Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA
Association of improved outcome in acute ischaemic stroke patients with atrial fibrillation who receive early antithrombotic therapy: analysis from VISTA
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DOI：
10.1111/ene.12577
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发表时间：
2015-07-01
影响因子：
5.1
通讯作者：
Lees, K. R.
中科院分区：
文献类型：
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作者：
Abdul-Rahim, A. H.;Fulton, R. L.;Lees, K. R.
背景与目的缺血性脑卒中合并心房颤动（AF）患者有早期卒中复发（RS）的危险。然而，在急性期开始使用抗血栓药物可能会加剧出血转化，引发症状性脑出血（siich）。研究了抗血栓药物与队列模式和结果的相关性。方法采用非随机队列分析，数据来源于VISTA （Virtual International Stroke Trials Archive）。描述了抗血栓药物与卒中后AF患者90天的改良Rankin量表（mRS）结果以及RS和SICH的发生（每一个都是致命和非致命事件的联合终点）的关系。二分类结局也被认为是次要终点（即死亡率和90天的良好结局测量）。结果共检出1644例患者；1462例（89%）接受抗血栓药物治疗，157例（10%）发生RS， 50例（3%）在第90天发生SICH。联合抗血栓治疗（即抗凝剂和抗血小板），782例（48%）与正常mRS的有利结果相关，与未使用抗血栓治疗组相比，在第90天发生RS、SICH和死亡率的风险显著降低。RS和SICH的相对风险在卒中后的前2天出现最高，然后随着时间的推移逐渐减弱并保持不变。结论抗血栓药物对近期卒中合并房颤患者的风险和获益似乎是一致的。早期引入抗凝剂（卒中后2-3天），以及在较小程度上使用抗血小板药物，与随后几周RS事件的显著减少相关，但没有增加SICH的风险。在这个问题上，需要更多的证据来指导临床医生。
Background and purposeIschaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated.MethodsA non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive). The associations of antithrombotics with the modified Rankin Scale (mRS) outcome and the occurrence of RS and SICH (each as a combined end-point of fatal and non-fatal events) at 90days for post-stroke patients with AF were described. Dichotomized outcomes were also considered as a secondary end-point (i.e. mortality and good outcome measure at 90days).ResultsIn all, 1644 patients were identified; 1462 (89%) received antithrombotics, 157 (10%) had RS and 50 (3%) sustained SICH by day 90. Combined antithrombotic therapy (i.e. anticoagulants and antiplatelets), 782 (48%), was associated with favourable outcome on ordinal mRS and a significantly lower risk of RS, SICH and mortality by day 90, compared with the no antithrombotics group. The relative risk of RS and SICH appeared highest in the first 2days post-stroke before attenuating to become constant over time.ConclusionsThe risks and benefits of antithrombotics in recent stroke patients with AF appear to track together. Early introduction of anticoagulants (2-3days post-stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer RS events over the following weeks but with no excess risk of SICH. More evidence is required to guide clinicians on this issue.