Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
Intern Med J. 2022 Jun;52(6):1024-1028. doi: 10.1111/imj.15167. Epub 2022 May 31.
Anticoagulants are recommended to prevent cardioembolic stroke in most patients with atrial fibrillation (AF). Management errors with anticoagulation and use of aspirin instead of anticoagulants have been documented worldwide, especially with vitamin K antagonists.
To assess the rate of anticoagulant mismanagement errors in patients admitted with ischaemic stroke and the clinical correlates with stroke outcomes in the era of non-vitamin K oral anticoagulants.
We performed a retrospective analysis of patients admitted with ischaemic stroke and history of AF to a single-centre tertiary hospital stroke unit in Melbourne, Australia, between January 2016 and June 2019. We assessed management errors as defined using European Heart Rhythm Association criteria with anticoagulation in the 2 weeks prior to the index stroke.
A total of 306 patients with AF and ischaemic stroke was included, of whom 196 (64%) had management errors. Patients with management errors were older (median age 84 vs 81 years; P = 0.002) and more often female (53% vs 38%; P = 0.02). Of those with management errors, 74 (37%) were not prescribed any anticoagulation despite increased stroke risk and absence of contraindications and 40 (20%) had anticoagulation inappropriately ceased. Mortality at 3 months was 32% in those with management errors, compared with 17% in the appropriately anticoagulated group (P = 0.005).
Inappropriate management of anticoagulants is present in the majority of acute ischaemic stroke in the 2 weeks preceding the event and is linked to higher mortality. Improved anticoagulation practice has the potential to substantially reduce stroke rates in patients with AF.
大多数心房颤动（AF）患者都推荐使用抗凝剂来预防心源性栓塞性卒中。在全球范围内，抗凝治疗管理失误和使用阿司匹林代替抗凝剂的情况屡有报道，尤其是在维生素 K 拮抗剂方面。
评估在非维生素 K 口服抗凝剂时代，因缺血性卒中入院且伴有 AF 病史的患者中抗凝管理失误的发生率，以及这些失误与卒中结局之间的临床相关性。
我们对 2016 年 1 月至 2019 年 6 月期间在澳大利亚墨尔本的一家单中心三级医院卒中病房因缺血性卒中且伴有 AF 病史入院的患者进行了回顾性分析。我们根据欧洲心律协会的标准评估了在指数性卒中发生前 2 周内的抗凝管理失误。
共纳入 306 例 AF 合并缺血性卒中患者，其中 196 例（64%）存在管理失误。有管理失误的患者年龄更大（中位数年龄 84 岁比 81 岁；P = 0.002），且更常为女性（53%比 38%；P = 0.02）。在有管理失误的患者中，尽管卒中风险增加且无抗凝禁忌证，但仍有 74 例（37%）未开具任何抗凝药物，而 40 例（20%）抗凝药物使用不当。在有管理失误的患者中，3 个月死亡率为 32%，而在适当抗凝的患者中为 17%（P = 0.005）。
在事件发生前 2 周内，大多数急性缺血性卒中患者的抗凝治疗管理不当，这与更高的死亡率有关。改善抗凝治疗实践有可能显著降低 AF 患者的卒中发生率。
