在心房动相关的缺血性中风患者中使用抗凝药和血栓治疗
Joseph Harbison1,2,3, Joan McCormack1, Olga Brych1
1Irish National Audit of Stroke, National Office of Clinical Audit, Dublin, Ireland.
概括
直接口服抗凝剂 (DOAC) 越来越多地用于心房动 (AF) 中风预防,但突破性中风仍然是一个问题. 服用DOAC的患者比服用华法林的患者接受的血栓消毒疗法少.
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:
- 前庭动 (AF) 是缺血性中风的重要危险因素,导致多达20%的病例.
- 广泛采用直接口服抗凝剂 (DOACs) 尚未明显减少AF相关的中风患病率.
- 抗凝血患者的突破性中风,以及DOACs对抗凝血率的影响,需要进一步调查.
研究的目的:
- 用爱尔兰国家中风审计 (INAS) 数据库分析AF相关中风中的抗凝剂实践.
- 在AF患者中特化突破性中风.
- 评估遵守处方指南以及对血栓溶解率的影响.
主要方法:
- 一个横截面的队列研究,分析了2017-2022年的INAS数据.
- 收集有关人口统计,中风特征,中风前AF状态和出院结果 (修改的兰金得分) 的数据.
- 2022年增强的数据收集包括处方遵守,非一致原因和华法林国际规范比率 (INR) 控制;统计分析包括t测试,奇方位和后勤回归.
主要成果:
- 完整的AF数据可用于22485次中风;5321次 (23.7%) 是AF相关的缺血性中风.
- 在已知的AF患者中,有80.4%的患者被处方抗凝药;在2022年,在84.6%的抗凝AF中风中,DOACs被用于抗凝AF中风.
- 与已知的AF (4.0%) 相比,以前未知的AF患者更年轻,更有可能接受血栓溶解 (17.3%).
- 接受DOAC的人比使用维生素K对抗剂 (VKA) 的人 (8.5%) 接受血栓溶解的可能性更低 (2.9%). 抗凝血状态没有显著影响出色的结果或死亡率.
结论:
- 几乎一半的AF患者在中风前没有发现他们的病情.
- 已知的AF患者通常使用DOACs进行治疗,代表突破性中风.
- 与华法林相比,DOAC使用与血栓消毒治疗的显著降低率有关.
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