Wednesday, May 29, 2024

Stroke: one of the main causes is undertreated in 8 out of 10 cases

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It can be announced with palpitations, shortness of breath, dizziness. But in many cases its presence is detected once it has caused damage. Atrial fibrillation (AF) is the most frequent arrhythmia and those who present it are five times more likely to suffer a cerebrovascular attack (CVA) .

Deactivating the conditions for which the abnormal functioning of the heart endangers the brain (and lifestyle itself) is possible, but only two in 10 people at risk receive adequate treatment, warns a study that seeks to alert about the “catastrophic” consequences ” of subtreatment.

AF – which is very prevalent after the age of 60, but can occur at any age – causes irregular heartbeats. This is because instead of contracting rhythmically and thus allowing the normal passage of blood towards the ventricle, the left atrium performs a chaotic movement that favors the formation of clots. The risk? That the thrombus detaches and travels through the arteries to different parts of the body. The biggest fear? May the final destination of this journey be the brain. “There comes a time when the clot cannot advance any further and, by clogging the artery, the region that depends on it begins to die .

If there is no possibility of reopening it and dissolving the clot, all the brain tissue that depends on that vessel dies forever and that is when the. People begin to have difficulty speaking, moving an arm, seeing , depending on which part of the brain is affected. It is the most feared complication of atrial fibrillation,” explains Argentine vascular neurologist Luciano Sposato, who is currently in charge of the Stroke, Dementia and Heart Disease team at the London Health Sciences Center at the University of Western Ontario, in Canada.

“It is a highly preventable medical, social, and economic catastrophe,” says Sposato’s study “Decision-making interventions to stop the atrial fibrillation-related stroke tsunami” (published in the International Journal of Stroke), which outlines a parallel between the devastation caused by the natural disaster that struck Indonesia in 2004 and the dramatic consequences of the global underutilization of oral anticoagulation to prevent stroke in patients with this type of arrhythmia.They estimate that the prevalence of AF will double by 2050.They estimate that the prevalence of AF will double by 2050.

Data from a large study published in 2014 show that 25% of patients with atrial fibrillation who should be on anticoagulation are not on medication. To that is added almost 30% who are receiving only aspirin. ” There are still doctors in the world who think that if they give AF patients aspirin they are helping them not to have a stroke and what we know very clearly is that, in terms of prevention, it is like giving them nothing”, emphasizes the specialist who led teams at INECO and the Favaloro Foundation and is dedicated to investigating the relationship between the heart and the brain.

What is sought in the patient with atrial fibrillation is to prevent thrombi from blocking blood vessels. The first drugs used for this purpose were born 60 years ago (antivitamin K) and have had a huge impact, surpassed even by the new generation of direct-acting drugs. “Few drugs achieve this clinical efficacy of reducing the risk of stroke by 64%, with a clear decrease in mortality”, points out María Esther Aris Cancela, Head of Hematology at the Cardiovascular Institute of Buenos Aires (ICBA). 

The tsunami of atrial fibrillation

Only a quarter of those who suffer an attack due to this cause survive without sequelae, another quarter die and half are disabled. “ Detecting arrhythmia and not treating it is outrageous . It is like taking the patient by the hand to the coast and leaving him alone waiting for the tsunami to arrive”, compares the neurologist.

Poor risk stratification and subjective overinterpretation of contraindications are the main reasons why clinicians avoid oral anticoagulation in practice despite the fact that, according to international guidelines, it should be the treatment of choice in patients with high-risk atrial fibrillation .

According to the Consensus on Atrial Fibrillation of the Argentine Society of Cardiology, the risk of hemorrhage from drugs is almost always five to eight times lower than the risk of cerebral embolism.

“There is a tendency towards therapeutic inertia,” considers Fernando Botto, a cardiologist at the Center for Hypertension and Arterial Aging at Hospital Austral. “Anticoagulation of atrial fibrillation is the only proven treatment that reduces the risk of stroke and death . The worst behavior is not to anticoagulate ”, he underlines.

The scientific evidence shows that there is a net clinical benefit in the prescription of the treatment. “The patient must be told that the chances of having an ischemic stroke, a brain hemorrhage or of dying are reduced by 50% with anticoagulants. There is nothing stronger than that”, adds Sposato.

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