Ischemic stroke in case of atrial fibrillation: influence of previous therapy at the early functional recovery of the patient

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Resumo

It is proven, that the risk of brain stroke is reduces by 60–70% in patients with atrial fibrillation (AF) under the influence of anticoagulant therapy. However, the number of cases of acute cerebrovascular accidents in these patients remains to be considerable, which is associated with patients’ multimorbidity.

The aim: to clarify the relationship between early functional recovery in patients with ischemic stroke (IS) and AF and previous preventive therapy.

Material and methods. Retrospective analysis of data from the register of patients with IS and AF was performed. The severity of neurological disorders at admission (NIHSS) and the degree of early functional recovery of patients at discharge from the hospital (mRs) were assessed.

Results. Before the stroke, 82 (41%) of patients took antithrombotic drugs: thrombocytic antiplatelet agents (TAA) – 36 (18%), direct oral anticoagulants – 27 (13.5%), vitamin K antagonists – 19 (9.5%). Antihypertensive therapy (AHT) was received by 52% of patients with arterial hypertension (AH), statins – by 17 (8.5%). Only 7 (3.5%) of patients with AF received preventive treatment in accordance with modern standards (combination of oral anticoagulants, AHT and lipid-lowering therapy). According to the discriminant analysis data, a multifactorial model was obtained to assess the potential for early recovery of patients. It included the NIHSS score, severity of arterial hypertension, presence of chronic heart failure, AHT, antiplatelet therapy, lipid metabolism indexes, glycaemia level (Wilks’ Lambda: 0.42605 approx. F (10.111) = 14.953, p < 0.0000). Favorable functional outcome was associated with the presence of AHT – odds ratio (OR) 2.498 (95% confidence interval (CI): 1.401-4.454), taking OACs – OR 2.622 (95% CI: 1.213–5.666) or TAA – OR 2.98 (95% CI: 1.328– 6.687). Lipid-lowering therapy was also associated with a favorable functional outcome – OR 2.469 (95% CI: 0.775–7.861), which, however, did not reach the level of statistical significance and may be existing due to the small number of patients taking statins.

Conclusion. Compliance of preventive treatment with current recommendations for the management of patients with AF is associated with more favorable early functional recovery.

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Sobre autores

Lyudmila Geraskina

Scientific Center of Neurology; RUDN University

Autor responsável pela correspondência
Email: neurocor@mail.ru
ORCID ID: 0000-0002-1253-1082

MD., Dr. Sci. (Medicine), leading researcher at the Depertment of cardioneurology of the 2nd Neurological Department of Scientific Center of Neurology, professor of the Department of nervous diseases and neurosurgery named after Yu.S. Martynov of the Medical Institute of RUDN University

Rússia, 125367, Moscow, 80 Volokolamskoe Highway; 117198, Moscow, 8 Miklouho-Maklaya St.

Marina Maksimova

Scientific Center of Neurology

Email: ncnmaximova@mail.ru
ORCID ID: 0000-0002-7682-6672

MD, Dr. Sci. (Medicine), professor, head of the 2nd Neurological Department

Rússia, 125367, Moscow, 80 Volokolamskoe Highway

Andrey Fonyakin

Scientific Center of Neurology

Email: fonyakin@mail.ru
ORCID ID: 0000-0001-5452-2152

MD, Dr. Sci. (Medicine), professor, leading researcher, head of the laboratory of cardioneurology of the 2nd Neurological Department

Rússia, 125367, Moscow, 80 Volokolamskoe Highway

Naida Garabova

RUDN University

Email: doctorn1980@mail.ru
ORCID ID: 0000-0002-8140-6699

MD, PhD (Medicine), associate professor of the Department of nervous diseases and neurosurgery named after Yu.S. Martynov

Rússia, 117198, Moscow, 8 Miklouho-Maklaya St.

Madina Burzhunova

RUDN University

Email: burzhunova@gmail.ru
ORCID ID: 0000-0003-4238-9985

MD, assistant at the Department of nervous diseases and neurosurgery named after Yu.S. Martynov

Rússia, 117198, Moscow, 8 Miklouho-Maklaya St.

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