke during NOAC therapy. Differentiation of AF-unrelated stroke and demonstration of combined cardiac disease/systemic coagulopathy are important in these patients and may provide improved results in their treatment. In addition, ensuring appropriate dosing and good adherence to NOAC treatment is important. Cardioembolism, despite sufficient anticoagulation and no other causes, is the most common and challenging complication because switching to anticoagulants or adding antiplatelets to the treatment regimen does not reduce the risk of recurrent stroke, and there are no guidelines for this specific situation. This review article aimed to present the most updated data on the prevalence, causes, and secondary prevention strategies, specifically focusing on non-pharmacological approaches, together with relevant cases of AF in patients who developed ischemic stroke on NOAC therapy.

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来源期刊
Journal of Stroke
Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE
CiteScore
11.00
自引率
3.70%
发文量
52
审稿时长
12 weeks
期刊介绍: The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.
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