Lin Sheng-Feng, Lu Yi-Hsuan, Bai Chyi-Huey
School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
Ther Adv Chronic Dis. 2020 Nov 29;11:2040622320974853. doi: 10.1177/2040622320974853. eCollection 2020.
The aim of this study was to establish whether non-vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin in preventing stroke recurrence for atrial fibrillation (AF) patients with an ischemic or hemorrhagic stroke at the baseline.
From 1 January 2009 to 31 December 2017, stroke patients with AF treated with oral anticoagulants in the National Health Insurance Research Database in Taiwan were enrolled. The study was retrospective cohort design. Outcome measures were ischemic and hemorrhagic stroke recurrence. The Cox proportional hazard model was used to obtain the hazard ratio (HR).
In total, 39,840 stroke patients with AF treated with NOAC and 42,583 treated with warfarin were identified. NOACs were superior to warfarin in preventing all recurrent stroke [adjusted HR: 0.67, 95% confidence interval (CI), 0.63-0.71, < 0.001]. Results for the ischemic stroke population were the same as that for all types for stroke (adjusted HR: 0.66, 95% CI, 0.62-0.70, < 0.001). For the hemorrhagic stroke population, NOACs were equivalent to warfarin in preventing ischemic stroke (adjusted HR: 1.11, 95% CI, 0.86-0.43, < 0.001), but NOACs were superior to warfarin in preventing hemorrhagic stroke (adjusted HR: 0.64, 95% CI, 0.55-0.74, < 0.001).
NOACs were generally superior to warfarin in terms of efficacy and safety in previous stroke patients. The robustness of our findings was verified and should add new information to current recommendations for Asian stroke patients in selecting NOACs.
本研究旨在确定在预防基线时有缺血性或出血性卒中的心房颤动（AF）患者的卒中复发方面，非维生素K拮抗剂口服抗凝剂（NOACs）是否优于华法林。
纳入2009年1月1日至2017年12月31日在台湾国民健康保险研究数据库中接受口服抗凝剂治疗的AF卒中患者。本研究为回顾性队列设计。观察指标为缺血性和出血性卒中复发。采用Cox比例风险模型获得风险比（HR）。
共识别出39840例接受NOAC治疗的AF卒中患者和42583例接受华法林治疗的患者。在预防所有复发性卒中方面，NOACs优于华法林[调整后HR：0.67，95%置信区间（CI），0.63 - 0.71，<0.001]。缺血性卒中人群的结果与所有类型卒中的结果相同（调整后HR：0.66，95%CI，0.62 - 0.70，<0.001）。对于出血性卒中人群，在预防缺血性卒中方面，NOACs与华法林相当（调整后HR：1.11，95%CI，0.86 - 1.43，<0.001），但在预防出血性卒中方面，NOACs优于华法林（调整后HR：0.64，95%CI，0.55 - 0.74，<0.001）。
在既往有卒中的患者中，NOACs在疗效和安全性方面总体上优于华法林。我们研究结果的稳健性得到了验证，应为亚洲卒中患者选择NOACs的当前推荐增加新信息。
