Temporal trends of atrial fibrillation and/or rheumatic heart disease-related ischemic stroke, and anticoagulant use in Chinese population: An 8-year study
Temporal trends of atrial fibrillation and/or rheumatic heart disease-related ischemic stroke, and anticoagulant use in Chinese population: An 8-year study
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中国人群房颤和/或风湿性心脏病相关缺血性卒中的时间趋势以及抗凝药物的使用：一项为期 8 年的研究
DOI：
10.1016/j.ijcard.2020.08.046
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发表时间：
2021-01-01
影响因子：
3.5
通讯作者：
Liu，Ming
中科院分区：
文献类型：
--
作者：
Liu，Junfeng;Wang，Yanan;Liu，Ming
背景和目的缺血性卒中合并房颤(房颤)和/或风湿性心脏病(风湿性心脏病)患者抗凝药物使用不足是全球关注的问题，尤其是在中国。然而，中国患者在房颤和/或风湿性心脏病相关的缺血性卒中中抗凝药物使用不足的程度尚未得到很好的描述。我们旨在探讨中国人群中房颤和/或风湿性心脏病相关的缺血性卒中患者的时间趋势、抗凝药物的使用情况以及抗凝药物使用不佳的相关因素。方法选择2010年1月1日至2017年12月31日四川大学中国西医院神经内科收治的急性缺血性卒中患者。比较了两个时期(2010-2011年、2012-2013年、2014-2015年和2016-2017年)与房颤和风湿性心脏病相关的缺血性卒中的时间趋势。结果在2010年至2017年纳入的4357例急性缺血性卒中患者中，823例(18.9%)与房颤和/或风湿性心脏病(≤)相关。在这8年中，风湿性心脏病缺血性中风的比例从2010-2011年的7.8%显著下降到2016-2017年的4.5%，而房颤缺血性中风的比例没有观察到减少。房颤和/或风湿性心脏病患者出院时使用抗凝药物的比例增加(从26.4%增加到45.1%，P为Trend<；0.001)，而接受抗血小板治疗的比例随着时间的延长而减少(从56.0%下降到30.0%，P为趋势<；0.001)。出院时非维生素K拮抗剂(NOAC)的使用率仍然较低(2.1%)。年龄较大(每5年增加一次，OR 1.91，95%CI 1.28-2.86)，入院时NIHSS评分较高(OR 1.08，95%CI 1.05-1.11)，存在无症状性出血转化(OR 2.54，95%CI 1.67-3.94)和症状性出血转化(OR 3.04，95%可信区间1.14~9.73)与出院时未使用抗凝剂独立相关。然而，入院前有房颤/风湿性心脏病和抗凝的患者在出院时接受抗凝治疗的可能性更大。结论在中国的缺血性卒中人群中，抗凝药物的使用有所增加，但仍然很少。需要进一步研究如何改善缺血性卒中患者出院时的抗凝使用，包括获得NOAC。
Background and PurposeUnderuse of anticoagulants in ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) is a global concern, especially in China. However, the extent to which anticoagulants are underused in AF and/or RHD-related ischemic stroke in China has not been well characterized. We aimed to explore the temporal trends of AF and/or RHD-related ischemic stroke patients, anticoagulation use and factors related to suboptimal use of anticoagulants in a Chinese population.MethodsAcute ischemic stroke patients admitted to department of neurology, West China hospital, Sichuan university were included from January 1st 2010 to December 31st 2017. Temporal trends of AF and RHD related ischemic strokes were compared over 2 year epochs (2010–2011, 2012–2013, 2014–2015 and 2016–2017). Multivariable logistic regression models were performed to evaluate the variables associated with non-anticoagulants at discharge.ResultsOf 4357 acute ischemic stroke patients (≤7 days after onset) included between 2010 and 2017, 823(18.9%) were AF and/or RHD-related. Over the 8 years, the proportion of RHD-ischemic stroke decreased significantly from 7.8% in 2010–2011 to 4.5% in 2016–2017, whereas no reduction in AF-ischemic stroke was observed. There was an increase in the proportion of AF and/or RHD patients who were prescribed anticoagulants at discharge (from 26.4% to 45.1%, P for trend<0.001), while the proportion given antiplatelet therapy decreased with time (from 56.0% to 30.0%, P for trend<0.001). The use of non-vitamin K antagonist oral anticoagulants (NOAC) use at discharge remained low during the study period (2.1%).Older age (per 5 years increase, OR 1.91, 95% CI 1.28–2.86), higher NIHSS score on admission(OR 1.08, 95% CI 1.05–1.11), the presence of non-symptomatic hemorrhagic transformation(OR 2.54, 95% CI 1.67–3.94) and symptomatic hemorrhagic transformation(OR 3.04, 95% CI 1.14–9.73) were independently associated with non-anticoagulant use at discharge. However, patients with a prior diagnosis of AF/RHD and anticoagulation before admission were more likely to receive anticoagulants at discharge.ConclusionsIn an ischemic stroke population in China we found an increasing but still low use of anticoagulation. Further research is required on how to improve anticoagulation use at discharge in ischemic stroke patients, including access to NOAC's.