摘要
目的探讨既往接受口服抗凝治疗的非瓣膜性心房颤动(NVAF)患者发生急性缺血性卒中(AIS)的临床特征。方法回顾性分析单中心患者登记研究(NCT04080830)中2016年1月至2021年12月在首都医科大学宣武医院神经内科住院的合并NVAF的AIS患者数据,根据发病前抗凝状态将患者分为未抗凝组、充分抗凝组和抗凝不足组,比较3组患者的临床特征。结果共纳入749例合并NVAF的AIS患者,其中未抗凝组661例,充分抗凝组33例,抗凝不足组55例。充分抗凝组出现大面积脑梗死的比例、初始和出院时的美国国家卫生研究院卒中量表评分均低于未抗凝组[15.2%(5/33)比34.2%(226/666)、4.00(1.00,7.50)分比8.00(3.00,15.00)分、2.00(0,5.00)分比4.00(1.00,12.00)分],出院时改良Rankin量表评分≤2分的比例高于未抗凝组[66.7%(22/33)比44.0%(226/666)],差异均有统计学意义(均P<0.05)。充分抗凝组和抗凝不足组的静脉溶栓比例低于未抗凝组[3.0%(1/33)、3.6%(2/55)比5.6%(37/666)],差异有统计学意义(P<0.01)。充分抗凝组存在心源性/大动脉粥样硬化性卒中型的AIS病因的患者比例高于未抗凝组和抗凝不足组[42.4%(14/33)比21.8%(144/666)、16.4%(9/55)],差异有统计学意义(P<0.01)。结论既往充分抗凝治疗与NVAF患者发生AIS后卒中严重程度较低和出院时功能预后较好相关,竞争性大动脉动脉粥样硬化性AIS发生机制可能是充分抗凝治疗未能有效防控NVAF患者AIS风险的原因之一。
Objective To analyze the clinical characteristics of acute ischemic stroke(AIS)in non-valvular atrial fibrillation(NVAF)patients with prior anticoagulant therapy.Methods Data of NVAF patients with AIS hospitalized in the Department of Neurology,Xuanwu Hospital of Capital Medical University from January 2016 to December 2021 in the observational study(NCT04080830)was retrospectively analyzed.Patients were divided into the non-anticoagulant,adequate anticoagulant and insufficient anticoagulant groups according to anticoagulant status before onset.The clinical characteristics were compared among the three groups.Results A total of 749 AIS patients with NVAF were recruited,including 661 in non-anticoagulant group,33 in adequate anticoagulant group and 55 in insufficient anticoagulant group.The rates of massive infarction and the scores of National Institute of Health Stroke Scale(NIHSS)at admission and discharge of the adequate anticoagulant group were lower than those of the non-anticoagulant group[15.2%(5/33)vs 34.2%(226/666),4.00(1.00,7.50)vs 8.00(3.00,15.00),2.00(0,5.00)vs 4.00(1.00,12.00)].The proportion of patients with scores of Modified Rankin Scale(mRS)≤2 at discharge in the adequate anticoagulant group were higher than that in the non-anticoagulant group[66.7%(22/33)vs 44.0%(226/666)].The differences were statistically significant(all P 0.05).The proportion of intravenous thrombolysis in the adequate anticoagulant group and the insufficient anticoagulant group was lower than that in the non-anticoagulant group[3.0%(1/33)and 3.6%(2/55)vs 5.6%(37/666)],and the difference was statistically significant(P 0.01).Compared with the non-anticoagulant group and the insufficient anticoagulant group,patients in the adequate anticoagulant group had higher rates of cardioembolic/large-artery AIS[42.4%(14/33)vs 21.8%(144/666)and 16.4%(9/55),P<0.01].Conclusions Adequate anticoagulant therapy in NVAF patients might be associated with milder ischemic stroke severity and better outcomes at discharge.The mechanism of competitive large artery atherosclerosis induced AIS may be one of the reasons why adequate anticoagulant treatment fails to effectively prevent and control AIS risk in NVAF patients.
作者
薛素芳
董静
娜日苏
王秋佳
魏敏
Xue Sufang;Dong Jing;Na Risu;Wang Qiujia;Wei Min(Department of Neurology,Xuanwu Hospital of Capital Medical University,Bejing 100053,China)
出处
《神经疾病与精神卫生》
2023年第6期427-433,共7页
Journal of Neuroscience and Mental Health
关键词
卒中
心房颤动
抗凝
竞争性卒中机制
Stoke
Atrial fibrillation
Anticoagulant therapy
Competing stroke mechanism
