Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?
Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?
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DOI：
10.1111/anec.12417
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Platonov, Pyotr G.
中科院分区：
文献类型：
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作者：
Bayes de Luna, Antoni;Baranchuk, Adrian;Platonov, Pyotr G.
心房颤动(房颤)目前被认为是中风的危险因素。根据临床因素的严重程度(风险评分)，建议进行全面抗凝。虽然房颤肯定是缺血性中风的危险因素，但并不一定是其直接原因。据报道，卒中事件和房颤发作(或设备检测到的房颤高频率发作)之间缺乏时间关系，因此房颤和缺血性中风之间的因果关系受到了质疑。在不同的研究中，只有2%的患者在中风或系统性栓塞时有亚临床房颤持续时间为6分钟。是时候认为房颤只是内皮细胞紊乱的一个因素，而不是卒中的主要因素吗？在这篇“意见书”中，我们建议不仅要考虑预测房颤/卒中的临床变量，还要考虑心房纤维化的心电图学标记物，因为我们假设这是房颤/卒中风险的有力指标。我们问是否现在是时候改变范式，并在一些特殊情况下考虑保护没有房颤证据的患者(预防中风)。
Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this "opinion paper" we propose to consider not only clinical variables predicting AF/stroke but also electrocardio-graphic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.