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The role of atrial fibrillation and other risk factors in the development of ischemic stroke


Author: Diaconu Nadejda
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2011
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Institution: Medical-Sanitary Public Institution Institute of Cardiology
Scientific council: DH 51-14.00.06-27.03.08
Medical-Sanitary Public Institution Institute of Cardiology

Status

The thesis was presented on the 6 September, 2011
Approved by NCAA on the 11 November, 2011

Abstract

Adobe PDF document – 0.39 Mb / in romanian

Keywords

atrial fibrillation, stroke, thrombo-embolic complications, risk factors, CHADS2 score, Framingham score, antithrombotic treatment, warfarine

Summary

The thesis is presented on 146 pages, consisting of introduction, 5 chapters, conclusions, practical recommendations, references with 191 sources, 5 supplements; it also includes 41 tables, and 27 figures. The results have been presented in 15 scientific publications.

The goal of the study: To determine the impact of AF and thrombo-embolic risk factors on the development of ischemic stroke.

Objectives of the study: to evaluate the incidence and the structure of CV diseases in ischemic stroke patients; clinical and paraclinical characterization of patients with AF complicated with ischemic stroke; to determine the CV risk factors and to evaluate the risk for development of thromo-embolic complications in AF, with analysis of preceding antithrombotic interventions; to evaluate the risk for recurrence of thromboembolic events and risk of death in patients with ischemic stroke and AF; to evaluate the necessary timeframe for achievement of average dosage of oral anticoagulants and of therapeutic range for INR (2,0-3,0) in patients with a high thrombo-embolic risk; to underline the possible difficulties in oral anticoagulation.

Methods: The following methods have been applied: questioning, monitoring, and statistics. Scientific innovation and originality: Estimation of overall incidence of AF in ischemic stroke patients; determination of predisposing factors for stroke in AF, recurrence and death rate, evaluation of the thromboembolic risk, recurrence and 5-year death risks with the use of CHADS2 and Framingham scores for patients with non-valvular AF.

Theoretic importance and applicative value: utilization of CHADS2 and Framingham scores in the assessment of risk for ischemic stroke, risk of recurrence and/or death allows the identification of a high risk group in need of oral anticoagulation. Anticoagulation treatment applied in selected patients also pointed to eventual difficulties in oral anticoagulation, avoidance of which could lead to an increase in prescribing rate of oral anticoagulants.

Implementation of scientific results: The study results have been approved as scientific value and implemented in the current medical activity of Institute of Cardiology.