One of 5 ischemic strokes is cardioembolic in nature. Despite the robust data on cardioembolic stroke (CES) in western literature, there is scarcity of locally published data on Asian patients. The higher prevalence of rheumatic heart disease in developing countries and the availability of novel anticoagulants may contribute to an evolving patient profile. This study aims to define the clinical profile, management patterns, and in hospital outcomes of Filipino patients with CES.Design and Method:
This is a retrospective study of Filipino patients with CES admitted at a tertiary hospital from 2013–2014. Data were obtained through review of medical records using a standardized data collection form.Results:
About 126 patients were enrolled. Mean age was 59.9 ± 15.28. Majority (88%) had a CHADS-VASC Score of >2. Atrial fibrillation remains the most common rhythm abnormality (67%) while 20% has rheumatic valvular heart disease (mitral stenosis). On echo, 92% had left ventricular hypertrophy and 58% had left atrial enlargement. Only 5% had intra-cardiac thrombus while 8% had rheologic stasis. Most of the patients had moderate to large artery territory infarctions, and 40% had hemorrhagic conversion within 4 days post ictus. Two of 3 patients were given initial anticoagulation. However, only 50% of those who survived were discharged on oral anticoagulation. New oral anticoagulants were used in only 10% of patients. The mean HAS BLED score was 1.9 ± 0.96. Bleeding complications were noted in 6%. Physician and patient related barriers to anticoagulation were identified. Cardioembolic strokes were associated with longer hospital stay (16 days) and development of nosocomial pneumonia (46%).Conclusions:
The profile of Filipino CES patients was similar to the previous studies in terms of the patients’ mean age, neuroimaging findings, rate of hemorrhagic conversion, and low anticoagulation rate. Contrary to western studies, Filipino CES patients are younger, with majority of them having rheumatic heart disease.