Факторы риска и профилактика инсульта при фибрилляции предсердий

Stroke is one of the top three causes of death in the population and a leading cause of disability in the elderly; ischemic stroke (IS) constitutes a major portion (70–85%) of all strokes so its prevention  s a relevant problem of modern medicine. Among the risk factors  RFs) of stroke, nonvalvular atrial fibrillation (AF) is of great  ignificance, which occurs in persons over 70 years of age in  pproximately 5–10% of cases and increases the risk of IS 3–4-fold. The review analyzes RFs for stroke in AF. The CHA2DS2-VASc scale encompassing several RFs is noted to be informative and easy-to-use. There are data of large-scale randomized trials that show that novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) are as good as warfarin or offer an advantage over the latter, by more substantially decreasing the risk of stroke and reducing the likelihood of profuse bleeding, intracranial hemorrhage in particular. There is evidence for the efficacy of rivaroxaban in the secondary prevention of stroke. The authors provide their experience with patient management to prevent recurrent cardioembolic stroke. In our country, most patients who have sustained IS or transient ischemic attack in the presence of AF do not take warfarin due to the fact that it is difficult to regularly monitor the international normalized ratio (INR). It is noted that the administration of the novel anticoagulants, which differs from that of warfarin, does not require INR monitoring and can increase the number of patients on anticoagulant therapy and therefore reduce the incidence of stroke in the presence of AF.