Paciaroni Maurizio, Agnelli Giancarlo, Ageno Walter, Caso Valeria
Maurizio Paciaroni, Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Via G. Dottori 1, Perugia 06100, Italy, Tel./Fax: +39 0 75 5782765, E-mail:
Thromb Haemost. 2016 Aug 30;116(3):410-6. doi: 10.1160/TH16-03-0217. Epub 2016 Jun 23.
In patients with acute stroke and atrial fibrillation (AF), the risk of early recurrence has been reported to range between 0.1 % and 1.3 % per day. Anticoagulants are the most effective therapy for the prevention of recurrent ischaemic stroke in these patients, but randomised clinical trials have failed to produce any evidence supporting the administration of heparin within 48 hours from stroke onset as it has been associated with a non-significant reduction in the recurrence of ischaemic stroke, no substantial reduction in death and disability, and an increase in intracranial bleeding. As early haemorrhagic transformation is a major concern in the acute phase of stroke patients with AF, determining the optimal time to start anticoagulant therapy is essential. This review which focuses on the epidemiology of recurrent ischaemic stroke and haemorrhagic transformation in patients with acute ischaemic stroke and AF, proposes a model for decision making on optimal timing for initiating anticoagulation, based on currently available evidence.
在急性中风和心房颤动（AF）患者中，据报道早期复发风险为每天0.1%至1.3%。抗凝剂是预防这些患者复发性缺血性中风的最有效疗法，但随机临床试验未能提供任何证据支持在中风发作后48小时内使用肝素，因为这与缺血性中风复发率的非显著降低、死亡和残疾的实质性减少以及颅内出血的增加有关。由于早期出血性转化是AF中风患者急性期的主要关注点，确定开始抗凝治疗的最佳时间至关重要。本综述聚焦于急性缺血性中风和AF患者复发性缺血性中风和出血性转化的流行病学，基于现有证据提出了一个关于启动抗凝治疗最佳时机的决策模型。
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