| Background: Atrial fibrillation(AF)is one of the most common arrhythmias in clinic.Due to decreased atrial systolic function,the blood of patients with atrial fibrillation is easily stagnated in the atrium.So that it is easy to form thrombosis.And the study suggests that the risk of embolism in patients with atrial fibrillation increased with age Hyperthyroidism is the one of the most common and reversible cause of atrial fibrillation,there is evidence that 10%-20% hyperthyroidism combined with atrial fibrillation.Trials and clinical practice found that excessive thyroxine promotes blood clotting and may have a synergistic effect with atrial fibrillation in thromboembolic events.Whether hyperthyroidism is the risk factor of ischemic event that comes from atrial fibrillation is still controversial.Currently there is no specific anticoagulation strategy for patients with atrial fibrillation and hyperthyroidism.Objective: This study was designed to investigate the current status of anticoagulation and ischemic stroke in hospitalizedpatients with hyperthyroidism and atrial fibrillation,and to investigate the relationship between hyperthyroidism and thrombosis in patients with atrial fibrillation.So that to provide some advice for anticoagulation therapy of th inpatients with hyperthyroidism and atrial fibrillation.Method: Retrospectively continuous selected the patients who hospitalized during May1,2010 to May1,2015 in the The First Affiliated Hospital of Dalian Medical University.According to the inclusion criteria and exclusion criteria,234 patients with atrial fibrillation and hyperthyroidism were selected.Detailed records of the patients include history,clinical test results and drugs using.All the collected data were analyzed and the patients were selected according toCHA2DS2-VASc score.In this study,CHA2DS2-VAScscore ≥ 2 points in patients with atrial fibrillation for thrombotic events occurred in high-risk groups.Result:1,The left atrial diameter(LAD)of the inpatients with atrial fibrillation and hyperthyroidism are larger.(41.90 ± 7.89)mm.The LAD of 112 patients are larger than 40mm(59.6%);40 ~ 50 mm,87 cases(46.2%);51 ~ 60 mm,20 cases(10.6%);61 ~ 70 mm,5 cases(2.7%).2,The inpatients with hyperthyroidism and atrial fibrillation usually combined with hypertension(42.7%),heart failure(41.9%),hyperthyroidism heart disease(38.4%),advanced age(63.10 ± 12.72 years).3,51 cases of all inpatients occur thrombotic embolism(21.8%),including42 cases are ischemic stroke(82.4%),5 of splenic artery embolization(2.0%),1 case of mesenteric artery embolization(2.0%);25 male(49%),26 female(51%),P = 0.459,the difference of gender is not significant.4,CHA2DS2-VASc score was 2.43 ± 1.59 in patients without thromboembolic events and 4.8 ± 1.65 in patients with thromboembolic events,P <0.01.So CHA2DS2-VASc score in patients with thromboembolism was significantly higher than that in patients without thromboembolism patients.5,The percentage of the usage of warfarin is 17.0% in the patients with CHA2DS2-VASc score ≥ 2 points,while 0.6% in rivaroxaban,57.9% for other antithrombotic drugs include aspirin,24.5% without antithrombotic or anticoagulant drugs.The correct rate of anticoagulation strategy is low.6.32 patients taking warfarin,but 5 patients(15.2%)still occured thromboembolic events;In these people,INR was 1.66 ± 1.01,23 patients(71.9%)with INR <2,7 patients with INR between 2-3 21.9%);INR> 3 in 2 cases(6.2%),INR compliance rate is low.Conclusion: 1,The incidence of thromboembolic events in hospitalized patients with atrial fibrillation and hyperthyroidism increased obviously.2.The inpatients with atrial fibrillation and hyperthyroidism mostly combined with CHA2DS2-VASc risk factors,such as hypertension,heart failure,advanced age.3.The inpatients with atrial fibrillation and hyperthyroidism mostly without strict anticoagulation;INR is not up to standard.More attention should be payed with anticoagulant therapy and the intensity of anticoagulation should be increased in clinical practice. |
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