在接受口服抗凝剂时患有心房的患者中,复发性缺血性中风
Mette Foldager Hindsholm1,2, Luis Alberto García Rodríguez3, Axel Brandes4,5
1Department of Neurology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
JAMA neurology
|June 24, 2024
概括
在缺血性中风 (IS) 后停止服用口服抗凝剂 (OAC) 的心房 (AF) 患者,会使IS复发的风险增加一倍. 持续的OAC治疗对于AF患者的二次中风预防至关重要.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 公共卫生 公共卫生
背景情况:
- 心房动 (AF) 患者面临缺血性中风 (IS) 的显著风险,即使在口服抗凝剂 (OAC) 治疗中也是如此.
- 关于OAC停止对AF患者复发IS风险的影响的了解有限.
研究的目的:
- 评估在接受OAC治疗的AF患者中复发IS的风险.
- 评估OAC停药与该人群中复发性IS风险之间的关联.
主要方法:
- 丹麦 (2014-2021) 全国队列研究,包括8119名50岁以上的AF患者,先前有IS.
- 嵌套病例对照分析将复发性IS病例与没有中风的OAC用户相匹配.
- 随访至2022年6月,通过赎回的处方分析OAC使用情况.
主要成果:
- 复发性IS发生在663名患者中,平均随访时间为2.9年;80.4%的人在OAC.
- 复发性IS的原始1年发病率为4.3%,所有原因的死亡率为15.4%.
- 与继续使用OAC相比,OAC停止显著增加了复发性IS风险 (aOR,2.13;95% CI,1.57-2.89).
结论:
- 尽管OAC治疗,AF患者仍然存在复发性IS和死亡率的高风险.
- 停止OAC增加了复发性IS的风险一倍,强调了治疗坚持的重要性.
- 改善二次中风预防策略对于AF患者至关重要,重点是OAC的延续.
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