Jung Yo-Han, Han Sang-Won, Park Joong-Hyun
Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Department of Neurology, Inje University College of Medicine, Seoul 04551, Republic of Korea.
J Clin Med. 2023 Jan 22;12(3):887. doi: 10.3390/jcm12030887.
Although clinical studies have demonstrated that prior use of antiplatelets was associated with decreased blood viscosity (BV) in patients with acute ischemic stroke, the impact of previous anticoagulant use on blood viscosity in cardioembolic stroke with non-valvular AF (NVAF) has not yet been clearly studied. This single-center retrospective observational study aimed to determine the impact of prior antithrombotic (antiplatelet and anticoagulant) use on BV in patients with cardioembolic stroke (CES) due to NVAF. Patients with CES and NVAF were analyzed with the following inclusion criteria: (1) patients over 20 years of age admitted within five days of stroke onset; (2) ischemic stroke presumably due to an NVAF-derived embolus; (3) compatible cortical/subcortical lesion on brain computed tomography or magnetic resonance imaging; (4) hemoglobin level of 10-18 mg/dL; and (5) receiving antiplatelets within five days or anticoagulants within two days if previously medicated. From the screening of 195 patients (22% of the total stroke population during the study period) who had experienced ischemic stroke with AF, 160 were included for the final analysis. Eighty-nine patients (56%) were taking antithrombotics (antiplatelet, 57%; warfarin, 13%; NOACs, 30%) regularly. Compared to patients without previous antithrombotic use, those with previous antithrombotic use (antiplatelets, warfarin, and NOACs) were significantly associated with decreased systolic BV (SBV) and diastolic BV (DBV) ( < 0.036). In multiple linear regression analysis, hematocrit (Hct) level and prior antithrombotic use were significantly associated with decreased SBV and DBV. Hct was positively correlated with increased SBV and DBV. In Hct-adjusted partial correlation analysis, prior uses of any antithrombotic agents were associated with decreased SBV (r < -0.270, < 0.015) and DBV (r < -0.183, < 0.044). In conclusion, this study showed that prior antithrombotic use (antiplatelets, VKAs, and NOACs) was associated with decreased SBV and DBV in patients presenting with acute CES secondary to NVAF. Our results indicated that previous use of NOACs may be a useful hemorheological parameter in patients with acute CES due to NVAF. Accumulation of clinical data from a large number of patients with the risk of stroke occurrence, initial stroke severity, and functional outcome is necessary to assess the usefulness of BV.
尽管临床研究表明，急性缺血性中风患者先前使用抗血小板药物与血液粘度（BV）降低有关，但先前使用抗凝剂对非瓣膜性房颤（NVAF）所致心源性栓塞性中风患者血液粘度的影响尚未得到明确研究。这项单中心回顾性观察研究旨在确定先前使用抗血栓药物（抗血小板药物和抗凝剂）对NVAF所致心源性栓塞性中风（CES）患者BV的影响。对符合以下纳入标准的CES和NVAF患者进行分析：（1）中风发作后五天内入院的20岁以上患者；（2）推测为NVAF源性栓子所致的缺血性中风；（3）脑部计算机断层扫描或磁共振成像显示皮质/皮质下病变相符；（4）血红蛋白水平为10-18mg/dL；（5）如果之前用药，则在五天内接受抗血小板治疗或在两天内接受抗凝治疗。在对195例经历过房颤缺血性中风的患者（占研究期间中风总人数的22%）进行筛查后，160例被纳入最终分析。89例患者（56%）定期服用抗血栓药物（抗血小板药物，57%；华法林，13%；新型口服抗凝药，30%）。与未使用过抗血栓药物的患者相比，之前使用过抗血栓药物（抗血小板药物、华法林和新型口服抗凝药）的患者收缩期BV（SBV）和舒张期BV（DBV）显著降低（<0.036）。在多元线性回归分析中，血细胞比容（Hct）水平和先前使用抗血栓药物与SBV和DBV降低显著相关。Hct与SBV和DBV升高呈正相关。在Hct校正的偏相关分析中，先前使用任何抗血栓药物均与SBV降低（r<-0.270，<0.015）和DBV降低（r<-0.183，<0.044）相关。总之，本研究表明，先前使用抗血栓药物（抗血小板药物、维生素K拮抗剂和新型口服抗凝药）与NVAF继发的急性CES患者的SBV和DBV降低有关。我们的结果表明，先前使用新型口服抗凝药可能是NVAF所致急性CES患者的一个有用的血液流变学参数。有必要积累大量有中风发生风险、初始中风严重程度和功能转归的患者的临床数据，以评估BV的有用性。
