Appelros Peter, Farahmand Bahman, Terént Andreas, Åsberg Signild
From the Department of Neurology, Örebro University Hospital, Sweden (P.A.); Epi-consultant Formerly Karolinska Institute, Alzheimer Disease Research Center, Gävlegatan, Stockholm, Sweden (B.F.); and Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset, Sweden (A.T., S.A.).
Stroke. 2017 Jun;48(6):1617-1623. doi: 10.1161/STROKEAHA.117.016902. Epub 2017 May 9.
Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age.
For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ≥90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death.
Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the ≥90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage.
Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.
抗凝治疗对于预防心房颤动患者复发性缺血性卒中有效。这种益处是以出血风险略有增加为代价的。抗凝相关出血似乎随年龄增长而增加，但很少有研究表明治疗益处是否在老年患者中持续存在。
对于这项观察性研究，使用了4种不同的登记系统，其中包括瑞典卒中登记系统Riksstroke。纳入2006年至2013年期间近期发生缺血性卒中、年龄在80至100岁且患有心房颤动的患者。患者被分为3个年龄组：80至84岁、85至89岁和≥90岁。从登记系统中收集有关卒中严重程度、危险因素、药物和合并症的信息。对患者进行随访，观察缺血性或出血性卒中、其他出血或死亡情况。
在所有23356例心房颤动患者中，6361例（27%）在缺血性卒中后使用了抗凝剂。抗凝治疗在所有年龄组中均与复发性缺血性卒中减少相关。出血在≥90岁年龄组中增加最多，但这并未抵消抗凝剂的总体有益效果。除年龄外，未发现其他心血管危险因素或合并症会影响抗凝相关出血的风险。抗凝剂以外的药物不影响大出血的发生率。
鉴于本研究中的患者特征，有更多患者接受抗凝治疗的空间，且不会以出血为主。在九旬老人中，出血增加幅度稍大，但这并未影响该年龄层的总体结果。
