CARDIOEMBOLIC STROKE IN LATVIA: PREVENTION AND LONG-TERM OUTCOME

  • Elina Pucite Pauls Stradins Clinical University Hospital
  • Kristaps Jurjāns Pauls Stradins Clinical University Hospital
  • Evija Miglāne Pauls Stradins Clinical University Hospital
  • Baiba Luriņa Pauls Stradins Clinical University Hospital
  • Oskars Kalējs Pauls Stradins Clinical University Hospital
  • Andrejs Millers Pauls Stradins Clinical University Hospital
  • Zanda Priede Pauls Stradins Clinical University Hospital
Keywords: Atrial fibrillation, cardio embolic stroke, stroke mortality, primary stroke prevention, secondary stroke prevention

Abstract

INTRODUCTION: Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goal of the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.

METHODS: This study involved 531 cardio embolic stroke patients of the Paul’s Stradins Clinical University Hospital, Riga, Latvia, in 2014. After discharge the patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’ abilities and use of prescribed secondary prevention medication. The results were compared between patient groups, assigned according to prescribed medications.

RESULTS: Of all the patients included in the study, 8.9% were using oral anticoagulants before stroke onset. One year after discharge, 1.44% of patients were not using any preventive medication, 23.56% were using antiplatelet agents, 43.27% warfarin, and 31.73% target-specific oral anticoagulants. The one-year mortality rate was 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventive medication or antiplatelet agents compared to the patient group that used oral anticoagulants.

CONCLUSION: Cardio embolic stroke primary and secondary prevention in Latvia is lacking. The study outcomes suggest that action is needed to increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia, and patients’ incompliance limits the use of oral anticoagulants in secondary prevention.

References

Arboix, A., & Alio, J. (2010). Cardio embolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev, 6(3), 150-161. DOI:10.2174/157340310791658730

Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., & Guidelines, E. S. C. C. f. P. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J, 33(21), 2719-2747. DOI:10.1093/eurheartj/ehs253

European Heart Rhythm, A., European Association for Cardio-Thoracic, S., Camm, A. J., Kirchhof, P., Lip, G. Y., Schotten, U., & Rutten, F. H. (2010). Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J, 31(19), 2369-2429. DOI:10.1093/eurheartj/ehq278

Friberg, L., Skeppholm, M., & Terent, A. (2015). Benefit of anticoagulation unlikely in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. J Am Coll Cardiol, 65(3), 225-232. DOI:10.1016/j.jacc.2014.10.052

Gladstone, D. J., Bui, E., Fang, J., Laupacis, A., Lindsay, M. P., Tu, J. V., & Kapral, M. K. (2009). Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke, 40(1), 235-240. DOI:10.1161/STROKEAHA.108.516344

Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., & Singer, D. E. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA, 285(18), 2370-2375.

Heeringa, J., van der Kuip, D. A., Hofman, A., Kors, J. A., van Herpen, G., Stricker, B. H., & Witteman, J. C. (2006). Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J, 27(8), 949-953. DOI:10.1093/eurheartj/ehi825

Hobbs, F. R., Taylor, C. J., Jan Geersing, G., Rutten, F. H., Brouwer, J. R., & on behalf of the European Primary Care Cardiovascular Society, S. w. g. (2015). European Primary Care Cardiovascular Society (EPCCS) consensus guidance on stroke prevention in atrial fibrillation (SPAF) in primary care. Eur J Prev Cardiol. DOI:10.1177/2047487315571890

Kirchhof, P., Auricchio, A., Bax, J., Crijns, H., Camm, J., Diener, H. C., & Breithardt, G. (2007). Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J, 28(22), 2803-2817. DOI:10.1093/eurheartj/ehm358

Jurjâns, K., Sabeïnikova, S., Miglâne, E., Luriòa1, B., Kalçjs, O., Millers, A., & Priede, Z. (2015). Problems of cardio embolic stroke primary and secondary prevention in the Latvian population. Proceedings of the Latvian Academy of Sciences. Section B, Vol. 69 (2015), No. 5(698), 199–204. DOI: 10.1515/prolas-2015-0029. Retrieved from https://www.degruyter.com/downloadpdf/j/prolas.2015.69.issue-5/prolas-2015-0029/prolas-2015-0029.xml

Lane, D. A., & Lip, G. Y. (2012). Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation, 126(7), 860-865. DOI:10.1161/CIRCULATIONAHA.111.060061

Lip, G. Y., Clementy, N., Pericart, L., Banerjee, A., & Fauchier, L. (2014). Stroke and major bleeding risk in elderly patients aged >/=75 years with atrial fibrillation: the Loire Valley atrial fibrillation project. Stroke, 46(1), 143-150. DOI:10.1161/STROKEAHA.114.007199

Menke, J., Luthje, L., Kastrup, A., & Larsen, J. (2010). Thromboembolism in atrial fibrillation. Am J Cardiol, 105(4), 502-510. DOI:10.1016/j.amjcard.2009.10.018

Moran, G. M., Calvert, M., Feltham, M. G., & Marshall, T. (2014). Retrospective case review of missed opportunities for primary prevention of stroke and TIA in primary care: protocol paper. BMJ Open, 4(11), e006622. DOI:10.1136/bmjopen-2014-006622

Nedeltchev, K., Renz, N., Karameshev, A., Haefeli, T., Brekenfeld, C., Meier, N., & Mattle, H. P. (2010). Predictors of early mortality after acute ischaemic stroke. Swiss Med Wkly, 140(17-18), 254-259. DOI:smw-12919

Stewart, S., Hart, C. L., Hole, D. J., & McMurray, J. J. (2001). Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart, 86(5), 516-521.

Sulter, G., Steen, C., & De Keyser, J. (1999). Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke, 30(8), 1538-1541.

Tanislav, C., Milde, S., Schwartzkopff, S., Sieweke, N., Kramer, H. H., Juenemann, M., & Kaps, M. (2014). Secondary stroke prevention in atrial fibrillation: a challenge in the clinical practice. BMC Neurol, 14, 195. DOI:10.1186/s12883-014-0195-y

Published
2016-09-18