Khan Farhan, Lu Vivien, Yaghi Shadi, Prabhakaran Shyam
Department of Neurology, Brown University, Providence, RI, USA.
, 593 Eddy Street, Providence, RI, 02903, USA.
Sci Rep. 2025 Jul 1;15(1):21467. doi: 10.1038/s41598-025-06428-5.
The optimal timing for initiating anticoagulation following an ischemic stroke remains a debated issue. While several professional societies offer guidelines derived from observational studies and randomized clinical trials in patients with atrial fibrillation, these studies often exclude patients with high-risk embolic sources and hemorrhagic transformation. To address this gap, we conducted a nationwide survey to determine current practice patterns among vascular neurologists. We used the REDCap platform at the University of Chicago to distribute a survey to board-certified vascular neurologists identified through the American Board of Psychiatry and Neurology and the American Academy of Neurology databases. Statistical analyses, including t-tests, chi-squared tests, Mann-Whitney-Wilcoxon tests, and Kruskal-Wallis tests, were performed to evaluate continuous and categorical variables as applicable. Out of 1,556 invited participants, 201 (approximately 13%) responded, with 62% identifying as academic neurologists. Early anticoagulation is defined as within 24 h for ischemic stroke < 1.5 cm, 5 days for one third of MCA territory with hemorrhagic transformation type 1, and 7 days with parenchymal hemorrhage type 2. When compared to atrial fibrillation, vascular neurologists are more likely to initiate early anticoagulation in ischemic stroke with hemorrhagic transformation type 1 when it is caused by LV thrombus (69% vs. 21%, p < 0.001), antiphospholipid syndrome (87% v 21%, p < 0.001), and non-occlusive thrombus (83% vs. 21%, p < 0.001). A similar trend of early anticoagulation was noted in cases of ischemic stroke with parenchymal hemorrhage type 2 caused by LV thrombus (63% vs. 13%, p < 0.001), antiphospholipid syndrome (73% vs. 13%, p < 0.001), and non-occlusive thrombus (71% vs. 13%, p < 0.001) when compared to atrial fibrillation as the underlying cause. This study suggests that vascular neurologists prefer early anticoagulation in high-risk stroke mechanisms as compared to atrial fibrillation.
缺血性卒中后启动抗凝治疗的最佳时机仍是一个有争议的问题。虽然几个专业学会提供了源自房颤患者观察性研究和随机临床试验的指南，但这些研究往往排除了具有高风险栓子来源和出血转化的患者。为了填补这一空白，我们进行了一项全国性调查，以确定血管神经科医生目前的实践模式。我们利用芝加哥大学的REDCap平台，向通过美国精神病学和神经病学委员会以及美国神经病学学会数据库确定的获得委员会认证的血管神经科医生分发了一份调查问卷。进行了统计分析，包括t检验、卡方检验、曼-惠特尼-威尔科克森检验和克鲁斯卡尔-沃利斯检验，以评估适用的连续变量和分类变量。在1556名受邀参与者中，201人（约13%）做出了回应，其中62%为学术神经科医生。早期抗凝的定义为：缺血性卒中<1.5 cm时在24小时内，大脑中动脉三分之一区域出现1型出血转化时在5天内，出现2型实质出血时在7天内。与房颤相比，当缺血性卒中伴1型出血转化由左心室血栓引起时（69%对21%，p<0.001）、抗磷脂综合征（87%对21%，p<0.001）以及非闭塞性血栓引起时（83%对21%，p<0.001），血管神经科医生更倾向于早期抗凝。在与房颤作为潜在病因相比，由左心室血栓引起的2型实质出血性缺血性卒中病例（63%对13%，p<0.001）、抗磷脂综合征（73%对13%，p<0.001）以及非闭塞性血栓引起的病例（71%对13%，p<0.001）中，也注意到了类似的早期抗凝趋势。这项研究表明，与房颤相比，血管神经科医生在高风险卒中机制中更倾向于早期抗凝。
