Early Initiation of Direct Oral Anticoagulants After Onset of Stroke and Short- and Long-Term Outcomes of Patients With Nonvalvular Atrial Fibrillation
Early Initiation of Direct Oral Anticoagulants After Onset of Stroke and Short- and Long-Term Outcomes of Patients With Nonvalvular Atrial Fibrillation
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DOI：
10.1161/strokeaha.119.028118
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发表时间：
2020-03-01
期刊：
影响因子：
8.3
通讯作者：
Koga, Masatoshi
中科院分区：
文献类型：
--
作者：
Mizoguchi, Tadataka;Tanaka, Kanta;Koga, Masatoshi
背景和目的-我们旨在比较缺血性卒中合并非瓣膜性心房颤动患者在卒中发病后早期和晚期开始直接口服抗凝剂（DOAC）的结果。方法-根据一项前瞻性、多中心、观察性研究中 1192 名患有急性缺血性卒中或短暂性脑缺血发作的非瓣膜性心房颤动患者的数据，纳入了在急性住院期间开始使用 DOAC 的患者，并根据中位天数分为 2 组发病后 DOAC 启动的情况。结局包括中风或全身性栓塞、大出血以及 3 个月和 2 岁时的死亡。 结果 - 499 名患者在发病后中位 4 天（四分位距，2-7）天内在急性住院期间启动 DOAC。因此，223 名患者（中位年龄，74 [四分位距，68-81] 岁；78 名女性）被分配到早期组（= 4 天）组。与晚期组相比，早期组的美国国立卫生研究院卒中量表基线评分较低，梗塞面积较小。排除死亡或失访的患者，DOAC 给药持续 2 年的总体率为 85.2%。多变量 Cox 共同衰弱模型显示，2 年时各组之间的中风或全身性栓塞（风险比，0.86 [95% CI，0.47-1.57]）、大出血（风险比，1.39 [95% CI，0.42-4.60]）和死亡（风险比，0.61 [95% CI，0.47-1.57]）和死亡（风险比，0.61 [95% CI，0.47-1.57]）具有相当的风险。 0.28-1.33]）。各组之间 3 个月的结果风险也没有显着差异。 结论 - 无论 DOAC 是在非瓣膜性心房颤动相关缺血性中风或短暂性脑缺血发作后 3 天内开始，还是从 4 天或更长时间开始，包括中风或全身性栓塞、大出血和死亡在内的事件风险相当。
Background and Purpose-We aimed to compare outcomes of ischemic stroke patients with nonvalvular atrial fibrillation between earlier and later initiation of direct oral anticoagulants (DOACs) after stroke onset.Methods-From data for 1192 nonvalvular atrial fibrillation patients with acute ischemic stroke or transient ischemic attack in a prospective, multicenter, observational study, patients who started DOACs during acute hospitalization were included and divided into 2 groups according to a median day of DOAC initiation after onset. Outcomes included stroke or systemic embolism, major bleeding, and death at 3 months, as well as those at 2 years.Results-DOACs were initiated during acute hospitalization in 499 patients in median 4 (interquartile range, 2-7) days after onset. Thus, 223 patients (median age, 74 [interquartile range, 68-81] years; 78 women) were assigned to the early group (= 4 days) group. The early group had lower baseline National Institutes of Health Stroke Scale score and smaller infarcts than the late group. The rate at which DOAC administration persisted at 2 years was 85.2% overall, excluding patients who died or were lost to follow-up. Multivariable Cox shared frailty models showed comparable hazards between the groups at 2 years for stroke or systemic embolism (hazard ratio, 0.86 [95% CI, 0.47-1.57]), major bleeding (hazard ratio, 1.39 [95% CI, 0.42-4.60]), and death (hazard ratio, 0.61 [95% CI, 0.28-1.33]). Outcome risks at 3 months also did not significantly differ between the groups.Conclusions-Risks for events including stroke or systemic embolism, major bleeding, and death were comparable whether DOACs were started within 3 days or from 4 days or more after the onset of nonvalvular atrial fibrillation-associated ischemic stroke or transient ischemic attack.