卒中前口服抗凝对伴有心房颤动的缺血性和出血性卒中严重程度及结局的影响。

Impact of prestroke oral anticoagulation on severity and outcome of ischemic and hemorrhagic stroke in patients with atrial fibrillation.

机构信息

Center for Stroke Research, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.

出版信息

Cerebrovasc Dis. 2010;29(5):476-83. doi: 10.1159/000297963. Epub 2010 Mar 19.

DOI:10.1159/000297963

PMID:20299787

Abstract

BACKGROUND

Stroke prevention with oral anticoagulation is effective in patients with atrial fibrillation. An additional beneficial effect of oral anticoagulation prior to the event on stroke severity and prognosis was suggested in ischemic strokes. We tested whether this benefit is preserved after inclusion of hemorrhagic strokes and adjustment for prestroke living conditions.

METHODS

Data were used from a prospective hospital-based intervention trial evaluating quality of care and outcome in ten district hospitals. All ischemic and hemorrhagic stroke patients with atrial fibrillation were included. We analyzed separate multivariable regression models to identify factors associated with prescription of oral anticoagulation before stroke and to investigate the independent effect of anticoagulation on admission stroke severity, 3-month mortality and functional outcome.

RESULTS

The analysis comprised 804 (718 ischemic, 86 hemorrhagic) stroke patients admitted between July 2003 and March 2005. Males, patients aged 65-84, living independently, with diabetes, previous cerebrovascular event or additional high cardioembolic risks were more likely to receive oral anticoagulation before admission. Admission international normalized ratio (INR) between 2 and 3 (OR 0.35, 95% CI: 0.17-0.71) or higher (OR 0.32, 95% CI: 0.11-0.92) was associated with less severe strokes (including hemorrhagic strokes) compared with INR <2. Anticoagulation was associated with decreased risk of death and poor functional outcome (modified Rankin Scale >3) at 3 months (OR 0.54, 95% CI: 0.36-0.84, and OR 0.70, 95% CI: 0.47-1.06). After adjustment for stroke severity, anticoagulation had no additional effect on mortality and functional outcome.

CONCLUSIONS

The beneficial effect of prestroke anticoagulation on stroke outcome related to the reduced stroke severity is not offset by adverse effects in hemorrhagic stokes.

摘要

背景

口服抗凝剂预防中风对房颤患者有效。在缺血性中风中，提示事件发生前口服抗凝剂对中风严重程度和预后有额外的有益影响。我们测试了在包括出血性中风并调整中风前生活条件后，这种益处是否仍然存在。

方法

数据来自一项前瞻性医院干预试验，该试验评估了十家地区医院的护理质量和结果。所有患有房颤的缺血性和出血性中风患者均包括在内。我们分析了单独的多变量回归模型，以确定与中风前服用口服抗凝剂相关的因素，并研究抗凝对入院中风严重程度、3 个月死亡率和功能结果的独立影响。

结果

分析包括 2003 年 7 月至 2005 年 3 月期间收治的 804 例（718 例缺血性，86 例出血性）中风患者。男性、年龄在 65-84 岁之间、独立生活、患有糖尿病、有过脑血管事件或有其他高心源性栓塞风险的患者更有可能在入院前接受口服抗凝治疗。与 INR<2 相比，INR 在 2-3（OR 0.35，95%CI：0.17-0.71）或更高（OR 0.32，95%CI：0.11-0.92）与较严重的中风（包括出血性中风）相关。与 INR<2 相比，抗凝与 3 个月时的死亡风险降低和不良功能结果（改良 Rankin 量表>3）相关（OR 0.54，95%CI：0.36-0.84，和 OR 0.70，95%CI：0.47-1.06）。在调整中风严重程度后，抗凝对死亡率和功能结果没有额外的影响。