Nakase Taizen, Moroi Junta, Ishikawa Tatsuya
Department of Neurology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
J Stroke Cerebrovasc Dis. 2018 May;27(5):1174-1177. doi: 10.1016/j.jstrokecerebrovasdis.2017.11.032. Epub 2017 Dec 21.
Since non-vitamin K antagonist oral anticoagulants (NOACs) were released for clinical use, many studies have investigated its effectiveness in stroke prevention. In this study, to determine whether or not there is a difference in outcome in secondary stroke prevention between warfarin and NOACs, patients with embolic stroke with newly prescribed anticoagulants were prospectively analyzed.
Patients with acute ischemic stroke, who newly started anticoagulant therapy, were consecutively asked to participate in this study. Enrolled patients (76.3 ± 11.0 years old) were classified into warfarin (n = 48), dabigatran (n = 73), rivaroxaban (n = 49), and apixaban (n = 65). The outcome in 1 year was prospectively investigated at outpatient clinic or telephone interview. Recurrence of stroke and death was considered as the critical incidence.
The prevalence of risk factors was not different among all medicines. Patients with dabigatran showed significantly younger onset age (P < .001: 72.2 years old) and milder neurologic deficits than patients on other medicines (P < .001). Cumulative incident rates were 7.1%, 15.3%, 19.0%, and 29.7% for dabigatran, apixaban, rivaroxaban, and warfarin, respectively. Dabigatran showed relatively better outcome compared with warfarin (P = .069) and rivaroxaban (P = .055). All patients on NOACs presented lower cumulative stroke recurrence compared with warfarin.
Even in the situation of secondary stroke prevention, noninferiority of NOACs to warfarin might be demonstrated.
自从非维生素K拮抗剂口服抗凝药（NOACs）被批准用于临床以来，许多研究都对其在预防中风方面的有效性进行了调查。在本研究中，为了确定华法林和NOACs在二级预防中风的疗效上是否存在差异，我们对新开具抗凝药的栓塞性中风患者进行了前瞻性分析。
连续邀请新开始抗凝治疗的急性缺血性中风患者参与本研究。入选患者（76.3±11.0岁）被分为华法林组（n = 48）、达比加群组（n = 73）、利伐沙班组（n = 49）和阿哌沙班组（n = 65）。通过门诊或电话访谈对1年内的结局进行前瞻性调查。中风复发和死亡被视为关键事件。
所有药物之间危险因素的患病率没有差异。达比加群治疗的患者发病年龄显著更年轻（P <.001：72.2岁），且神经功能缺损比其他药物治疗的患者更轻（P <.001）。达比加群、阿哌沙班、利伐沙班和华法林的累积发生率分别为7.1%、15.3%、19.0%和29.7%。与华法林（P = 0.069）和利伐沙班（P = 0.055）相比，达比加群显示出相对更好的结局。与华法林相比，所有接受NOACs治疗的患者累积中风复发率更低。
即使在二级预防中风的情况下，也可能证明NOACs不劣于华法林。
