Chang Kay-Won, Xian Ying, Zhao Xin, Mi Xiaojuan, Matsouaka Roland, Schwamm Lee H, Shah Shreyansh, Lytle Barbara L, Smith Eric E, Bhatt Deepak L, Fonarow Gregg C, Hsu Jonathan C
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Duke Clinical Research Institute, Department of Neurology, Duke University Medical Center, Durham, NC, United States of America.
Int J Cardiol. 2020 Dec 15;321:88-94. doi: 10.1016/j.ijcard.2020.08.011. Epub 2020 Aug 14.
To determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation.
In a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE).
Of 64,228 subjects (median [interquartile range] age, 84 [78-89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62-0.66, P < .001) and MACNBE (adjusted HR 0.69, 95% CI 0.67-0.71, P < .001).
Among Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.
确定急性缺血性卒中入院且出院时未接受口服抗凝治疗的房颤患者出院时抗血小板治疗处方与1年预后的相关性。
在一项来自“遵循卒中指南”登记处的回顾性队列研究中，我们确定了2003年4月至2014年12月期间所有年龄在65岁及以上、因急性缺血性卒中入院且出院时未接受口服抗凝治疗的医疗保险按服务付费受益患者，使用医疗保险理赔数据确定出院时抗血小板治疗处方与1年预后的相关性。主要结局为1年死亡率以及主要不良心血管/神经/出血事件（MACNBE）的复合终点。
在64228名受试者（年龄中位数[四分位间距]为84[78 - 89]岁；女性占62.5%）中，54621名（85.0%）出院时接受抗血小板治疗，9607名（15.0%）出院时未接受抗血栓治疗。接受抗血小板治疗的患者1年未调整死亡率（37.3%）低于未接受抗血栓治疗的患者（48.1%）；接受抗血小板治疗的患者MACNBE未调整发生率（45.5%）低于未接受抗血栓治疗的患者（55.2%）。在对潜在混杂因素进行调整后，抗血小板治疗处方与降低1年死亡率（调整后风险比[HR]0.64，95%置信区间[CI]0.62 - 0.66，P <.001）和MACNBE（调整后HR 0.69，95%CI 0.67 - 0.71，P <.001）相关。
在因急性缺血性卒中入院但出院时未接受口服抗凝治疗的医疗保险房颤受益患者中，与未接受抗血栓治疗相比，抗血小板治疗与降低1年死亡率和MACNBE相关。
