A case report of a hemorrhagic stroke with atrial fibrillation in combination with hypertension

Abstract

Stroke is a heterogeneous syndrome, and identification of risk factors and treatment depends on the specific pathogenesis of the disease. Cardiovascular diseases are risk factors for the development of acute disorders of cerebral circulation. According to recent studies, one third of all ischemic strokes are cardioembolic. The main pathoetiology of a hemorrhagic stroke in the form of intracerebral hemorrhages is chronic hypertension and cerebral amyloid angiopathy. The occurrence of a hemorrhagic stroke against the background of atrial fibrillation in combination with hypertension is a rather rare phenomenon and poses a problem in the choice of treatment for such patients. The aim was to determine the optimal treatment for a complex case of a hemorrhagic stroke with atrial fibrillation in combination with hypertension. We present the clinical case of an 84-year-old woman who developed a hemorrhagic stroke on the background of atrial fibrillation in combination with hypertension. The main issue the cardio-neurological team faced was the administration of oral anticoagulants. On the one hand, the patient had indications for their administration according to current clinical guidelines (CHA2 DS2-VASc score of 6 points); on the other hand, the presence of a hemorrhagic stroke is a contraindication. This case demonstrates the solution to the difficult issue of choosing treatment for a hemorrhagic stroke and prevention of secondary complications of atrial fibrillation in combination with hypertension. After medical cardioversion, using clinical recommendations for the treatment of a hemorrhagic stroke, as well as given the positive dynamics of the neurological status, the patient was prescribed apixaban at a dose of 2.5 mg twice a day under the control of a coagulogram from the 7th day of the disease onset. Conclusions. We believe it is necessary to perform a thorough neurological examination and assessment of cognitive functions in all patients with atrial fibrillation, as well as to consider neuroimaging prior to the prescription of anticoagulant therapy. We recommend considering the administration of oral anticoagulants to patients with a low risk of recurrence and a high risk of thromboembolic complications after intracerebral hemorrhage.