Canavero Isabella, Cavallini Anna, Sacchi Lucia, Quaglini Silvana, Arnò Natale, Perrone Patrizia, DeLodovici Maria Luisa, Marcheselli Simona, Micieli Giuseppe
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
J Stroke Cerebrovasc Dis. 2017 Jan;26(1):7-18. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.022. Epub 2016 Sep 7.
It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking.
In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHADS-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding.
Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.
已有广泛报道称，抗凝剂（ACs）在心房颤动（AFib）患者缺血性卒中的一级和二级预防中未得到充分使用。此外，目前缺乏关于急性卒中后启动AC的最佳时机的精确循证指南。
在这项回顾性观察研究中，我们分析了在我们所在地区（意大利伦巴第）的四个神经卒中单元住院的急性缺血性卒中AFib患者的处方趋势。住院期间抗血栓药物的处方模式高度异质。卒中前使用AC进行治疗是住院期间增加AC处方的主要因素。促进AC使用的其他因素包括男性、年龄较轻、卒中前残疾程度较低和卒中严重程度较低以及卒中体积较小。AFib亚型仅在未使用过AC的患者中影响AC处方。有趣的是，充血性心力衰竭、高血压、年龄大于75岁、糖尿病、既往卒中或短暂性脑缺血发作或血栓栓塞、血管疾病、年龄64 - 75岁、女性（CHADS - VASc）以及高血压、肝肾功能异常、卒中、出血、国际标准化比值不稳定、老年、药物和酒精（HAS - BLED）评分与AC处方无关。然而，接受AC治疗的患者，包括早期治疗（<48小时），出血率较低。
我们的研究结果可能表明，尽管明显忽略了常见的风险分层工具，但我们的神经科医生能够选择更适合及时接受AC治疗的患者。需要进一步研究以开发新的评分系统，以辅助卒中二级预防中的缺血性和出血性风险评估。
