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Yıl:2017; Cilt: 54; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2017;54(4):318-321
Bir İnme Ünitesinde Kardiyoembolik İnmede Warfarin Deneyimi
E Çoban, D Kırbaş, D Ataklı, A Soysal
Bakırköy Eğitim ve Araştırma Hastanesi, İstanbul
Amaç: Kardiyoembolik inme, tekrarlayan inme riski ile birlikte yüksek morbidite ve mortalite ile ilişkilidir. Oral antikoagülanlar plaseboya göre mortaliteyi ve inme riskini azaltmada oldukça etkilidirler. Çalışmamız varfarin tedavisi altında olan 20 yıl içinde takip ettiğimiz hastalarda ilacın etkinlik ve güvenirliğini ortaya koymak amacıyla planlanmıştır. Yöntem: Retrospektif olarak planlanan çalışmamıza İnme ünitemizde 1992-2012 yılları arasında varfarin tedavisi alarak takip edilen iskemik inme tanılı hastalar dahil edildi. İnme riskini belirlemede CHADS skoru, kanama komplikasyonunun belirlemede HASBLED skoru kullanıldı. Bulgular: Çalışmaya 394 hasta dahil edildi. Hastaların ortalama yaşı 66,35±13,60, ortalama izlem süreleri 4,85±3,57 yıldı. %79,9 hastada varfarin bağlı herhangi bir komplikasyon gözlenmedi. Otuz yedi hastada kanama komplikasyonu; 33 hastada sistemik kanama (burun kanaması, hematüri, hematokezya), dört hastada intraserebral kanama geliştiği gö- rüldü. 33 hastanın %75,8’inde ve dört hastanın %75’inde INR değeri >2,5 idi. Sistemik kanama geçiren hastaların %72,7’sinde HAS-BLED skoru >3 idi. İzlem süresince 41 hastada tekrarlayan iskemik inme/GİA gözlendi. Bu hastaların %92,7’sinde INR değeri
Efficacy and Safety of Warfarin Experience in a Stroke Polyclinic in Stroke Patients
Introduction: Cardioembolic stroke is associated with high morbidity and mortality, with an increased risk of recurrent stroke. Oral anticoagulation is highly effective in reducing the risk of stroke and mortality compared with placebo. Our study aimed to highlight the safety and efficacy of warfarin by analyzing the 20-year follow-up of patients on warfarin therapy. Methods: A retrospective observational study was performed with ischemic stroke patients receiving warfarin at our stroke polyclinic between 1992 and 2012. The CHADS2 scoring system was used to assess the annual risk of stroke, and a bleeding risk score termed the HAS-BLED scoring system was calculated to estimate the risk of bleeding. Results: In our study, 394 patients who were receiving warfarin therapy were included. The patients’ median age was 66.35±13.602 years. The median follow-up period of the patients was 4.85±3.572 years. During follow-up, 79.9% of the patients revealed no complication on warfarin therapy. Thirty-seven patients had hemorrhagic complications; among these, 33 had systemic complications (including nose bleeding, hematuria, hematochezia) and 4 patients had intracerebral bleeding. The INR value related to hemorrhagic complications was >2.5 in 75.8% of 33 patients having systemic bleeding and in 75% of 4 patients having intracerebral bleeding. The HAS-BLED risk score was >3 in 72.7% of the patients experiencing systemic bleeding complications. Forty-one patients had a recurrent ischemic stroke/TIA during the follow-up. Of this patient group, the INR value at the time of recurrent ischemic stroke was