Woo Ho Geol, Chung Inyoung, Gwak Dong Seok, Kim Baik Kyun, Kim Beom Joon, Bae Hee-Joon, Han Moon-Ku
Department of Neurology, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea.
J Clin Neurosci. 2019 Jun;64:127-133. doi: 10.1016/j.jocn.2019.03.037. Epub 2019 Mar 28.
The etiology or rate of recurrent ischemic stroke according to dosing methods including drug adherence in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) remain uncertain. We investigated the association between dosing methods including drug adherence achieved with NOACs and the presence of major vessel occlusion (MVO) in patients with ischemic stroke with non-valvular atrial fibrillation (NVAF). From July 2013 through December 2016, 120 patients with recurrent ischemic stroke with NVAF on NOACs were retrospectively analyzed. Patients taking non-standard doses of NOACs were divided into the missed dose group that discontinued NOACs for ≥48 h prior to arrival, and the under-dose group that used lower doses of NOACs. A logistic regression analysis was performed to determine the association between MVO and dosing methods including drug adherence. There were 60 (50.0%), 39 (32.5%), and 21 (17.5%) patients, respectively, in the standard dose, under-dose, and missed dose groups. Twelve patients (20.0%) in the standard dose group, 15 (38.5%) in the under-dose group, and 13 (61.9%) in the missed dose group had MVO. MVO was significantly higher in the missed dose group than in the standard dose and under-dose groups (P = 0.002). In patients with ischemic stroke with NVAF, who are on NOACs, anticoagulation caused by missed or lowered doses of NOACs was significantly associated with MVO in patients with recurrent cardioembolic stroke.
在服用非维生素K拮抗剂口服抗凝药（NOACs）的患者中，根据给药方法（包括药物依从性）导致的复发性缺血性卒中的病因或发生率仍不确定。我们调查了在非瓣膜性心房颤动（NVAF）缺血性卒中患者中，包括使用NOACs实现的药物依从性在内的给药方法与大血管闭塞（MVO）存在之间的关联。从2013年7月至2016年12月，对120例服用NOACs的NVAF复发性缺血性卒中患者进行了回顾性分析。服用非标准剂量NOACs的患者被分为漏服组（在到达前停用NOACs≥48小时）和低剂量组（使用较低剂量的NOACs）。进行逻辑回归分析以确定MVO与包括药物依从性在内的给药方法之间的关联。标准剂量组、低剂量组和漏服组分别有60例（50.0%）、39例（32.5%）和21例（17.5%）患者。标准剂量组中有12例（20.0%）、低剂量组中有15例（38.5%）、漏服组中有13例（61.9%）发生MVO。漏服组的MVO显著高于标准剂量组和低剂量组（P = 0.002）。在服用NOACs的NVAF缺血性卒中患者中，NOACs漏服或剂量降低导致的抗凝与复发性心源性栓塞性卒中患者的MVO显著相关。
