1 Neurology, Justus Liebig University, Giessen, Germany.
2 Neurology, Bad Salzhausen, Germany.
Int J Stroke. 2018 Apr;13(3):308-312. doi: 10.1177/1747493017733928. Epub 2017 Sep 27.
Background New evidence regarding stroke prevention in atrial fibrillation has been published. Implementing knowledge into clinical practice remains challenging. Aims To investigate oral anticoagulants in stroke patients documented in a nationwide registry. Methods The database is an obligatory federal-state-wide hospital-based registry that covers more than 95% of all ischemic strokes, transient ischemic attacks and intracerebral hemorrhages in a community of more than six million inhabitants (Hesse/Germany). We analyzed oral anticoagulants prescribed on discharge in patients with stroke or transient ischemic attack during 2006-2015. Results From 2006 to 2015, we annually selected median 20,895 patients. From 2006 to 2015, the proportion of patients treated with oral anticoagulants increased (9.8% to 24%). The annual proportion of patients with atrial fibrillation remained constant (median: 23%). In atrial fibrillation patients treated with oral anticoagulants, the age increased (median 2008/2009: 76.9 years vs. 2014/2015 79.4 years). The percentage of treated individuals in atrial fibrillation increased dramatically (2006: 30.1% to 2015: 74.5%); in 2015, 30.8% of these patients received vitamin K antagonists and 70.2% new oral anticoagulants. Independent factors associated with new oral anticoagulants therapy were a previous medication with new oral anticoagulants and a treatment on stroke unit. Between new oral anticoagulants- and vitamin K antagonists-treated patients (2015), no differences in age were noted (both mean: 79.4 years). Conclusions The new oral anticoagulants availability enhanced a general trend treating more target patients with oral anticoagulants.
新的房颤卒中预防证据已经发表。将知识付诸临床实践仍然具有挑战性。目的：调查全国注册登记系统中记录的卒中患者使用口服抗凝剂的情况。方法：该数据库是一个强制性的州级医院为基础的注册登记系统，涵盖了超过 600 万居民社区中所有缺血性卒中和短暂性脑缺血发作及颅内出血的 95%以上（德国黑森州）。我们分析了 2006-2015 年卒中或短暂性脑缺血发作出院患者的口服抗凝剂处方。结果：2006 年至 2015 年，每年选择中位数为 20895 例患者。2006 年至 2015 年，接受口服抗凝剂治疗的患者比例增加（9.8%至 24%）。房颤患者的比例保持不变（中位数：2008/2009 年 23%）。接受口服抗凝剂治疗的房颤患者年龄增加（中位数 2008/2009 年 76.9 岁 vs. 2014/2015 年 79.4 岁）。接受治疗的房颤患者比例显著增加（2006 年 30.1%至 2015 年 74.5%）；2015 年，30.8%的患者接受维生素 K 拮抗剂，70.2%的患者接受新型口服抗凝剂。与新型口服抗凝剂治疗相关的独立因素是之前使用过新型口服抗凝剂和在卒中单元接受治疗。在新型口服抗凝剂和维生素 K 拮抗剂治疗的患者（2015 年）之间，年龄无差异（均为 79.4 岁）。结论：新型口服抗凝剂的应用增强了一般趋势，使更多的目标患者接受口服抗凝剂治疗。
