Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Empoli, Italy.
Neurology, San Giuseppe Hospital, Empoli, Italy.
Neurologist. 2024 Nov 1;29(6):329-338. doi: 10.1097/NRL.0000000000000579.
The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF).
We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded.
A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences.
In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.
急性缺血性脑卒中（AIS）合并口服抗凝药物（OA）治疗的患者管理颇具挑战。本研究旨在分析非瓣膜性心房颤动（NVAF）合并 AIS 并接受直接口服抗凝剂（DOAC）或维生素 K 拮抗剂（VKA）治疗的患者的临床特征和结局。
回顾性分析了 2017 年至 2022 年期间入住我院卒中单元的 NVAF 合并 AIS 且正在接受 DOAC 或 VKA 治疗的患者的数据。记录了 90 天改良 Rankin 量表（mRS）评分、90 天和 12 个月的卒中复发情况。
共纳入 169 例患者（53.2%为女性，平均年龄 82.8±6.7 岁），其中 117 例（69.2%）接受 DOAC 治疗，52 例（30.8%）接受 VKA 治疗。VKA 组患者的平均年龄、住院期间死亡率和 90 天 mRS≥4 评分较高。63.4%的 VKA 患者 INR 值低于治疗范围，而 47.1%的 DOAC 患者剂量较低（14.2%为超适应证用药）。VKA 组患者大血管闭塞和栓塞性病因更为常见（34.6%比 26.4%，P=0.358；92.3%比 74.3%，P=0.007），而 DOAC 组患者腔隙性卒中更为常见（19.8%比 12.2%，P=0.366）。AIS 前正在接受 VKA 治疗的患者中，86.4%转为 DOAC 治疗，25.4%转为 VKA 治疗，11.7%转为 DOAC 治疗。90 天时有 6.4%的患者发生卒中复发，12 个月时有 10.7%的患者发生卒中复发。抗凝药物转换与卒中复发无关。
在本研究中，DOAC 组患者的非栓塞性病因更为常见，抗凝药物转换并未降低卒中复发风险。需要开展前瞻性多中心研究。
