Kanai Yukie, Oguro Hiroaki, Tahara Nao, Matsuda Hanako, Takayoshi Hiroyuki, Mitaki Shingo, Onoda Keiichi, Yamaguchi Shuhei
Department of Neurology, Faculty of Medicine, Shimane University, Izumo City, Shimane, Japan.
Department of Neurology, Faculty of Medicine, Shimane University, Izumo City, Shimane, Japan.
J Stroke Cerebrovasc Dis. 2018 Feb;27(2):338-345. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.007. Epub 2017 Oct 13.
We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke.
We administered 4 NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban in 101 postcardioembolic strokes with NVAF. In a retrospective study, we measured recurrent stroke volume with magnetic resonance imaging volumetric software and compared them between 10 vitamin K anticoagulant (VKA: warfarin) cases and 13 NOAC cases under anticoagulant therapy.
Of 101 cases, 31 were started with a VKA and switched to NOACs after 10 recurrent strokes. Other 70 cases were directly started with NOACs and 13 cases with NOACs as first anticoagulants had recurrent stroke. The frequency of recurrent stroke during anticoagulant therapy is not different between the VKA group and the 3 NOACs group. Recurrent stroke volume is significantly larger in the VKA group (26.4 cm) than in the NOACs group (1.2 cm).
Secondary prevention with NOACs after stroke might be more beneficial than a VKA by reducing recurrent infarct volume.
我们调查了接受非维生素K拮抗剂口服抗凝剂（NOACs）治疗的非瓣膜性心房颤动（NVAF）患者的复发性卒中体积，涉及临床背景和复发性卒中的数量。
我们对101例患有NVAF的心源性栓塞性卒中患者使用了4种NOACs，即达比加群、利伐沙班、阿哌沙班和依度沙班。在一项回顾性研究中，我们使用磁共振成像容积软件测量复发性卒中体积，并在10例接受维生素K抗凝剂（VKA：华法林）治疗的病例和13例接受NOACs抗凝治疗的病例之间进行比较。
在101例病例中，31例开始使用VKA，在发生10次复发性卒中后改用NOACs。其他70例直接开始使用NOACs，其中13例将NOACs作为首次抗凝剂的患者发生了复发性卒中。VKA组和3种NOACs组在抗凝治疗期间复发性卒中的频率没有差异。VKA组的复发性卒中体积（26.4立方厘米）明显大于NOACs组（1.2立方厘米）。
卒中后使用NOACs进行二级预防可能比VKA更有益，因为它可以减少复发性梗死体积。
