非维生素K拮抗剂口服抗凝剂治疗的缺血性中风患者的葡萄牙观察性研究
Portuguese Observational Study of Ischaemic Stroke in Patients Medicated with Non-Vitamin K Antagonist Oral Anticoagulants.
作者信息
Beato-Coelho José, Marto João Pedro, Alves José Nuno, Marques-Matos Cláudia, Calado Sofia, Araújo José, Cunha Luís, Pinho João, Azevedo Elsa, Viana-Baptista Miguel, Sargento-Freitas João
机构信息
Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
出版信息
Eur Neurol. 2018;79(1-2):108-112. doi: 10.1159/000486755. Epub 2018 Feb 8.
INTRODUCTION
Clinical trials and subsequent meta-analyses showed advantages of non-vitamin K antagonists oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation. The impact of preadmission anticoagulation in acute ischaemic stroke (AIS) has not been established.
OBJECTIVE
To compare functional outcome of patients with AIS with preadmission NOACs vs. VKAs.
METHODS
A retrospective analysis was conducted on consecutive AIS patients under oral anticoagulation (VKAs or NOACs) admitted in 4 Portuguese hospitals within a period of 30 months. Two primary outcomes were defined and compared between VKA and NOAC groups: symptomatic intracerebral hemorrhage transformation (sICH) and modified Rankin Scale (mRS) at 3 months.
RESULTS
Four hundred sixty-nine patients were included, of whom 332 (70.8%) were treated with VKA and 137 (29.2%) with NOAC. Patients' median age was 78.0 and 234 (49.9%) were male. NOAC-treated patients had a higher median CHA2DS2-VASc score than those under VKA (5.0 vs. 4.0, p = 0.023). The two primary outcomes showed no statistical differences between the VKAs' group and the NOACs' group (sICH: 5.4 vs. 5.4% [p = 0.911]; mRS at 3 months: 3.0 vs. 3.0 [p = 0.646], respectively).
CONCLUSION
Preadmission anticoagulation with NOACs in AIS has a functional impact similar to that of VKAs.
引言
临床试验及后续的荟萃分析表明，在非瓣膜性心房颤动患者中，非维生素K拮抗剂口服抗凝药（NOACs）相较于维生素K拮抗剂（VKAs）具有优势。急性缺血性卒中（AIS）入院前抗凝治疗的影响尚未明确。
目的
比较入院前使用NOACs与VKAs的AIS患者的功能转归。
方法
对葡萄牙4家医院在30个月内收治的连续接受口服抗凝治疗（VKAs或NOACs）的AIS患者进行回顾性分析。定义了两个主要结局，并在VKA组和NOAC组之间进行比较：症状性脑出血转化（sICH）和3个月时的改良Rankin量表（mRS）评分。
结果
共纳入469例患者，其中332例（70.8%）接受VKA治疗，137例（29.2%）接受NOAC治疗。患者的中位年龄为78.0岁，男性有234例（49.9%）。接受NOAC治疗的患者CHA2DS2-VASc评分中位数高于接受VKA治疗的患者（5.0对4.0，p = 0.023）。两个主要结局在VKA组和NOAC组之间无统计学差异（sICH：5.4%对5.4% [p = 0.911]；3个月时的mRS评分：3.0对3.0 [p = 0.646]）。
结论
AIS患者入院前使用NOACs抗凝与使用VKAs具有相似的功能影响。
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