Weimar C, Benemann J, Katsarava Z, Weber R, Diener H-C
Department of Neurology, University of Duisburg-Essen, Essen, Germany.
Eur Neurol. 2008;60(3):142-8. doi: 10.1159/000144085. Epub 2008 Jul 14.
BACKGROUND/AIMS: Low rates and poor quality of oral anticoagulation (OAC) have been reported in patients with atrial fibrillation (AF). We therefore sought to investigate the prescription patterns at discharge, adherence and quality of OAC in cerebrovascular disease patients with AF.
Consecutive ischemic stroke (IS) and transient ischemic attack (TIA) patients were prospectively documented in 11 German stroke centers. A central telephone follow-up after 1-2 years assessed the current antithrombotic medication and results of coagulation checks.
Of 1,463 surviving patients with AF, 30.5% were discharged on OAC and 13.9% on high-dose heparin. Of 329 AF patients discharged on OAC and with consent for follow-up, 88.7% of surviving patients were still on OAC at the follow-up. Of these, 52.7% reported coagulation values out of the therapeutic range during the preceding 3 months. A recurrent IS was seen in 9 patients (2.1%/year) and an intracranial hemorrhage in 2.
We found an important underuse of OAC following TIA or IS mainly in older patients and with greater stroke-related disability. Although the reported coagulation checks showed an only moderate rate within therapeutic ranges, safety and efficacy of OAC in this cohort seem comparable to previous randomized and observational trials in AF patients.
背景/目的：已有报道称心房颤动（AF）患者口服抗凝药（OAC）的使用率低且质量差。因此，我们试图调查合并AF的脑血管疾病患者出院时OAC的处方模式、依从性及质量。
在11个德国卒中中心对连续性缺血性卒中（IS）和短暂性脑缺血发作（TIA）患者进行前瞻性记录。1至2年后进行中心电话随访，评估当前的抗栓药物及凝血检查结果。
在1463例存活的AF患者中，30.5%出院时使用OAC，13.9%使用高剂量肝素。在329例出院时使用OAC且同意随访的AF患者中，88.7%的存活患者在随访时仍在使用OAC。其中，52.7%的患者报告在前3个月内凝血值超出治疗范围。9例患者出现复发性IS（2.1%/年），2例出现颅内出血。
我们发现TIA或IS后OAC的使用严重不足，主要见于老年患者及卒中相关残疾程度较高的患者。尽管报告的凝血检查结果显示治疗范围内的比例仅为中等，但该队列中OAC的安全性和有效性似乎与既往AF患者的随机和观察性试验相当。
