Deguchi Ichiro, Osada Takashi, Takao Masaki, Takahashi Shinichi
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Clinical Laboratory, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan.
Keio J Med. 2021 Dec 25;70(4):93-99. doi: 10.2302/kjm.2020-0019-OA. Epub 2021 Mar 16.
Although the severity of acute cerebral infarction varies in patients receiving direct oral anticoagulants (DOACs), no practical method to predict the severity has been established. We analyzed retrospectively the relationship between cardioembolic cerebral infarction severity and coagulation indicators in patients treated with DOACs. We assessed the anticoagulation effect of DOACs using the activated partial thromboplastin time (APTT), prothrombin time (PT), and prothrombin time international standardized ratio (PT-INR) in 71 patients with cardioembolic cerebral infarction admitted to our hospital between January 2015 and December 2019. The participants were divided into a prolongation group (prolonged APTT for oral thrombin inhibitors or prolonged PT for oral factor Xa inhibitors, n =37) and a normal group (no prolongation of coagulation markers, n =34). Of the 71 patients, 21 (30%) and 50 (70%) were using oral thrombin and oral factor Xa inhibitors, respectively. PT, PT-INR, and APTT were significantly higher in the prolongation group (PT: 17.4 ± 5.1 vs. 12.8 ± 1.4 s, P < 0.001; PT-INR: 1.5 ± 0.5 vs. 1.1 ± 0.1, P < 0.001; APTT: 44.8 ± 26.4 vs. 30.4 ± 4.1 s, P = 0.003). The median National Institutes of Health Stroke Scale (NIHSS) score on admission and the prevalence of large vessel occlusion were significantly lower in the prolongation group (NIHSS: 2.0 vs. 9.5, P = 0.007; large vessel occlusion: 27% vs. 53%, P = 0.031). The prevalence of large vessel occlusion was low and stroke severity was mild in patients undergoing DOAC therapy with prolongation of coagulation assay markers upon onset of cardioembolic cerebral infarction.
尽管接受直接口服抗凝剂（DOACs）治疗的急性脑梗死患者病情严重程度各异，但尚未建立预测严重程度的实用方法。我们回顾性分析了接受DOACs治疗的患者中心源性脑栓塞性脑梗死严重程度与凝血指标之间的关系。我们使用活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）和凝血酶原时间国际标准化比值（PT-INR）评估了2015年1月至2019年12月期间我院收治的71例心源性脑栓塞性脑梗死患者中DOACs的抗凝效果。参与者被分为延长组（口服凝血酶抑制剂时APTT延长或口服Xa因子抑制剂时PT延长，n = 37）和正常组（凝血指标未延长，n = 34）。在这71例患者中，分别有21例（30%）和50例（70%）使用口服凝血酶和口服Xa因子抑制剂。延长组的PT、PT-INR和APTT显著更高（PT：17.4±5.1对12.8±1.4秒，P < 0.001；PT-INR：1.5±0.5对1.1±0.1，P < 0.001；APTT：44.8±26.4对30.4±4.1秒，P = 0.003）。延长组入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数和大血管闭塞患病率显著更低（NIHSS：2.0对9.5，P = 0.007；大血管闭塞：27%对53%，P = 0.031）。在心源性脑梗死发作时凝血检测指标延长的DOAC治疗患者中，大血管闭塞患病率低且卒中严重程度较轻。
