Harahsheh Ehab, Elshaigi Omer, Alhayek Nour, Buckner Skye A, Quillen Jaxon K, O'Carroll Cumara B, Dumitrascu Oana M
Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Neurohospitalist. 2024 Oct;14(4):379-388. doi: 10.1177/19418744241254897. Epub 2024 May 15.
Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen.
Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups.
One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], = .27 and HR 1.02 [.53- 1.98], = .95, respectively) or MBE (HR .85 [.19-3.67], = .83 and HR 1.49 [.67-3.33)], = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes.
In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.
尽管使用了抗凝剂（AC），心房颤动（AF）患者发生缺血性脑血管事件的风险仍会增加。我们旨在评估在已接受AC治疗但仍发生急性缺血性卒中（AIS）或短暂性脑缺血发作（TIA）的AF患者中，更改AC或在抗凝剂基础上加用抗血小板治疗（AP + AC）与继续使用相同AC方案的患者相比，是否能降低复发性AIS/TIA的风险。
纳入2011年至2021年间在我们中心因AIS或TIA而接受AC治疗的AF患者。提取人口统计学数据、索引事件、索引事件前后的抗栓治疗、复发性AIS/TIA或重大出血事件（MBE）的数据。使用Cox比例风险模型比较AC不变与AC更改组以及AP + AC组与仅使用AC组之间的结局。
共纳入185例患者（平均年龄78.3岁；62%为男性，中位随访时间9个月（四分位间距1 - 34））。17例患者（9%）更改了AC，100例（54%）接受了AP + AC，39例（21%）发生了复发性AIS/TIA，27例（15%）在索引事件后发生了MBE。在复发性AIS/TIA方面，AC不变与AC更改组以及AP + AC组与仅使用AC组之间未观察到差异（风险比分别为1.72 [.65 - 4.57]，P = .27和1.02 [.53 - 1.98]，P = .95）；在MBE方面，两组间也无差异（风险比分别为.85 [.19 - 3.67]，P = .83和1.49 [.67 - 3.33]，P = .33）。该队列由14名血管神经科医生治疗，其中9名（64%）实施了AC更改。
在这项对185例尽管接受AC治疗但仍患有AF和AIS/TIA的患者进行的单中心回顾性研究中，更改AC或加用AP药物并未降低缺血性脑血管事件的风险。
