Matos-Ribeiro Joao, Castro-Chaves Paulo, Oliveira-Ferreira Marta, Fonseca Luísa, Pintalhao Mariana
Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Cardiovascular Research Centre (UnIC), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
J Neurol. 2022 Apr;269(4):2099-2112. doi: 10.1007/s00415-021-10788-z. Epub 2021 Sep 9.
To evaluate the effects of early anticoagulation on functional outcome, recurrent ischaemic events and haemorrhagic complications in Atrial Fibrillation (AF)-related acute ischaemic strokes (AIS).
We retrospectively evaluated patients hospitalised in a Stroke Unit due to AF-related AIS. Patients were divided according to anticoagulation initiation timing (0-4 days, 5-14 days, no anticoagulation by the 14th day). We assessed the following outcomes at 3 months: favourable functional outcome [modified Rankin Scale (mRS) score 0-2 or equal to pre-stroke], recurrent ischaemic events and haemorrhagic complications after anticoagulation initiation.
We included 395 patients. Anticoagulation was initiated at days 0-4 in 33.9% of patients, days 5-14 in 25.3% and not initiated by the day 14 in 40.8%. Factors associated with earlier anticoagulation included lower previous mRS, valvular AF and lower stroke severity. Favourable functional outcome occurred in 40.2% of patients, with lower odds in those anticoagulated at 5-14 versus 0-4 days (OR: 0.47, 95% CI: 0.23-0.94), independently of age, previous mRS and stroke severity. Recurrent ischaemic events occurred in 8.3% of patients, with higher odds in non-anticoagulated patients by the 14th day, compared to the remainder groups (OR: 3.26, 95% CI: 1.29-8.22 vs. 0-4 days and OR: 8.16, 95% CI: 1.76-37.9 vs. 5-14 days). In patients who started anticoagulation (n = 288), haemorrhagic complications occurred in 10.8%, being more frequent in those who started at 0-4 days vs. > 14 days. However, it did not abolish the 0-4-day initiation's benefit on functional outcome.
Early anticoagulation was associated with lower ischaemic recurrence and better functional outcome at 3 months. Additional studies are needed to better clarify its haemorrhagic risk.
评估早期抗凝治疗对心房颤动（AF）相关急性缺血性卒中（AIS）患者功能结局、缺血性事件复发及出血并发症的影响。
我们回顾性评估了因AF相关AIS入住卒中单元的患者。根据抗凝治疗开始时间（0 - 4天、5 - 14天、至第14天未进行抗凝）对患者进行分组。我们在3个月时评估以下结局：良好的功能结局[改良Rankin量表（mRS）评分0 - 2或与卒中前评分相同]、抗凝治疗开始后的缺血性事件复发及出血并发症。
我们纳入了395例患者。33.9%的患者在0 - 4天开始抗凝，25.3%在5 - 14天开始抗凝，40.8%至第14天未开始抗凝。与早期抗凝相关的因素包括既往mRS较低、瓣膜性AF及卒中严重程度较低。40.2%的患者获得良好的功能结局，5 - 14天开始抗凝的患者获得良好功能结局的几率低于0 - 4天开始抗凝的患者（比值比：0.47，95%置信区间：0.23 - 0.94），且与年龄、既往mRS及卒中严重程度无关。8.3%的患者发生缺血性事件复发，与其余组相比，至第14天未进行抗凝的患者发生缺血性事件复发的几率更高（比值比：3.26，95%置信区间：1.29 - 8.22对比0 - 4天开始抗凝组，比值比：8.16，95%置信区间：1.76 - 37.9对比5 - 14天开始抗凝组）。在开始抗凝治疗的患者（n = 288）中，10.8%发生出血并发症，0 - 4天开始抗凝的患者比>14天开始抗凝的患者更常见。然而，这并未消除0 - 4天开始抗凝在功能结局方面的益处。
早期抗凝与3个月时较低的缺血性复发率及更好的功能结局相关。需要进一步研究以更好地阐明其出血风险。
