Recurrent Stroke and Bleeding Events after Acute Cardioembolic Stroke-Analysis Using Japanese Healthcare Database from Acute-Care Institutions.
Recurrent Stroke and Bleeding Events after Acute Cardioembolic Stroke-Analysis Using Japanese Healthcare Database from Acute-Care Institutions.
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DOI：
10.1016/j.jstrokecerebrovasdis.2017.11.002
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发表时间：
2017-12
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通讯作者：
M. Yasaka;Y. Koretsune;T. Yamashita;E. Oda;D. Matsubayashi;K. Ota;Masafumi Kobayashi;Y. Matsushita;Jumpei Kaburagi;Kei Ibusuki;A. Takita;Mikio Iwashita;Takuhiro Yamaguchi
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作者：
M. Yasaka;Y. Koretsune;T. Yamashita;E. Oda;D. Matsubayashi;K. Ota;Masafumi Kobayashi;Y. Matsushita;Jumpei Kaburagi;Kei Ibusuki;A. Takita;Mikio Iwashita;Takuhiro Yamaguchi
背景了解心源性栓塞性卒中（CES）患者的实际情况是很重要的，因为复发性卒中的发生率很高，并且需要考虑与抗凝治疗相关的出血风险。我们阐明了目前的现实世界中的医疗护理患者谁有CES和确定的风险因素复发stroke.Methods和ResultsThe研究包括9804例患者谁被诊断为CES之间的2008年4月和2013年9月确定在日本的急性护理机构使用的医疗数据库。我们分析了CES患者卒中和出血事件的发生率和危险因素。在68天的中位观察期内，卒中的发生率为10.3%，主要包括复发性CES（8.5%）。出血事件和颅内出血的发生率分别为10.3%和7.0%。抗凝治疗组缺血性卒中的复发率明显较低，脑出血的发生率明显较高。脑梗死或短暂性脑缺血发作史、糖尿病、CHA 2DS 2-VASc和CHADS 2评分增加是脑卒中风险增加的相关因素。出血事件的危险因素是高血压，肾功能不全，和使用质子泵抑制剂（PPIs）。结论经历CES的患者有很高的复发性卒中或CES，主要包括复发性CES。尽管抗凝可能有利于减少缺血性卒中复发，但考虑到抗凝治疗期间脑出血风险增加，需要谨慎管理，尤其是对于高血压、肾功能不全和使用PPI的患者。
BackgroundTo understand the reality of patients who experienced a cardioembolic stroke (CES) is important because of the high incidence of recurrent stroke and the need to account for bleeding risk in relation to the need for anticoagulation treatment. We elucidated the current real-world medical care in patients who had a CES and identified the risk factors for recurrent stroke.Methods and ResultsThe study comprised 9804 patients who were diagnosed with CES between April 2008 and September 2013 as identified in a healthcare database used by acute-care institutions in Japan. We analyzed the incidence and risk factors of stroke and bleeding events in CES patients. The incidence of stroke was 10.3% during the median observation period of 68 days, mainly consisting of recurrent CES (8.5%). The incidence of bleeding events and intracranial bleeding was 10.3% and 7.0%, respectively. The recurrence of ischemic stroke was significantly lower, and brain hemorrhage was significantly higher in the anticoagulation treatment group. The factors related to an increased risk of stroke were a history of cerebral infarction or transient ischemic attack, diabetes, and increase of CHA2DS2-VASc and CHADS2scores. The risk factors for bleeding events were hypertension, renal dysfunction, and use of proton pump inhibitors (PPIs).ConclusionsThe patients who experienced CES had a high rate of recurrent stroke or CES, mainly consisting of recurrent CES. Although anticoagulation may be beneficial for reducing recurrence of ischemic stroke, careful management is required given consideration of increased risk of brain hemorrhage during anticoagulation treatment, especially for patients with hypertension, renal dysfunction, and use of PPIs.