Schumann Sophie, Schwarze Jens Jürgen, Brandt Silvio, Jöhrens Korinna, Dirsch Olaf, Ibrahim Karim, Rosengarten Bernhard
Neurology, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
Department of Neuoradiology, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
BMJ Neurol Open. 2025 Jul 3;7(2):e000954. doi: 10.1136/bmjno-2024-000954. eCollection 2025.
Atrial fibrillation (AF) is an important risk factor for cerebral stroke. We studied whether anticoagulation affected histological age aspects of thrombi retrieved from patients with AF-related stroke.
In this monocentric study, AF patients according to criteria (Trial of Org 10 172 in Acute Stroke Treatment) with occlusion of the middle cerebral artery were prospectively and consecutively included. They were assigned to three groups: anticoagulation naïve, adequately anticoagulated, and with paused anticoagulation. In addition to patient characteristics and stroke workup, extracted thrombi were histologically classified into different age categories according to their cellular to fibrotic transition.
A total of 244 patients were studied, from which 136 (58 females; 78±9 years) were drug naïve, 34 (15 females; 78±8 years) had paused anticoagulation, and 74 (29 females; 79±9 years) were adequately anticoagulated. Groups did not differ regarding stroke severity at admission (modified Rankin Score, mRS: median, IQR: 5 (1); 5 (0.75); 5 (1), respectively; National Institutes of Health Stroke Scale (NIHSS): median, IQR: 16 (8); 16 (8); 16 (7), respectively). Due to thrombectomy, median scores declined in all groups without differences between groups (mRS: 3.5 (4); 4 (4); 4 (4); NIHSS: 5 (16); 11 (31); 7 (18)). With a small but significant effect (p=0.043), thrombus age differed between the groups due to significantly younger thrombi in the paused medication group as compared with the adequately anticoagulated patients.
Thrombus age distribution seems not to be affected by anticoagulation. The younger thrombi in patients with paused anticoagulation possibly point to a rebound effect needing further investigations.
心房颤动（AF）是脑卒的一个重要危险因素。我们研究了抗凝治疗是否会影响从房颤相关性卒中患者体内取出的血栓的组织学年龄特征。
在这项单中心研究中，根据标准（急性卒中治疗中Org 10172试验）纳入大脑中动脉闭塞的房颤患者，并对其进行前瞻性连续研究。他们被分为三组：未接受抗凝治疗组、抗凝治疗充分组和抗凝治疗中断组。除患者特征和卒中检查外，根据细胞到纤维化的转变，将提取的血栓进行组织学分类，分为不同的年龄类别。
共研究了244例患者，其中136例（58例女性；78±9岁）未接受药物治疗，34例（15例女性；78±8岁）抗凝治疗中断，74例（29例女性；79±9岁）抗凝治疗充分。三组患者入院时的卒中严重程度无差异（改良Rankin量表评分，mRS：中位数，四分位间距分别为5（1）；5（0.75）；5（1）；美国国立卫生研究院卒中量表（NIHSS）：中位数，四分位间距分别为16（8）；16（8）；16（7））。由于进行了血栓切除术，所有组的评分中位数均下降，组间无差异（mRS：3.5（4）；4（4）；4（4）；NIHSS：5（16）；11（31）；7（18））。尽管影响较小但具有统计学意义（p = 0.043），与抗凝治疗充分的患者相比，抗凝治疗中断组的血栓年龄明显更年轻，因此三组之间的血栓年龄存在差异。
血栓年龄分布似乎不受抗凝治疗的影响。抗凝治疗中断患者的血栓较年轻，这可能表明存在一种需要进一步研究的反弹效应。
