Stroke prevention in atrial fibrillation
Stroke prevention in atrial fibrillation
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DOI：
10.1016/s0140-6736(16)31257-0
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发表时间：
2016-08-20
期刊：
影响因子：
168.9
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
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作者：
Freedman, Ben;Potpara, Tatjana S.;Lip, Gregory Y. H.
三分之一的缺血性中风患者会出现房颤，在中风后进行房颤监测后发现的比例更高。来自中风登记的数据显示，未知的和未经治疗或治疗不足的房颤是大多数中风的原因，这些中风通常是致命的或使人衰弱的。如果努力在卒中发生前检测房颤，通过筛查或病例发现，并使用控制良好的维生素K拮抗剂或非维生素K拮抗剂抗凝剂治疗所有卒中风险增加的房颤患者，大多数是可以预防的。默认策略应该是对所有房颤患者提供抗凝血栓预防，除非通过简单验证的风险评分（如CHA（2）DS（2）-VASc）定义为真正的低风险。使用HAS-BLED评分评估出血风险时，应重点关注可逆性出血风险因素。最后，患者需要医生和各种其他来源的支持，以开始抗凝治疗，并确保长期坚持治疗。
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants. The default strategy should be to off er anticoagulant thromboprophylaxis to all patients with atrial fibrillation unless defined as truly low risk by simple validated risk scores, such as CHA(2)DS(2)-VASc. Assessment of bleeding risk using the HAS-BLED score should focus attention on reversible bleeding risk factors. Finally, patients need support from physicians and various other sources to start anticoagulant treatment and to ensure adherence to and persistence with treatment in the long term.