Tromboembolijski rizik bolesnika s fibrilacijom atrija

master's thesis

• Title (english): Thromboembolic risk in patients with atrial fibrillation
• Author: Ivana Jonjić
• Mentor: Anton Šmalcelj (mentor)
• Committee member: Davor Puljević (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Anton Šmalcelj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Fibrilacija atrija (FA) smatra se najčešćom trajnom aritmijom u kliničkoj praksi. Smatra se da 21. stoljeće nosi epidemiju FA, a uzrok je prolongirani životni vijek. Zbog teških tromboembolijskih komplikacija čest je uzrok smrti. Najteža komplikacija svakako se smatra cerebrovaskularni inzult (CVI). 2/3 slučajeva CVI-a adekvatno primijenjenom terapijom se može prevenirati.
Prikupila sam podatke 743 pacijenta s nevalvularnom FA koji su u KBC Zagreb bili upućeni iz različitih krajeva Hrvatske u proteklom dvogodišnjem razdoblju. Pacijenti su stratificirani prema tromboembolijskim riziku kojega sam procjenjivala pomoću sustava bodovanja CHA2DS2- VASC score . To je sustav koji koristimo kod izračunavanja procjene rizika od CVI-a. Prema ESC smjernicama iz 2012. godine pacijenti se klasificiraju u tri grupe ovisno o zbroju bodova. Svaka od skupina nam govori o riziku i načinu primjene adekvatne terapije. Analiza je uključivala standardne demografske i kliničke podatke. INR vrijednost prikupljana je za svakog pacijenta zasebno.
Dobiveni rezultati svakako su potvrdili postavljenu hipotezu. Visoke vrijednosti CHA2DS2- VASC score i INR vrijednosti koje nisu u preporučenoj širini od 2.0-3.0 utječu na pojavu tromboembolijskih komplikacija kod pacijenata oboljelih od FA. Rezultati su pokazali da najveći dio pacijenata ima vrijednost CHA2DS2- VASC score 3,4 što zasigurno povećava opasnost od razvoja CVI-a. Samo 32.7% populacije postigao je preporučenu terapijski raspon INR-a 2.0-3.0. Uz to najveći broj pacijenata ima HA kao rizični čimbenik.
Usporedivši svoje rezultate s rezultatima dobivenim u "zapadnim" zemljama nalazimo se na samom kraju. Upravo to me navelo na zaključak kako je učinkovitost prevencije tromboembolijskih incidenata niska s obzirom na dobivene rezultate.

Abstract (english)

Atrial fibrillation (AF ) is the most frequent persistent arrhythmia in clinical practice. It is believed that the 21st century carries the epidemy of AF, and the cause is prolonged life expectancy. AF is associated with severe thromboembolic complications that are common cause of death. The most severe of them is stroke. Two thirds of stroke can be prevented by using the adequate anticoagulation therapy.
I collected the data of 743 patients with non-valvular AF who were referred to KBC Zagreb from various regions of Croatia in the past two years. Patients were stratified according to the thromboembolic risk which I considered or assessed by using a scoring system of CHA2DS2-VASC score. It is a system that we use when calculating the risk assessment of stroke. According to the ESC guidelines from 2012. patients are classified into three groups depending on score result. Each group tells us about the risk and mode of application of appropriate therapy. Analysis included standard demographic and clinical data. NR value was measured for each patient individually.
The results confirmed the hypothesis. High CHA2DS2- VASC score and INR values outside the recommended therapeutic range affect the occurrence of thromboembolic complications of FA. The results obtained that most of the patients have CHA2DS2 -VASC score 3 or 4 which surely increases the risk of stroke. Only 32.7 % of the population achieved the recommended therapeutic range of INR 2.0-3.0. In addition, most patients have HA as a risk factor.
By comparing the research results, Croatia lags behind the developed western countries. This is what led me to the conclusion that the effectiveness of the prevention of thromboembolism is low due to the results shown in research.

• Keywords: fibrilacija atrija; CHA2DS2-VASC score; tromboembolijski rizik
• Keywords (english): Atrial Fibrillation; CHA2DS2- VASC score; thromboembolic risk
• Language: croatian
• URN:NBN: urn:nbn:hr:105:400611
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-30 11:46:53