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新型口服抗凝剂治疗的心房颤动患者的缺血性卒中危险因素

Ischemic Stroke Risk Factors in Patients with Atrial Fibrillation Treated with New Oral Anticoagulants.

作者信息

Wańkowicz Paweł, Staszewski Jacek, Dębiec Aleksander, Nowakowska-Kotas Marta, Szylińska Aleksandra, Rotter Iwona

机构信息

Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland.

Department of Neurology, Military Medical Institute, Warszawa, Szaserów 128, 04-141 Warszawa, Poland.

出版信息

J Clin Med. 2021 Mar 16;10(6):1223. doi: 10.3390/jcm10061223.

Abstract

The most commonly used therapeutic option for the prevention of ischemic stroke in patients with atrial fibrillation is new- or old-generation oral anticoagulants. New oral anticoagulants are at least as effective as old-generation oral anticoagulants in the prevention of ischemic stroke, with a reduced risk of life-threatening hemorrhage. Moreover, the constant monitoring of these drugs in the patient's blood is not required during routine use. However, ischemic stroke can still occur in these patients. Therefore, the aim of this study was to investigate the pattern of risk factors for ischemic stroke in patients with atrial fibrillation treated with new oral anticoagulants. Our multicenter retrospective study involved 2032 patients with acute ischemic stroke. The experimental group consisted of 256 patients with acute ischemic stroke and nonvalvular atrial fibrillation, who were treated with new oral anticoagulants. The control group consisted of 1776 ischemic stroke patients without coexisting atrial fibrillation. The results of our study show that patients with atrial fibrillation treated with new oral anticoagulants are more likely to display thrombotic, proatherogenic, and proinflammatory factors in addition to the embolic factors associated with atrial fibrillation. Therefore, solely taking new oral anticoagulants is insufficient in protecting this group of patients from ischemic stroke.

摘要

预防心房颤动患者缺血性卒中最常用的治疗方法是新一代或旧一代口服抗凝药。新一代口服抗凝药在预防缺血性卒中方面至少与旧一代口服抗凝药一样有效,且危及生命的出血风险降低。此外,常规使用期间无需持续监测患者血液中的这些药物。然而,这些患者仍可能发生缺血性卒中。因此,本研究的目的是调查接受新一代口服抗凝药治疗的心房颤动患者缺血性卒中的危险因素模式。我们的多中心回顾性研究纳入了2032例急性缺血性卒中患者。实验组由256例急性缺血性卒中和非瓣膜性心房颤动患者组成,他们接受了新一代口服抗凝药治疗。对照组由1776例无并存心房颤动的缺血性卒中患者组成。我们的研究结果表明,接受新一代口服抗凝药治疗的心房颤动患者除了具有与心房颤动相关的栓塞因素外,更有可能表现出血栓形成、促动脉粥样硬化和促炎因素。因此,仅服用新一代口服抗凝药不足以保护这组患者免受缺血性卒中的影响。

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Selection of Oral Anticoagulants in Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation.非瓣膜性心房颤动缺血性卒中患者口服抗凝剂的选择
J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2627-2631. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.036. Epub 2018 Jun 30.

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