Engleski Frequency of vascular risk factors and the impact of their treatment on the outcome of acute ischemic stroke in patients treated with recanalization therapy
Sažetak
SAŽETAK
Uvod: Moždani udar (MU) je vodeći uzrok smrtnosti i dugotrajne onesposobljenosti ljudi širom sveta. Blagovremena dijagnoza i kontrola vaskularnih faktora rizika je prioritet za adekvatnu prevenciju MU.
Materijali i metode: Sprovedena je retrospektivna analiza podataka pacijenata sa AIMU lečenih rekanalizacionom terapijom u jednogodišnjem periodu na Odeljenju urgentne neurologije. Izvršena je analiza karakteristika studijske populacije, faktora rizika i komorbiditeta kao i terapije u primarnoj prevenciji AIMU. Simptomatska intracerebralna hemoragija (sICH) je definisana prema ECASS-2 kriterijumima. Istraživanje je uključilo i procenu funkcionalnog ishoda pacijenata nakon tri meseca koji je definisan korišćenjem modifikovanog Rankin skora (mRS).
Rezultati: Studijom je bilo uključeno ukupno 117 pacijenata sa AIMU, od kojih je 70 (60%) bilo muškog pola. Prosečna starost studijske populacije iznosila je 65 godina (64.6 ± 14), a njihov incijalni NIHSS skor pri prijemu iznosio je 12 (12 ± 6.7). Najčešći prisutni faktori rizka su bili arterijska hipertenzija i hiperholesterolemija. Najzastupljeniji lekovi u sklopu primarne prevencije su bili antihipertenzivi i antitrombotična terapija. U cilju sagledavanja efekata korišćenja antitrombotične terapije (AT) u sklopu primarne prevencije AIMU,studijska populacija je podeljena na dve grupe (onu koja je koristila prethodnu AT terapiju, i na onu koja nije). Analiza je pokazala da pacijenti koji nisu bili na prethodnoj AT terapiji su bili: češće muškog pola, starosti 45-75 godina ili mlađi od 45 godina, ređe su imali prethodnu AF, hiperholesterolemiju i prethodni AIMU i trend inicijalno nižeg NIHSS skora. Nije bilo statistički značajne razlike između dve grupe u pojavi sICH.
Zaključak: Identifikacija faktora rizika i njihovo lečenje u svim starosnim grupama je značajno za primarnu prevenciju AIMU. Prethodna upotreba antitrombotočne terapije ne povećava verovatnoću pojave sICH kod pacijenata sa AIMU lečenih rekanalizacionom terapijom.
Reference
- Kostić S. Vladimir plays the author, Neurology for medical students; Belgrade: Faculty of Medicine, University of Belgrade; 2007; 237-263
- Patel RA, White CJ. Acute ischemic stroke treatment: State of the art.VascMed.2011; 16 (1): 19–28.
- Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006; 367 (9524): 1747-1757.
- Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017; 120 (3): 472-495.
- Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7 (10): 915-926.
- Furie K. Epidemiology and Primary Prevention of Stroke. Continuum (MinneapMinn). 2020 Apr; 26 (2): 260-267.
- Caprio FZ, Sorond FA. Cerebrovascular Disease: Primary and Secondary Stroke Prevention. Med Clin North Am. 2019; 103 (2): 295-308.
- Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, et. Prevention of stroke: a global perspective. Lancet. 2018; 392 (10154): 1269-1278.
- Lees, KR, Bluhmki, E, von Kummer, R. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010; 375 (9727): 1695–1703.
- Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association. Stroke. 2019; 50 (12).
- Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, et al. European Stroke Organization (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute IschaemicStrokeEndorsed by Stroke Alliance for Europe (SAFE). Eur Stroke J. 2019; 4 (1): 6-12.
- Liebeskind DS, Bracard S, Guillemin F, Jahan R, Jovin TG, Majoie CB, et al. eTICI reperfusion: defining success in endovascular stroke therapy. J NeuroIntervent Surg. 2019; 11 (5): 433–8
- Rabinstein AA. Update on Treatment of Acute Ischemic Stroke. Continuum (MinneapMinn). 2020; 26 (2): 268-286.
- Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014; 60 (1): 61.
- Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 2014; 45 (12): 3754-832.
- Sarikaya H, Ferro J, Arnold M. Stroke prevention - medical and lifestyle measures. Eur Neurol. 2015; 73 (3-4): 150-7.
- Endres M. Statins and stroke. J Cereb Blood Flow Metab. 2005; 25 (9): 1093-110.
- Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke. 2009; 40 (1): 235-40.
- Man-Son-Hing M, Laupacis A. Anticoagulant-related bleeding in older persons with atrial fibrillation: physicians' fears often unfounded. Arch Intern Med. 2003; 163 (13): 1580-6.
- McBride D, Bruggenjurgen B, Roll S et al. Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice. J Thromb Thrombolysis 2007; 24: 65-72.
- Kotalczyk A, Mazurek M, Kalarus Z, Potpara TS, Lip GYH. Stroke prevention strategies in high-risk patients with atrial fibrillation. Nat Rev Cardiol. 2021; 18 (4): 276-290.
- Okşul M, ZiyaŞener Y, C.öteli C. CHADS-VASc Score in STEMI Patients: Should We Use It Really? ActaCardiol Sin. 2019; 35 (1): 89.
- Yoshizawa R, Komatsu T, Kunugita F, Ozawa M, Ohwada S, Satoh Y, et al. Comparison of the CHADS2, CHA2DS2-VASc and R2CHADS2 Scores in Japanese Patients with Non-valvular Paroxysmal Atrial Fibrillation Not Receiving Anticoagulation Therapy. Intern Med. 2017; 56 (21): 2827-2836.
- Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev CardiovascTher. 2010; 8 (7): 917-32.
- Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. J Am CollCardiol. 2020; 75 (15): 1804-1818.
- Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and
Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (2 Suppl).
- Sherman DG. Antithrombotic and hypofibrinogenetic therapy in acute ischemic stroke: what is the next step? Cerebrovasc Dis. 2004; 17Suppl 1: 138-43.
- Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008; 133.
- Adam SS, McDuffie JR, Ortel TL, Williams JW Jr. Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review. Ann Intern Med. 2012; 157 (11): 796-807.