Department of Neurology, Henry Ford Health, Detroit, MI, USA.
Department of Neurology, Henry Ford Health, Detroit, MI, USA.
J Stroke Cerebrovasc Dis. 2024 Jul;33(7):107757. doi: 10.1016/j.jstrokecerebrovasdis.2024.107757. Epub 2024 May 3.
Current literature lacks guidance on the safety of administering anticoagulation in acute ischemic stroke with emergent indications that require anticoagulation other than atrial fibrillation. Therefore, we tend to rely on studies investigating acute ischemic stroke in atrial fibrillation for anticoagulation recommendations.
We retrospectively reviewed data for patients with acute ischemic stroke who had a non-atrial fibrillation emergent indication for anticoagulation (e.g., intra-arterial thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, deep vein thrombosis and pulmonary embolism) diagnosed within 3 days of acute ischemic stroke. Patients who received anticoagulation ≤ 3 days of stroke onset (Group A) were compared to those who either received it afterwards or did not receive it at all (Group B).
Out of the 558 patients, only 88 patients met our inclusion criteria. Of the total cohort, 55.7 % patients were males, and basic demographics were similar in both groups except for milder strokes in Group A (national institute of health stroke scale 6 vs. 12.5, p = 0.03). Only 2 patients in Group A and 1 patient in Group B developed intracranial hemorrhage, which was not statistically significant. Group A patients had a lower incidence of both new diagnosis (2 % vs. 34.2 % %, p < 0.001) and propagation of an established venous thromboembolism. They also had a lower rate of any thromboembolic complication (2 % vs. 42 %, p < 0.001).
Early anticoagulation (i.e., ≤ 3 days) in non-atrial fibrillation ischemic stroke patients with an emergent indication may be safe and carry a lower risk of thromboembolic complications than later anticoagulation.
目前的文献缺乏关于在急性缺血性卒中伴有需要抗凝治疗的紧急情况下（除心房颤动外）使用抗凝治疗的安全性的指导。因此，我们倾向于依赖于研究急性缺血性卒中合并心房颤动患者的抗凝治疗建议。
我们回顾性分析了在急性缺血性卒中后 3 天内诊断为伴有非心房颤动紧急抗凝指征（如动脉内血栓、心内血栓、急性冠脉综合征、急性肢体缺血、深静脉血栓形成和肺栓塞）的急性缺血性卒中患者的数据。将接受抗凝治疗≤3 天的患者（A 组）与未接受抗凝治疗或接受抗凝治疗的患者（B 组）进行比较。
在 558 例患者中，仅有 88 例符合纳入标准。在总队列中，55.7%的患者为男性，两组基本人口统计学特征相似，除 A 组卒中较轻（美国国立卫生研究院卒中量表 6 分 vs. 12.5 分，p=0.03）外。A 组仅有 2 例患者和 B 组 1 例患者发生颅内出血，但无统计学意义。A 组新发诊断（2% vs. 34.2%，p<0.001）和已确诊静脉血栓栓塞症的扩展发生率较低。A 组的任何血栓栓塞性并发症发生率也较低（2% vs. 42%，p<0.001）。
在伴有紧急抗凝指征的非心房颤动缺血性卒中患者中，早期抗凝治疗（即≤3 天）可能是安全的，并且血栓栓塞并发症的风险低于晚期抗凝治疗。
