Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Medicine (Baltimore). 2021 Aug 13;100(32):e26945. doi: 10.1097/MD.0000000000026945.
Globally, 32% to 70% patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OACs) with warfarin for stroke prevention. However, patients with AF on OACs may experience intracranial hemorrhage (ICH), which presents a treatment dilemma. We therefore investigated whether resuming OACs in these patients is beneficial. Electronic medical records of patients with AF on OACs discharged with ICH between 2001 and 2013 were retrieved from the Taiwan National Health Insurance Research Database for analysis. We excluded patients who were <20 years old, who were not using OACs 6 months prior to ICH, or who had a CHA2DS2-VASc score of ≤1. We also excluded patients who died during admission for ICH, with follow-up for <6 weeks after discharge, or who started OAC >6 weeks after ICH diagnosis. The remaining patients were categorized into those who resumed OAC and those who discontinued OAC. Propensity score matching was performed between the 2 groups. Primary outcomes were mortality/ischemic stroke (IS)/systemic embolism (SE), IS/SE, and recurrent ICH at 6 months and 1 year. After the exclusion criteria were applied, 604 eligible patients (408 discontinued OAC and 196 resumed OAC within 6 weeks) were included in this study, and 186 patients in each group were 1:1 matched. Patients who resumed OAC had significantly lower mortality/IS/SE (hazard ratio [HR] = 0.39, 95% confidence interval [CI] = 0.20-0.76) and IS/SE (HR = 0.12, 95% CI = 0.03-0.53) at 6-month follow-up than patients who discontinued OAC. In addition, patients who resumed OAC had significantly lower mortality/IS/SE (HR = 0.56, 95% CI = 0.34-0.93) and IS/SE (HR = 0.26, 95% CI = 0.09-0.75) at 1-year follow-up. No difference in recurrent ICH was noted between the 2 groups. In conclusion, in patients with AF on OACs with ICH, resuming anticoagulant use was associated with significantly lower risks of composite outcomes of mortality/IS/SE and IS/SE than patients who discontinued OACs. No difference in recurrent ICH was observed between the 2 groups.
全球范围内，32%至 70%的心房颤动（AF）患者接受华法林等口服抗凝剂（OAC）治疗以预防中风。然而，服用 OAC 的 AF 患者可能会出现颅内出血（ICH），这给治疗带来了困境。因此，我们研究了在这些患者中是否恢复 OAC 治疗有益。我们从台湾全民健康保险研究数据库中检索了 2001 年至 2013 年期间因 ICH 出院的服用 OAC 的 AF 患者的电子病历进行分析。我们排除了年龄<20 岁、ICH 前 6 个月未使用 OAC 或 CHA2DS2-VASc 评分≤1 的患者。我们还排除了在 ICH 住院期间死亡、出院后随访<6 周或在 ICH 诊断后 6 周以上开始使用 OAC 的患者。剩余的患者分为恢复 OAC 治疗组和停止 OAC 治疗组。对两组患者进行倾向评分匹配。主要结局为 6 个月和 1 年时的死亡率/缺血性中风（IS）/系统性栓塞（SE）、IS/SE 和复发性 ICH。在应用排除标准后，共有 604 名符合条件的患者（408 名停止 OAC 治疗，196 名在 6 周内恢复 OAC 治疗）被纳入本研究，每组 186 名患者进行 1:1 匹配。与停止 OAC 治疗的患者相比，恢复 OAC 治疗的患者在 6 个月随访时的死亡率/IS/SE（风险比[HR] = 0.39，95%置信区间[CI] = 0.20-0.76）和 IS/SE（HR = 0.12，95% CI = 0.03-0.53）显著降低。此外，恢复 OAC 治疗的患者在 1 年随访时的死亡率/IS/SE（HR = 0.56，95% CI = 0.34-0.93）和 IS/SE（HR = 0.26，95% CI = 0.09-0.75）也显著降低。两组间复发性 ICH 无差异。总之，在服用 OAC 治疗的 ICH 合并 AF 患者中，与停止 OAC 治疗的患者相比，恢复抗凝治疗与死亡率/IS/SE 和 IS/SE 复合结局的风险显著降低。两组间复发性 ICH 无差异。
