Antiembolik, antitrombotik tedavi altında ikentekrarlayan iskemik inme ile acil servise başvuran hastalarda iskemi tekrarına etki eden faktörler
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş
Acil servisler inme hastalarının ilk defa başvurduğu, tanındığı ve tedavi edildiği ünitelerdir. Reküren iskemik inme mevcut gelişmelere rağmen hala sık izlenmektedir. Reküren inme atakları fonksiyonel bağımlılık ve mortalitede artışla ilişkilidir. İnme sonrasında uygulanan sekonder önleme stratejileri reküren inme riskini azaltmayı hedeflemektedir. Ancak sekonder önleme için yeterli antiagregan ve antikoagülan tedaviye rağmen rekürens izlenebilir. Bu çalışmada antiagregan veya antikoagülan tedavi altında reküren iskemik inme geçiren hastaların inme ile ilişkili risk faktörlerinin değerlendirilmesi amaçlandı.
Gereç ve yöntem
Bu çalışmaya 01.01.2017 ila 31.01.2021 tarihleri arasında acil servise reküren iskemik inme ile başvuran 273 hasta retrospektif olarak dahil edildi. Hastaların demografik özellikleri, antiagregan ve antikoagülan kullanımları, komorbid hastalıkları, elektrokardiyografi, ekokardiyografi ve görüntüleme bulguları, acil servis ve hastane sonlanımları değerlendirildi.
Bulgular
Hastaların yaş ortalaması 70,9 ± 12,6 yıl (20-101 yıl) idi. hastaların %46,2’si kadın, %53,8’i erkekti. Hastaların %20,9’unda atriyal fibrilasyon (AF) mevcuttu. En sık izlenen komorbiditeler hipertansiyon (HT) (%72,5), koroner arter hastalığı (KAH) (%37,7) ve diyabetes mellitus (DM) (%35,2) idi. Hastaların %5,3’ü antiagregan monoterapi, %7’si antiagregan ikili tedavi, %26,3’ü antiagregan ve antikoagülan, %54,4’ü ise antikoagülan monoterapi kullanırken, %7’si antiagregan veya antikoagülan kullanmamaktaydı. Hastaların acil sonlanımları sırasıyla servis (%45,4), YBÜ (%38,8), kendi isteği ile taburcu (%7,3), taburcu (%5,1), sevk (%1,8) ve eksitus(%1,5) idi. Hastane sonlanımı ise sırasıyla taburcu (%57,9), sevk (%28,2) ve eksitus(%13,9) idi. Kaybedilen hastaların yaş ortalaması daha yüksekti (p=0,011). Hastane sonlanımı eksitus olan hastalarda AF (p=0,009) ve malignite
IV
(p=0,002) sıklığı daha fazla, HT sıklığı (p=0,035) daha az idi. Taburcu edilen hastalarda antiagregan ikili tedavi kullanım sıklığı kaybedilen hastalardan daha fazla idi (p=0,047). Sonuç
Reküren iskemik inme ilk inmeye benzer özelliklere sahiptir. Antiagregan veya antikoagülan tedavi altındaki hastalar reküren iskemik inme geçirebilir. Ancak ikili antiagregan tedavi altındaki hastaların prognozu daha iyidir.
Introduction The department where stroke patients are admitted for the first time, is recognized and treated is the emergency department.Despite progress and declining trends, recurrent ischemic stroke is still frequent.Recurrent ischemic stroke has been associated with increased mortality and functional dependence. The primary goal of secondary prevention strategies after ischemic strokeis to reduce the risk of recurrent stroke. However, recurrence may develop despite adequate antiaggregant and amticoagulant therapy for secondary prevention.The aim of this study was to evaluate the risk factors associated with stroke in patients who had recurrent ischemic stroke under antiaggregant or anticoagulant therapy. Material and methods Two hundred seventy-three patients, applied to the emergency department with the diagnosis of recurrent ischemic stroke between 01.01.2017 and 31.01.2021, were included in our study retrospectively. The Patient’s demographic characteristics, usage of antiaggregant and anticoagulant drugs, comorbid diseases, electrocardiography, echocardiography and imaging findings, emergency department and hospital outcomes were evaluated. Results The mean age of the patients was 70.9 ± 12.6 years (20-101 years).46.2% were female, 53.8% were male. Atrial fibrillation (AF) was present in 20.9%of the patients. The most common comorbidities were hypertension (HT) (72.5%), coronary artery disease (CAD) (37.7%) and diabetes mellitus (DM) (35.2%). 5.3% of the patients were taking antiaggregant monotherapy, 7% antiaggregant dual therapy, 26.3% antiaggregant and anticoagulant, 54.4% anticoagulant monotherapy. However,7% were not taking neither antiaggregant nor anticoagulant.The emergency outcomes of the patients were respectively in theinpatientwards (45.4%), intensive care unit (ICU) (38.8%), voluntary discharge (7.3%), discharge (5.1%), VI referral (1.8%), and exitus (1.5%). Hospital outcomes were discharge (57.9%), referral (28.2%), and exitus (13.9%), respectively. The mean age of the patients who died was higher (p=0.011).The frequency of AF (p=0.009) and malignancy (p=0.002) was higher, and the frequency of HT was lower (p=0.035) in patients with hospital outcome wasexitus.The frequency of use of antiaggregant dual therapy was higher in patients who were discharged from the hospital than in patients who died (p=0.047).The frequency of septic infarcts was higher in MR imaging in patients who died (p=0.037). Conclusion Recurrent ischemic stroke has characteristics similar to the first stroke. Recurrence of ischemic stroke may occur in patients receiving antiaggregant or anticoagulant therapy. However, patients receiving dual antiaggregant therapy have a better prognosis.
Introduction The department where stroke patients are admitted for the first time, is recognized and treated is the emergency department.Despite progress and declining trends, recurrent ischemic stroke is still frequent.Recurrent ischemic stroke has been associated with increased mortality and functional dependence. The primary goal of secondary prevention strategies after ischemic strokeis to reduce the risk of recurrent stroke. However, recurrence may develop despite adequate antiaggregant and amticoagulant therapy for secondary prevention.The aim of this study was to evaluate the risk factors associated with stroke in patients who had recurrent ischemic stroke under antiaggregant or anticoagulant therapy. Material and methods Two hundred seventy-three patients, applied to the emergency department with the diagnosis of recurrent ischemic stroke between 01.01.2017 and 31.01.2021, were included in our study retrospectively. The Patient’s demographic characteristics, usage of antiaggregant and anticoagulant drugs, comorbid diseases, electrocardiography, echocardiography and imaging findings, emergency department and hospital outcomes were evaluated. Results The mean age of the patients was 70.9 ± 12.6 years (20-101 years).46.2% were female, 53.8% were male. Atrial fibrillation (AF) was present in 20.9%of the patients. The most common comorbidities were hypertension (HT) (72.5%), coronary artery disease (CAD) (37.7%) and diabetes mellitus (DM) (35.2%). 5.3% of the patients were taking antiaggregant monotherapy, 7% antiaggregant dual therapy, 26.3% antiaggregant and anticoagulant, 54.4% anticoagulant monotherapy. However,7% were not taking neither antiaggregant nor anticoagulant.The emergency outcomes of the patients were respectively in theinpatientwards (45.4%), intensive care unit (ICU) (38.8%), voluntary discharge (7.3%), discharge (5.1%), VI referral (1.8%), and exitus (1.5%). Hospital outcomes were discharge (57.9%), referral (28.2%), and exitus (13.9%), respectively. The mean age of the patients who died was higher (p=0.011).The frequency of AF (p=0.009) and malignancy (p=0.002) was higher, and the frequency of HT was lower (p=0.035) in patients with hospital outcome wasexitus.The frequency of use of antiaggregant dual therapy was higher in patients who were discharged from the hospital than in patients who died (p=0.047).The frequency of septic infarcts was higher in MR imaging in patients who died (p=0.037). Conclusion Recurrent ischemic stroke has characteristics similar to the first stroke. Recurrence of ischemic stroke may occur in patients receiving antiaggregant or anticoagulant therapy. However, patients receiving dual antiaggregant therapy have a better prognosis.
Açıklama
Anahtar Kelimeler
Reküren iskemik inme, Acil servis, Antiagregan, Antikoagülan, Recurrent ischemic stroke, Emergency department, Antiaggregant, Anticoagulant
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Gökmen, E. Ö. (2023). Antiembolik, antitrombotik tedavi altında ikentekrarlayan iskemik inme ile acil servise başvuran hastalarda iskemi tekrarına etki eden faktörler. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
