Hasan Syed Mustajab, Faluk Mohammed, Abdelmaseih Ramy, Patel Jay D, Thakker Ravi, Chacko Jay J, Zayas Dewid, Finer Alexis, Albaeni Aiham, Abusaada Khalid
University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA.
Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, FL, USA.
Cardiol Res. 2021 Aug;12(4):225-230. doi: 10.14740/cr1263. Epub 2021 Jul 9.
Atrial fibrillation (AF) is one of the leading causes of acute ischemic stroke requiring anticoagulation. Many patients experience treatment interruption in the hospital setting. The aim of this study was to evaluate the effect of anticoagulation interruption on short-term risk of ischemic stroke in hospitalized patients with AF.
We performed a retrospective medical record review using the Hospital Corporation of America (HCA) database. We included patients admitted to our institution between December 2015 and December 2018 who had a prior history of AF. Patients were excluded if they had ischemic stroke, hemorrhagic stroke, history venous thromboembolism or mechanical valve on admission. We compared the incidence of ischemic stroke in patients in whom anticoagulation was interrupted for more than 48 h to those who continued anticoagulation.
A total of 2,277 patients with history of AF were included in the study. In this cohort, 79 patients (3.47%) had anticoagulation interruption of more than 48 h during their hospital stay. There was no difference in incidence of stroke between the interruption and no interruption groups (1.27% (n = 1) vs. 0.23% (n = 5), P = 0.19). Interruption of anticoagulation did not associate with a significant increase in the risk of in-hospital ischemic stroke. CHADSVASc score was a strong predictor of in-hospital stroke risk regardless of anticoagulation interruption (odds ratio: 7.199, 95% confidence interval: 2.920 - 17.751).
In this study, the in-hospital incidence of ischemic stroke in patients with AF did not significantly increase by short-term anticoagulation interruption.
心房颤动（AF）是需要抗凝治疗的急性缺血性卒中的主要原因之一。许多患者在住院期间会出现治疗中断。本研究的目的是评估抗凝治疗中断对住院AF患者短期缺血性卒中风险的影响。
我们使用美国医院集团（HCA）数据库进行了一项回顾性病历审查。纳入2015年12月至2018年12月期间入住我院且有AF病史的患者。入院时患有缺血性卒中、出血性卒中、静脉血栓栓塞病史或机械瓣膜的患者被排除。我们比较了抗凝治疗中断超过48小时的患者与继续抗凝治疗的患者的缺血性卒中发生率。
本研究共纳入2277例有AF病史的患者。在这个队列中，79例患者（3.47%）在住院期间抗凝治疗中断超过48小时。中断组和未中断组的卒中发生率没有差异（1.27%（n = 1）对0.23%（n = 5），P = 0.19）。抗凝治疗中断与住院缺血性卒中风险的显著增加无关。无论抗凝治疗是否中断，CHADSVASc评分都是住院卒中风险的有力预测指标（比值比：7.199，95%置信区间：2.920 - 17.751）。
在本研究中，AF患者短期抗凝治疗中断并未显著增加住院缺血性卒中的发生率。
