Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Neuro-pathophysiological Imaging, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Eur J Neurol. 2017 Nov;24(11):1399-1406. doi: 10.1111/ene.13405. Epub 2017 Sep 5.
Anticoagulant treatment with a vitamin K antagonist (VKA) has been reported to reduce stroke severity when patients with atrial fibrillation (AF) suffer acute ischaemic stroke (AIS). Direct oral anticoagulant (DOAC) therapy also has the potential to reduce the initial severity of AIS. However, the effect of DOAC therapy on the severity of AIS is not well known. The aim of the present study was to investigate the effect of DOACs on initial stroke severity in patients with AIS and non-valvular AF.
From March 2011 to July 2016, consecutive patients with AIS having non-valvular AF were recruited. The effects of prior DOAC treatment on severity were assessed by multivariate logistic regression analyses.
A total of 484 patients [208 women; median age 79 (interquartile range, 71-85) years; National Institutes of Health Stroke Scale (NIHSS) score 9 (interquartile range, 3-20)] were enrolled. Of these, 352 (73%) were on no anticoagulant medication, 54 (11%) were undertreated with a VKA, 35 (7%) were sufficiently treated (admission prothrombin time-international normalized ratio: ≥2.0 for patients <70 years old and ≥1.6 for ≥70 years old) with a VKA and 43 (9%) were on a DOAC. The initial NIHSS score (median 10 in patients with no anticoagulation, 13 in undertreated VKA, 7 in sufficient VKA and 6 in DOAC, P = 0.018) was different among the groups. Multivariate analysis showed that DOAC was independently and negatively associated with severe (initial NIHSS score ≥ 10) stroke (odds ratio, 0.39; P = 0.041), compared with no anticoagulant therapy.
Direct oral anticoagulant treatment prior to the event should reduce initial stroke severity in patients with AIS and non-valvular AF.
有报道称，在伴有心房颤动（房颤）的急性缺血性脑卒中（AIS）患者中，应用维生素 K 拮抗剂（VKA）进行抗凝治疗可降低脑卒中严重程度。直接口服抗凝剂（DOAC）治疗也有可能降低 AIS 的初始严重程度。然而，DOAC 治疗对 AIS 严重程度的影响尚不清楚。本研究旨在探讨 DOAC 对伴有非瓣膜性房颤的 AIS 患者初始脑卒中严重程度的影响。
2011 年 3 月至 2016 年 7 月，连续入选伴有非瓣膜性房颤的 AIS 患者。采用多变量逻辑回归分析评估既往 DOAC 治疗对严重程度的影响。
共纳入 484 例患者[208 例女性；中位年龄 79（71-85）岁；美国国立卫生研究院卒中量表（NIHSS）评分 9（3-20）分]。其中，352 例（73%）未服用抗凝药物，54 例（11%）VKA 治疗不足，35 例（7%）VKA 充分治疗（INR：<70 岁时为 2.0，≥70 岁时为 1.6），43 例（9%）服用 DOAC。各组间初始 NIHSS 评分（无抗凝组中位数为 10 分，VKA 治疗不足组为 13 分，VKA 充分治疗组为 7 分，DOAC 组为 6 分，P=0.018）不同。多变量分析显示，与无抗凝治疗相比，DOAC 与严重脑卒中（初始 NIHSS 评分≥10 分）独立且负相关（比值比，0.39；P=0.041）。
在伴有非瓣膜性房颤的 AIS 患者中，事件发生前应用直接口服抗凝剂治疗应降低初始脑卒中严重程度。
