Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany.
Cerebrovasc Dis. 2009;28(6):611-7. doi: 10.1159/000251172. Epub 2009 Oct 22.
BACKGROUND/AIM: Prognosis and optimal secondary prevention in ischemic stroke patients with coagulopathies remain unclear. The goal of this prospective observational multicenter study was to determine the risk of recurrence in cryptogenic stroke patients with either no or defined coagulopathies under various prevention regimens.
A total of 429 patients from 14 German stroke centers with an acute cryptogenic ischemic stroke or transient ischemic attack in whom specialized coagulation testing for inherited and acquired coagulopathies (factor V Leiden mutation/resistance to activated protein C, prothrombin mutation, deficiencies of protein C, protein S, antithrombin III, anticardiolipin IgG antibodies, lupus anticoagulant) had been performed were included. Biannual follow-up in 339 (79%) of these patients assessed recurrent cerebrovascular events and secondary prevention therapy during a mean period of 2.5 years.
A defined coagulopathy was detected in 89 patients with follow-up, whereas no coagulopathy could be found in 250 patients with follow-up (control group). The Kaplan-Meier estimate for recurrent ischemic stroke or transient ischemic attack after 3 years was 13.6% (95% CI: 5.9-21.2%) in patients with a coagulopathy compared to 9.3% (95% CI: 5.4-13.2%) in controls, which was not significant after adjustment for potential risk factors by Cox regression analysis. Only a previous cerebrovascular ischemic event was an independent predictor for risk of recurrence in coagulopathy and control patients.
Our observational data do not indicate a significantly increased risk for recurrent cerebrovascular events in cryptogenic stroke patients with a coagulopathy or any significant influence of the type of antithrombotic treatment.
背景/目的：凝血障碍的缺血性脑卒中患者的预后和最佳二级预防仍不清楚。本前瞻性观察性多中心研究的目的是确定在各种预防方案下，无凝血障碍或明确凝血障碍的隐源性脑卒中患者的复发风险。
共纳入 14 家德国卒中中心的 429 例急性隐源性缺血性卒中和短暂性脑缺血发作患者，这些患者进行了专门的凝血检测，以确定遗传性和获得性凝血障碍（因子 V 莱顿突变/抗活化蛋白 C 抵抗、凝血酶原突变、蛋白 C、蛋白 S、抗凝血酶 III、抗心磷脂 IgG 抗体、狼疮抗凝剂）。其中 339 例（79%）患者进行了两年半的定期随访，评估复发性脑血管事件和二级预防治疗。
在有随访的 89 例患者中发现了明确的凝血障碍，而在有随访的 250 例患者中没有发现凝血障碍（对照组）。凝血障碍组 3 年后复发性缺血性卒中和短暂性脑缺血发作的 Kaplan-Meier 估计值为 13.6%（95%CI：5.9-21.2%），对照组为 9.3%（95%CI：5.4-13.2%），但 Cox 回归分析调整潜在危险因素后无显著差异。只有先前的脑血管缺血事件是凝血障碍和对照组患者复发风险的独立预测因素。
我们的观察性数据表明，凝血障碍的隐源性脑卒中患者的复发性脑血管事件风险没有显著增加，抗凝治疗的类型也没有显著影响。
