Palaiodimou Lina, Katsanos Aristeidis H, Melanis Konstantinos, Stefanou Maria-Ioanna, Romoli Michele, Papagiannopoulou Georgia, Theodorou Aikaterini, Köhrmann Martin, Dilaveris Polychronis, Tsioufis Konstantinos, Magiorkinis Gkikas, Krogias Christos, Themistocleous Marios, Sacco Simona, Katan Mira, Filippatos Gerasimos, Tsivgoulis Georgios
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
Eur Stroke J. 2025 Apr 23:23969873251334278. doi: 10.1177/23969873251334278.
Prolonged cardiac monitoring after stroke increases the detection of device-detected atrial fibrillation (DDAF), leading to a clinical dilemma regarding anticoagulation for secondary stroke prevention. While anticoagulation reduces thromboembolic risk in clinical AF, its benefit-risk profile in DDAF remains uncertain.
In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) evaluating anticoagulation among patients with DDAF post stroke or transient ischemic attack (TIA) were pooled. The primary efficacy outcome was any stroke recurrence, while stroke or systemic embolism, ischemic stroke recurrence, myocardial infarction, and cardiovascular mortality were assessed as secondary efficacy outcomes. The primary safety outcome was major bleeding, while hemorrhagic stroke and all-cause mortality were assessed as secondary safety outcomes.
Two RCTs with 599 patients (294 anticoagulation, 305 no-anticoagulation) were included. Anticoagulation significantly reduced any stroke recurrence (RR: 0.47; 95% CI: 0.23-0.94; = 0.034; number-needed-to-treat = 34). Anticoagulation lowered the risk of the composite outcome of stroke recurrence and systemic embolism (RR: 0.45; 95% CI: 0.22-0.90; = 0.023). However, anticoagulation was associated with an increased risk of major bleeding (RR: 2.30; 95% CI: 1.06-4.98; = 0.035; number-needed-to-harm = 37). There were no differences in ischemic stroke recurrence (RR: 0.53; 95% CI: 0.26-1.09; = 0.084), myocardial infarction (RR: 0.58; 95% CI: 0.17-1.96; = 0.379), cardiovascular mortality (RR: 0.68; 95% CI: 0.35-1.34; = 0.265), hemorrhagic stroke (RR: 0.25; 95% CI: 0.03-2.24; = 0.217) or all-cause mortality (RR: 0.97; 95% CI: 0.66-1.41; = 0.857).
Anticoagulation in DDAF patients with prior stroke/TIA reduces any stroke recurrence but increases major bleeding risk without raising hemorrhagic stroke incidence. This trade-off underscores the need for individualized risk stratification.
Anticoagulation lowers any stroke recurrence in DDAF patients post-stroke/TIA but raises major bleeding risk.
中风后延长心脏监测可增加设备检测到的心房颤动（DDAF）的检出率，这导致了二级中风预防中抗凝治疗的临床困境。虽然抗凝治疗可降低临床房颤中的血栓栓塞风险，但其在DDAF中的获益风险情况仍不确定。
在这项系统评价和荟萃分析中，汇总了评估中风或短暂性脑缺血发作（TIA）后DDAF患者抗凝治疗的随机对照临床试验（RCT）。主要疗效结局为任何中风复发，而中风或全身性栓塞、缺血性中风复发、心肌梗死和心血管死亡率被评估为次要疗效结局。主要安全性结局为大出血，而出血性中风和全因死亡率被评估为次要安全性结局。
纳入了两项RCT，共599例患者（294例接受抗凝治疗，305例未接受抗凝治疗）。抗凝治疗显著降低了任何中风复发的风险（风险比：0.47；95%置信区间：0.23 - 0.94；P = 0.034；需治疗人数 = 34）。抗凝治疗降低了中风复发和全身性栓塞复合结局的风险（风险比：0.45；95%置信区间：0.22 - 0.90；P = 0.023）。然而，抗凝治疗与大出血风险增加相关（风险比：2.30；95%置信区间：1.06 - 4.98；P = 0.035；需伤害人数 = 37）。在缺血性中风复发（风险比：0.53；95%置信区间：0.26 - 1.09；P = 0.084）、心肌梗死（风险比：0.58；95%置信区间：0.17 - 1.96；P = 0.379）、心血管死亡率（风险比：0.68；95%置信区间：0.35 - 1.34；P = 0.265）、出血性中风（风险比：0.25；95%置信区间：0.03 - 2.24；P = 0.217）或全因死亡率（风险比：0.97；95%置信区间：0.66 - 1.41；P = 0.857）方面无差异。
对既往有中风/TIA的DDAF患者进行抗凝治疗可降低任何中风复发的风险，但会增加大出血风险，且不增加出血性中风的发生率。这种权衡凸显了个体化风险分层的必要性。
抗凝治疗可降低中风/TIA后DDAF患者的任何中风复发风险，但会增加大出血风险。
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