Wang J R, Du X, He L, Dong J Z, Zhang H B, Guo J C, Ma C S
Department of Cardiology, Cardiovascular Center, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Sep 24;50(9):900-906. doi: 10.3760/cma.j.cn112148-20220310-00170.
This study aimed to investigate the oral anticoagulant (OAC) usage among new-onset acute ischemic stroke (AIS) patients with nonvalvular atrial fibrillation (NVAF) in China, and to explore the possible influencing factors of influent anticoagulant therapy in these patients. The NVAF patients who experienced new-onset and non-fatal AIS from August 2011 to December 2018 in the China Atrial Fibrillation Registry (China-AF), were enrolled. The follow-up ended in December 2019. Information including patients' demographic characteristics, medical history, medication usage, which were collected before and after the index stroke, were analyzed. Patients were classified into OAC group or non-OAC group according to OAC usage within 3 months post stroke. Multivariate logistic regression analysis were conducted to calculate the odds ratios (ORs) of factors which might be associated with OAC usage within 3 months post stroke. A total of 957 new-onset AIS patients were enrolled, 39.4% (377/957) patients were treated with OAC within 3 months after AIS. Covering by high-reimbursement-rate insurance (: 1.91, 95%CI: 1.28-2.86, =0.002), higher number of concomitant drugs (1-2 types : 2.10, 95%: 1.36-3.23, =0.001; ≥3 types : 2.31, 95%: 1.37-3.91, =0.002) and 3-month-peri-stroke AF recurrence (: 3.34, 95%: 2.34-4.76, <0.001) were associated with OAC usage within 3 months post stroke, while higher HASBLED score (: 0.49, 95%: 0.40-0.60, <0.001) and pre-stroke antiplatelet usage (: 0.29, 95%: 0.20-0.43, <0.001) were related to no OAC usage within 3 months post stroke. In China, the proportion of NVAF patients who initiated OAC therapy within 3 months after new-onset AIS is as low as about 39.4%. Factors related to the OAC usage within 3 months post stroke are 3-month-peri-stroke AF recurrence, number of concomitant drugs and patients with high-reimbursement-rate insurance coverage, but higher HASBLED score and pre-stroke antiplatelet usage are related to no OAC usage within 3 months post stroke.
本研究旨在调查中国非瓣膜性心房颤动（NVAF）合并新发急性缺血性卒中（AIS）患者的口服抗凝药（OAC）使用情况，并探讨影响这些患者抗凝治疗的可能因素。纳入了2011年8月至2018年12月在中国心房颤动注册研究（China-AF）中发生新发非致死性AIS的NVAF患者。随访于2019年12月结束。分析了包括患者人口统计学特征、病史、卒中前后用药情况等信息。根据卒中后3个月内OAC使用情况将患者分为OAC组或非OAC组。进行多因素logistic回归分析以计算卒中后3个月内可能与OAC使用相关因素的比值比（OR）。共纳入957例新发AIS患者，39.4%（377/957）的患者在AIS后3个月内接受了OAC治疗。高报销率保险覆盖（比值比：1.91，95%可信区间：1.28 - 2.86，P = 0.002）、合并用药数量较多（1 - 2种：比值比：2.10，95%可信区间：1.36 - 3.23，P = 0.001；≥3种：比值比：2.31，95%可信区间：1.37 - 3.91，P = 0.002）和卒中后3个月内房颤复发（比值比：3.34，95%可信区间：2.34 - 4.76，P < 0.001）与卒中后3个月内OAC使用相关，而较高的HASBLED评分（比值比：0.49，95%可信区间：0.40 - 0.60，P < 0.001）和卒中前使用抗血小板药物（比值比：0.29，95%可信区间：0.20 - 0.43，P < 0.001）与卒中后3个月内未使用OAC相关。在中国，NVAF合并新发AIS患者在发病后3个月内开始OAC治疗的比例低至约39.4%。与卒中后3个月内OAC使用相关的因素是卒中后3个月内房颤复发、合并用药数量以及有高报销率保险覆盖的患者，但较高的HASBLED评分和卒中前使用抗血小板药物与卒中后3个月内未使用OAC相关。
