Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105266. doi: 10.1016/j.jstrokecerebrovasdis.2020.105266. Epub 2020 Sep 10.
Oral anticoagulation (OAC) substantially reduces stroke risk in patients with atrial fibrillation (AF) at risk for stroke. Whether non-vitamin K-dependent oral anticoagulants (NOACs) improve OAC use in stroke prevention requires investigation.
To investigate temporal trends of OAC use in patients with known AF pre-stroke, we retrospectively analyzed records of 6,803 stroke patients admitted in 2003-2004 (n=1,496), 2008-2010 (n=1,638) or 2013-2015 (n=3,669) to the Charité-Universitätsmedizin Berlin, Germany. Adjusted regression models were used to identify factors associated with OAC use.
Of 1,209 AF patients (mean age 79 years, 55.9% female) with given indication for OAC according to the CHADS/CHADS-VASc score, 484 (40.0%) were anticoagulated prior to the index stroke, 458 (37.9%) received antiplatelets and 236 (19.5%) had no antithrombotic medication. Compared to 2003-2004 and 2008-2010, there was a higher rate of pre-admission OAC in 2013-2015 (28.2% vs. 49.6%, p<0.001). After adjustment for possible confounders, factors associated with OAC pre-admission were young age (OR 0.74 per decade [95%CI 0.64-0.85]), previous stroke/TIA (OR 1.29 [95%CI 1.00-1.67]), absence of heart failure (OR 0.63 [95%CI 0.47-0.85]) and admission in 2013-2015 (OR 2.45 [95%CI 1.91-3.15]). Prescription of OAC at hospital discharge increased from 2003-2010 compared to 2013-2015 (45.2% vs. 69.5%, p < 0.001).
Irrespective of temporal trends and despite given indication, more than half of all patients with known AF were not anticoagulated prior to the index stroke. In the NOAC era, there was an increase in OAC intake pre-stroke and a higher rate of OAC prescription at hospital discharge in stroke survivors with known AF.
口服抗凝剂（OAC）可显著降低有中风风险的心房颤动（AF）患者的中风风险。新型口服抗凝剂（NOAC）是否能改善中风预防中的 OAC 使用情况尚待研究。
为了研究中风前已知 AF 患者的 OAC 使用的时间趋势，我们回顾性分析了德国柏林夏洛蒂医科大学 2003-2004 年（n=1496）、2008-2010 年（n=1638）或 2013-2015 年（n=3669）收治的 6803 例中风患者的记录。采用调整后的回归模型确定与 OAC 使用相关的因素。
在根据 CHADS/CHADS-VASc 评分有 OAC 应用指征的 1209 例 AF 患者中（平均年龄 79 岁，55.9%为女性），484 例（40.0%）在指数性中风前接受了抗凝治疗，458 例（37.9%）接受了抗血小板治疗，236 例（19.5%）未使用任何抗血栓药物。与 2003-2004 年和 2008-2010 年相比，2013-2015 年的入院前 OAC 使用率更高（28.2%比 49.6%，p<0.001）。在调整了可能的混杂因素后，与入院前 OAC 相关的因素包括年龄较小（每十年降低 0.74[95%CI 0.64-0.85]）、既往中风/TIA（OR 1.29[95%CI 1.00-1.67]）、无心力衰竭（OR 0.63[95%CI 0.47-0.85]）和 2013-2015 年入院（OR 2.45[95%CI 1.91-3.15]）。与 2013-2015 年相比，2003-2010 年出院时 OAC 处方的比例有所增加（45.2%比 69.5%，p < 0.001）。
无论时间趋势如何，尽管有明确的适应证，但仍有一半以上的已知 AF 患者在指数性中风前未接受抗凝治疗。在新型口服抗凝剂时代，中风前 OAC 的摄入增加，中风幸存者中已知 AF 的 OAC 出院处方比例更高。
