Etiology and Status of Preventive Therapy of Cardioembolic Stroke: Hospital-Based Retrospective Analysis

J Korean Neurol Assoc > Volume 23(5); 2005 > Article

Journal of the Korean Neurological Association 2005;23(5): 595-600.

심인성 뇌색전의 원인 및 예방 실태에 대한 조사: 병원 기반 후향적 연구

김민정, 박종무a 김지영 윤병우

서울대학교 의과대학 신경과학교실, 을지의과대학 신경과학교실a

Etiology and Status of Preventive Therapy of Cardioembolic Stroke: Hospital-Based Retrospective Analysis

Min-Jeong Kim

Department of Neurology, Seoul National University College of Medicine, Seoul; Department of Neurology, Eulji Univertity School of Medicinea, Seoul, Korea

Abstract

Background: The etiology of cardioembolic stroke in Korea tends to be different from western countries. This study is to assess the current trend in the etiology and prevention of cardioembolic stroke in Korea.
Methods: We reviewed the medical records of patients with cardioembolic stroke retrospectively from 1998 to 2003. The following items were examined: type of cardioembolic source, previous anticoagulation or antiplatelet therapy, previous stroke, insight of the heart disease, and the International Normalized Ratio (INR) value of prothrombin time (PT) on arrival.
Results: The cardioembolic sources of 226 patients were found to be of non-valvular atrial fibrillation in 100 (44.2%), a left ventricle regional wall motion abnormality (LV RWMA) in 45 (19.9%), rheumatic heart disease (RHD) in 34 (15.1%), patent foramen ovale in 18 (8.0%), left atrial appendage thrombi in 11 (4.9%), prosthetic valve in 10 (4.4%), dilated cardiomyopathy in 5 (2.2%), and recent myocardial infarction in 3 (1.3%). In 179 patients with no previous stroke, primary prevention was made in 52 (66.7%). Twenty-five (53.2%) out of 47 patients with stroke history were under secondary prevention. Among 39 patients who developed stroke in spite of anticoagulation, PT INR values of 27 (69.3%) were below 2.0. Proportions of RHD and LV RWMA were decreased and increased respectively. The rate of primary prevention, anticoagulation as secondary prevention, and adequate anticoagulation were also increased.
Conclusions: The etiology of cardioembolic stroke in Korea seems to be changing according to the pattern of western countries. Many physicians are beginning to recognize the need for prevention of cardioembolism but more action is needed. KeyWords:Cerebral embolism, Heart disease