From the Department of Neurology (J.I.V., T.J.v.L., M.S.E., N.A.H., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; F. Hoffmann-La Roche Ltd. (N.A.M.M.), Basel, Switzerland; and Department of Neurology and Neurorehabilitation (L.C.A.R.-J.), Neurocentre, Luzerner Kantonsspital, Switzerland.
Neurology. 2022 Aug 9;99(6):e549-e559. doi: 10.1212/WNL.0000000000200808. Epub 2022 Jun 2.
Guidelines recommend antithrombotic medication as secondary prevention for patients with ischemic stroke or transient ischemic attack (TIA) at young age based on results from trials in older patients. We investigated the long-term risk of bleeding and ischemic events in young patients after ischemic stroke or TIA.
We included 30-day survivors of first-ever ischemic stroke or TIA aged 18-50 years from the Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, a prospective cohort study of stroke at young age. We obtained information on recurrent ischemia based on structured data collection from 1995 until 2014 as part of the FUTURE study follow-up, complemented with information on any bleeding and ischemic events by retrospective chart review from baseline until last medical consultation or June 2020. Primary outcome was any bleeding; secondary outcome any ischemic event during follow-up. Both were stratified for sex, age, etiology, and use of antithrombotic medication at discharge. Bleeding and ischemic events were classified according to location and bleeding events also by severity.
We included 544 patients (56.1% women, median age of 42.2; interquartile range [IQR] 36.5-46.7 years) with a median follow-up of 9.6 (IQR 2.5-14.3) years. Ten-year cumulative risk of any bleeding event was 21.8% (95% CI 17.4-26.0) and 33.9% (95% CI 28.3-37.5) of any ischemic event. Risk of bleeding was higher in women with a cumulative risk of 28.2% (95% CI 21.6-34.3) vs 13.7% (95% CI 8.2-18.9) in men ( < 0.01), mainly because of gynecologic bleeds. Female sex ( < 0.001) and age between 40 and 49 years ( = 0.04) were independent predictors of bleeding.
Young patients after ischemic stroke or TIA have a substantial long-term risk of both bleeding (especially women) and ischemic events. Future studies should investigate the effects of long-term antithrombotics in young patients, taking into account the risk of bleeding complications.
指南建议对年龄较小的缺血性卒中和短暂性脑缺血发作（TIA）患者使用抗血栓药物进行二级预防，这是基于对老年患者临床试验的结果。我们研究了年轻的缺血性卒中和 TIA 患者发生出血和缺血事件的长期风险。
我们纳入了来自前瞻性年轻卒中研究——Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation（FUTURE）研究的首发缺血性卒中和 TIA 30 天幸存者，年龄为 18-50 岁。我们通过 1995 年至 2014 年的结构化数据收集获取了复发性缺血的信息，作为 FUTURE 研究随访的一部分，同时通过回顾性病历审查获取了基线至最后一次就诊或 2020 年 6 月的任何出血和缺血事件的信息。主要结局是任何出血；次要结局是随访期间任何缺血事件。均按性别、年龄、病因和出院时抗血栓药物的使用情况进行分层。根据位置对出血和缺血事件进行分类，根据严重程度对出血事件进行分类。
我们纳入了 544 例患者（56.1%为女性，中位年龄为 42.2 岁；四分位间距 36.5-46.7 岁），中位随访时间为 9.6（四分位间距 2.5-14.3）年。10 年任何出血事件的累积风险为 21.8%（95%置信区间 17.4-26.0），任何缺血事件的累积风险为 33.9%（95%置信区间 28.3-37.5）。女性出血风险较高，女性的累积风险为 28.2%（95%置信区间 21.6-34.3），而男性为 13.7%（95%置信区间 8.2-18.9）（<0.01），主要是因为妇科出血。女性（<0.001）和 40-49 岁年龄（=0.04）是出血的独立预测因素。
缺血性卒中和 TIA 后的年轻患者有发生出血（尤其是女性）和缺血事件的长期风险。未来的研究应该考虑出血并发症的风险，调查长期使用抗血栓药物对年轻患者的影响。
