Audebert Heinrich J, Schenk Berit, Tietz Viola, Schenkel Johannes, Heuschmann Peter U
Stroke Unit, Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Cerebrovasc Dis. 2008;26(2):171-7. doi: 10.1159/000145324. Epub 2008 Jul 15.
Oral anticoagulation is highly effective for secondary prevention of cardioembolic strokes in patients with atrial fibrillation (AF). There are no studies investigating timing and complications of different strategies for initiation of oral anticoagulation after acute stroke or transient ischaemic attack (TIA).
Patients of ten community hospitals participating in the prospective evaluation of medical effects of the Telemedical Project for Integrative Stroke Care (TEMPiS) were included. This observational evaluation was restricted to ischaemic stroke or TIA patients with AF who were started on Phenprocoumon treatment during in-hospital stay. Antithrombotic co-medication was dichotomized in heparin bridging (weight or partial thromboplastin time-adjusted heparin) or conventional treatment (antiplatelets and/or low-dose heparin or nil). Besides treatment-relevant extracranial bleeding, major complications were documented according to the European Atrial Fibrillation Trial definitions including vascular death, ischaemic or haemorrhagic stroke, systemic embolism, and myocardial infarction.
Between July 2003 and March 2005, 4,082 ischaemic stroke or TIA patients were admitted. AF was recorded in 961 patients (23.5%), of whom 376 (39.1%) received oral anticoagulation. In 229 of these patients oral anticoagulation was started in hospital, 150 (65.5%) with heparin bridging and 79 (34.5%) with conventional treatment. Patients with heparin bridging were younger, and had a longer in-hospital stay after adjustment for potential confounders (p = 0.01). Major complications were infrequent in both groups (2.0 vs. 2.5%; p = 1.0) as well as extracranial bleeding (3.3 vs. 1.2%; p = 0.43).
Initiation of oral anticoagulation after acute ischaemic stroke yielded low complication rates independent of antithrombotic co-medication. Heparin bridging was associated with a longer stay in acute care hospitals.
口服抗凝药对心房颤动（AF）患者心源性栓塞性卒中的二级预防非常有效。目前尚无研究调查急性卒中或短暂性脑缺血发作（TIA）后启动口服抗凝药不同策略的时机及并发症。
纳入参与卒中综合治疗远程医疗项目（TEMPiS）医疗效果前瞻性评估的十家社区医院的患者。这项观察性评估仅限于住院期间开始接受苯丙香豆素治疗的缺血性卒中或TIA合并AF的患者。抗血栓联合用药分为肝素桥接（根据体重或部分凝血活酶时间调整的肝素）或传统治疗（抗血小板药物和/或低剂量肝素或无用药）。除了与治疗相关的颅外出血外，主要并发症根据欧洲心房颤动试验定义记录，包括血管性死亡、缺血性或出血性卒中、全身性栓塞和心肌梗死。
2003年7月至2005年3月期间，共收治4082例缺血性卒中或TIA患者。961例（23.5%）患者记录有AF，其中376例（39.1%）接受口服抗凝治疗。这些患者中有229例在医院开始口服抗凝治疗，150例（65.5%）采用肝素桥接，79例（34.5%）采用传统治疗。在对潜在混杂因素进行调整后，采用肝素桥接的患者更年轻，住院时间更长（p = 0.01）。两组的主要并发症发生率均较低（2.0%对2.5%；p = 1.0），颅外出血发生率也较低（3.3%对1.2%；p = 0.43）。
急性缺血性卒中后启动口服抗凝治疗的并发症发生率较低，与抗血栓联合用药无关。肝素桥接与急性护理医院住院时间延长有关。
