Hsu Jin-Yi, Liu Peter Pin-Sung, Sposato Luciano A, Huang Huei-Kai, Liu An-Bang, Lai Edward Chia-Cheng, Lin Swu-Jane, Hsieh Cheng-Yang, Loh Ching-Hui
Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Front Cardiovasc Med. 2022 Jul 22;9:929304. doi: 10.3389/fcvm.2022.929304. eCollection 2022.
Atrial fibrillation detected after stroke (AFDAS) has a lower risk of ischemic stroke recurrence than known atrial fibrillation (KAF). While the benefit of oral anticoagulants (OAC) for preventing ischemic stroke recurrence in KAF is well established, their role in patients with AFDAS is more controversial. This study aimed to evaluate the association between OAC use and the risk of recurrent ischemic stroke in patients with AFDAS in a real-world setting.
This nationwide retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients hospitalized with a first-ever ischemic stroke and AFDAS confirmed within 30 days after hospitalization were assigned to OAC and non-OAC cohorts. Inverse probability of treatment weighting was applied to balance the baseline characteristics of the cohorts. The primary outcome was ischemic stroke recurrence. Secondary outcomes were intracranial hemorrhage (ICH), death, and the composite outcome of "ischemic stroke recurrence, ICH, or death." Multivariate Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI).
A total of 4,508 hospitalized patients with stroke and AFDAS were identified. Based on OAC use, 2,856 and 1,652 patients were assigned to the OAC and non-OAC groups, respectively. During the follow-up period (median duration, 2.76 years), the OAC cohort exhibited a lower risk of ischemic stroke recurrence (aHR, 0.84; 95% CI, 0.70-0.99), death (aHR, 0.65; 95% CI, 0.58-0.73), and composite outcome (aHR, 0.70; 95% CI, 0.63-0.78) than did the non-OAC cohort. The risk of ICH (aHR, 0.96; 95% CI, 0.62-1.50) was not significantly different between the two cohorts.
OAC use in patients with AFDAS was associated with reduced risk of ischemic stroke recurrence, without an increased risk of ICH. This supports current guidelines recommending OACs for secondary stroke prevention in patients with AF, regardless of the time of diagnosis.
卒中后检测到的房颤（AFDAS）发生缺血性卒中复发的风险低于已知房颤（KAF）。虽然口服抗凝药（OAC）预防KAF患者缺血性卒中复发的益处已得到充分证实，但其在AFDAS患者中的作用更具争议性。本研究旨在评估在现实环境中使用OAC与AFDAS患者复发性缺血性卒中风险之间的关联。
本全国性回顾性队列研究使用了台湾国民健康保险研究数据库。首次发生缺血性卒中并在住院后30天内确诊为AFDAS的住院患者被分为OAC组和非OAC组。采用治疗权重逆概率法来平衡两组的基线特征。主要结局是缺血性卒中复发。次要结局是颅内出血（ICH）、死亡以及“缺血性卒中复发、ICH或死亡”的复合结局。采用多变量Cox比例风险模型来估计调整后的风险比（aHR）和95%置信区间（CI）。
共识别出4508例住院的卒中合并AFDAS患者。根据是否使用OAC，分别有2856例和1652例患者被分配到OAC组和非OAC组。在随访期（中位持续时间为2.76年）内，OAC组缺血性卒中复发风险（aHR，0.84；95%CI，0.70 - 0.99）、死亡风险（aHR，0.65；95%CI，0.58 - 0.73）和复合结局风险（aHR，0.70；95%CI，0.63 - 0.78）均低于非OAC组。两组之间ICH风险（aHR，0.96；95%CI，0.62 - 1.50）无显著差异。
AFDAS患者使用OAC与缺血性卒中复发风险降低相关，且未增加ICH风险。这支持了当前指南推荐对房颤患者进行二级卒中预防时使用OAC，无论诊断时间如何。
