Department of Neurology, Gosford Hospital, Gosford, New South Wales, Australia.
Intern Med J. 2023 Nov;53(11):1987-1993. doi: 10.1111/imj.16044. Epub 2023 Mar 20.
Anticoagulation significantly reduces the risk of ischaemic stroke in patients with atrial fibrillation (AF). There are a proportion of patients with known AF who remain off anticoagulation. Aims This study aims to retrospectively compare the baseline characteristics, treatments and functional outcomes between patients with ischaemic stroke and known AF based on their anticoagulation status.
A single-centre, retrospective review of consecutive patients with an ischaemic stroke and a known history of AF was conducted.
Two hundred four patients with an ischaemic stroke had documented AF prior to the index admission, of which 126 were anticoagulated. Median admission National Institutes of Health Stroke Scale score was lower for anticoagulated patients, though not statistically significant (5.1 vs 7.0, P = 0.09). Median baseline modified Rankin score (mRS) did not significantly differ. Nonanticoagulated patients were more likely to have large vessel occlusions (37.2% vs 23.8%, P = 0.04) and more likely to receive intravenous thrombolysis (15.4% vs 1.6%, P < 0.01). There was no difference in rates of endovascular clot retrieval between groups (P > 0.05). Unfavourable functional outcome at 90 days (mRS ≥ 3) did not significantly differ between groups (P = 0.51). A total of 38.5% of nonanticoagulated patients had no documented reason for this. Of the patients who survived the index admission, 81.5% of patients who were not anticoagulated on admission received anticoagulation.
Baseline anticoagulation was associated with milder stroke severity in ischaemic stroke patients with known AF. There was no significant difference in functional outcomes at 90 days between groups. Larger observational studies are required to further assess this cohort.
抗凝治疗显著降低了房颤（AF）患者发生缺血性卒中的风险。有一部分已知患有 AF 的患者并未接受抗凝治疗。目的 本研究旨在回顾性比较基于抗凝状态的缺血性卒中伴已知 AF 患者的基线特征、治疗方法和功能结局。
对连续的缺血性卒中伴已知 AF 病史的患者进行单中心回顾性分析。
204 例缺血性卒中患者在入院前有记录的 AF，其中 126 例接受了抗凝治疗。虽然抗凝组患者的入院时国立卫生研究院卒中量表评分中位数较低，但差异无统计学意义（5.1 比 7.0，P = 0.09）。中位数基线改良 Rankin 量表评分（mRS）无显著差异。未接受抗凝治疗的患者更可能有大血管闭塞（37.2%比 23.8%，P = 0.04），更可能接受静脉溶栓治疗（15.4%比 1.6%，P < 0.01）。两组之间血管内血栓切除术的比例无差异（P > 0.05）。90 天不良功能结局（mRS ≥ 3）在两组间无显著差异（P = 0.51）。未接受抗凝治疗的患者中，有 38.5%没有明确的原因。在入院时未接受抗凝治疗的存活患者中，81.5%的患者在入院后接受了抗凝治疗。
在已知 AF 的缺血性卒中患者中，基线抗凝与较轻的卒中严重程度相关。两组患者 90 天的功能结局无显著差异。需要更大规模的观察性研究来进一步评估这一人群。
