Seetge Jessica, Cséke Balázs, Karádi Zsófia Nozomi, Bosnyák Edit, Szapáry László
Stroke Unit, Department of Neurology, University of Pécs, 7624 Pécs, Hungary.
Department of Emergency Medicine, University of Pécs, 7624 Pécs, Hungary.
J Clin Med. 2024 Dec 1;13(23):7309. doi: 10.3390/jcm13237309.
: Despite the widespread use of oral anticoagulants (OACs), acute ischemic stroke (AIS) remains a significant risk for patients with atrial fibrillation (AF). The real-world effectiveness of OACs in preventing recurrent strokes, particularly following an initial stroke of cardioembolic (CE) origin, continues to be a major challenge for clinicians managing AF patients. This study evaluated the efficacy of OACs in secondary stroke prevention and investigated the influence of anticoagulation type and quality on recurrence risk. : We analyzed data from 128 AF patients in the prospective Transzlációs Idegtudományi Nemzeti Laboratórium (TINL) STROKE-registry, admitted with CE stroke between February 2023 and September 2024. Patients were categorized by anticoagulation status at admission (OAC-users, = 89; anticoagulation-naïve, = 39). Recurrence rates were assessed using logistic regression models, adjusted for age, sex, hypertension, diabetes, and pre-stroke disability. Subgroup analyses explored the effects of anticoagulation type and quality. : Recurrence rates were similar between the OAC-treated and anticoagulation-naïve patients after adjusting for confounders (19.10% vs. 17.95%, = 0.870). Among the anticoagulated patients, neither anticoagulation type nor quality alone significantly influenced the recurrence risk. However, their interaction was statistically significant ( = 0.049), suggesting that the effectiveness of anticoagulation in preventing strokes is strongly affected by treatment quality. : Although OACs are a cornerstone of stroke prevention in patients with AF, their efficacy in reducing recurrence depends on optimal management. These findings highlight that adequate anticoagulation, not just its use, is critical to minimize recurrence risk. To effectively prevent strokes in high-risk AF patients, future strategies must focus on standardized protocols, tailored monitoring, and individualized dosing regimens.
尽管口服抗凝药（OACs）被广泛使用，但急性缺血性卒中（AIS）仍是心房颤动（AF）患者的重大风险。OACs在预防复发性卒中方面的实际效果，尤其是在最初发生心源性栓塞（CE）性卒中之后，仍然是管理AF患者的临床医生面临的主要挑战。本研究评估了OACs在二级卒中预防中的疗效，并调查了抗凝类型和质量对复发风险的影响。：我们分析了前瞻性跨学科国家神经科学实验室（TINL）卒中登记处128例AF患者的数据，这些患者在2023年2月至2024年9月期间因CE卒中入院。患者根据入院时的抗凝状态进行分类（OAC使用者，n = 89；未使用抗凝药者，n = 39）。使用逻辑回归模型评估复发率，并对年龄、性别、高血压、糖尿病和卒中前残疾进行调整。亚组分析探讨了抗凝类型和质量的影响。：在调整混杂因素后，OAC治疗组和未使用抗凝药组的复发率相似（19.10%对17.95%，P = 0.870）。在接受抗凝治疗的患者中，单独的抗凝类型和质量均未显著影响复发风险。然而，它们的相互作用具有统计学意义（P = 0.049），表明抗凝治疗预防卒中的有效性受治疗质量的强烈影响。：尽管OACs是AF患者卒中预防的基石，但其降低复发的疗效取决于最佳管理。这些发现强调，充分的抗凝治疗，而不仅仅是使用抗凝药，对于将复发风险降至最低至关重要。为了有效预防高危AF患者的卒中，未来的策略必须侧重于标准化方案制定、针对性监测和个体化给药方案。
