Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Int J Stroke. 2013 Dec;8(8):689-95. doi: 10.1111/j.1747-4949.2012.00855.x. Epub 2012 Aug 29.
Warfarin is demonstrated to be superior in efficacy over antiplatelet agents for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischaemic stroke.
This observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals were estimated in Cox regression models.
Out of the 20 442 patients with atrial fibrillation and ischaemic stroke (mean age = 79·5 years), 31% (n = 6399) were prescribed warfarin. After adjustment for the propensity score, warfarin was associated with a reduced risk of death (0·67; 95% confidence interval, 0·63-0·71). The crude rate (per 100 person-years) of fatal non-haemorrhagic stroke was lower in patients who received warfarin (1·60; 95% confidence interval, 1·34-1·89) compared to those who received antiplatelet (6·83; 95% confidence interval, 6·42-7·25). The rates (per 100 person-years) of fatal haemorrhagic stroke were 0·21 (95% confidence interval, 0·12-0·32) and 0·43 (95% confidence interval, 0·34-0·55) in patients prescribed warfarin and antiplatelet therapy, respectively.
In addition to its established benefit for stroke prevention, warfarin therapy in patients with atrial fibrillation and ischaemic stroke was associated with a reduced risk of death, without an increased risk of fatal haemorrhagic stroke.
华法林在预防中风方面的疗效优于抗血小板药物，但华法林与死亡率之间的关系尚不清楚。我们的目的是在一个大型的、未经选择的房颤伴缺血性中风患者队列中研究这种关系。
本观察性研究基于 2001 年至 2005 年在瑞典中风登记处出院并存活的患者。通过与瑞典死因登记处的链接来检索生存状态。我们计算了出院时开华法林处方的可能性评分。使用 Cox 回归模型估计死亡风险和 95%置信区间。
在 20442 例房颤伴缺血性中风患者（平均年龄 79.5 岁）中，31%（n=6399）开了华法林。在校正倾向评分后，华法林与死亡风险降低相关（0.67；95%置信区间，0.63-0.71）。服用华法林的患者致命性非出血性中风的粗发生率（每 100 人年）较低（1.60；95%置信区间，1.34-1.89），而服用抗血小板药物的患者为 6.83（95%置信区间，6.42-7.25）。服用华法林的患者致命性出血性中风的发生率（每 100 人年）分别为 0.21（95%置信区间，0.12-0.32）和 0.43（95%置信区间，0.34-0.55）。
除了对预防中风的既定益处外，房颤伴缺血性中风患者服用华法林与降低死亡风险相关，且致命性出血性中风的风险没有增加。
