Maduna Ivanka, Vidaković Dorotea, Črnac Petra, Saleh Christian, Budinčević Hrvoje
Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia.
Health Center of Osijek-Baranja County, 31000 Osijek, Croatia.
Medicines (Basel). 2025 Jul 24;12(3):18. doi: 10.3390/medicines12030018.
: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. : We collected data on stroke risk factors, CHADS score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. : A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger ( = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; = 0.09). There was no difference between stroke localization among groups ( = 0.116). : Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge.
心房颤动（AF）是心源性栓塞性中风发生的最重要的可改变风险因素，与其他类型的缺血性中风相比，其预后更差，院内死亡率更高。抗血栓药物用于有中风风险的患者进行预防性治疗。本研究的目的是确定首次发生缺血性中风且伴有AF的患者在接受先前抗血栓治疗方面的预后指标。
我们收集了中风风险因素、CHADS评分以及华法林治疗背景下的国际标准化比值（INR）值的数据，以及与中风部位、严重程度和出院时功能预后相关的数据。
本横断面研究共纳入754例首次发生缺血性中风且伴有AF的患者（122例接受华法林治疗，210例接受乙酰水杨酸治疗，422例未接受过先前的抗血栓治疗）。31%的患者先前未知AF诊断。未接受过先前抗血栓治疗的组中，中风风险因素（动脉高血压、高脂血症、糖尿病和心肌病）显著更低。抗凝组明显更年轻（P = 0.001）。总体而言，45.4%先前已知有AF事件且有高中风风险的患者接受了抗凝治疗。接受华法林治疗的参与者的功能预后明显优于接受抗血小板治疗或未接受过先前抗血栓治疗的参与者（改良Rankin量表中位数分别为4、5、5；P =
0.025），且美国国立卫生研究院卒中量表（NIHSS）评分更低，尽管差异无统计学意义（中位数分别为10、12、12；P = 0.09）。各组之间的中风部位无差异（P = 0.116）。
我们的研究表明，在我们的队列中，由AF导致的首次缺血性中风在女性中更常见。接受过先前抗凝治疗的患者出院时预后更有利。
