| Summary: | 碩士 === 長庚大學 === 護理學研究所 === 98 === Atrial fibrillation (AF), the most frequently encountered cardiac arrhythmia in clinical practice, is the most important cause of ischemic stroke. Even though studies have disclosed that the effect of stroke prevention of warfarin is superior to aspirin, but warfarin is still under used clinically. The purposes of this study were to recognize the distribution of risk factors of AF and ischemic stroke in patients with AF, the incidence of ischemic stroke within 3 years after AF was diagnosed, the use of antithrombotic agents, the influence of the risk factors of ischemic stroke and the antithrombotic therapy on ischemic stroke; and the factors that affect the prescription of warfarin. This was a descriptive design and chart review study. This study comprised 1211 subjects, who were ≥60 years old and first time diagnosed AF at two hospitals in Northern Taiwan from January 2003 to December 2005. Chi square and logistic regression were used for data analysis. The results revealed hypertension and ≥75 years old were the most common risk factors of AF (69.4%, 51%) or ischemic stroke (72.7%, 51%). The incidence of ischemic stroke was 46.2% during 3 years after AF was diagnosed and 86.3% of ischemic stroke was diagnosed in the first year. During three years after AF was diagnosed, antithrombotic agents were prescribed in 53.3% of subjects. The prescription rate of warfarin was 10.8%. The positive predictors of ischemic stroke in AF patients were ≥75 years old (OR=1.48, p<0.01) and a history of ischemic stroke (OR=3.19, p<0.01); the negative predictors were persistent use of warfarin (OR=0.01, p<0.01), transient use of warfarin (OR＝0.25, p<0.01), alternative use of warfarin and antiplatelet agents (OR＝0.04, p<0.01), and antiplatelet use alone (OR＝0.13, p<0.01). The significant factors which encouraged physicians to prescribe warfarin were a history of ischemic stroke (OR=2.06, p=0.01), thromboembolism (OR=27.10, p<0.01), mitral stenosis (OR=6.78, p<0.01), and mechanical valve replacement (OR=89.89, p<0.01). The significant factor which prevented physicians from prescribing warfarin was ≥75 years old (OR=0.56, p=0.01). According to the study results, the incidence of ischemic stroke was developed mostly in the first year after AF was diagnosed. Therefore, physicians assess the risk stratification of ischemic stroke in new diagnosed AF patients then give appropriated antithrombotic therapy is very important in prevention of ischemic stroke.
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