Secondary stroke prevention in atrial fibrillation - Lessons from clinical practice
Secondary stroke prevention in atrial fibrillation - Lessons from clinical practice
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DOI：
10.1161/01.str.31.9.2106
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发表时间：
2000-09-01
期刊：
影响因子：
8.3
通讯作者：
Kalra, L
中科院分区：
文献类型：
--
作者：
Evans, A;Perez, I;Kalra, L
背景和目的：二级预防试验没有根据中风原因区分结果。该研究的目的是确定抗凝二级预防的试验效果是否可以在不同病因的中风的临床实践中复制。方法：288例卒中合并心房颤动患者（平均年龄76岁，55%为女性）接受抗凝治疗，维持国际标准化比值2.0:3.0，进行为期2年的观察研究。比较：(1)患者特征、抗凝控制、每年卒中/出血率与欧洲房颤试验的比较；(2)卒中复发的原因与卒中初始亚型的比较。结果：与相应的试验数据相比，受试者年龄大了5岁（95% CI为3 ~ 7年），发生小血管卒中的患者更多（26%对14%；95% CI为3% ~ 17%）。在目标抗凝范围内的持续时间（55%对59%）、卒中复发率（5.1%对3.6% /年）、主要（2.3%对2.2% /年）或轻微（9.5%对11.8% /年）出血率与随机研究中接受华法林治疗的患者相当。14例栓塞复发中有10例（71%）发生在既往心脏栓塞发作的患者中，11例腔隙性复发中有8例（73%）发生在既往腔隙性卒中作为抗凝合格事件的患者中（P=0.025）。在充分抗凝治疗期间，14例心脏栓塞复发中只有3例发生，11例腔隙性复发中只有8例发生。结论：在临床实践中，抗凝用于二级卒中预防的效果与随机试验相当。接近26%的符合条件的中风和40%的复发是非栓塞性的；在作出治疗决定时应考虑脑卒中亚型。
Background and Purpose-Secondary prevention trials do not distinguish outcomes according to stroke cause. The purpose of the study was to determine whether trial efficacy of anticoagulation for secondary prevention could be replicated in clinical practice in strokes of different etiology.Methods-A 2-year observation study was undertaken in 288 stroke patients with atrial fibrillation (mean age 76 years; 55% women) who were receiving anticoagulation therapy to maintain an international normalized ratio of 2.0 to 3.0. Comparisons were made of(1) patient characteristics, anticoagulation control, and annual stroke/hemorrhage rates with those of the European Atrial Fibrillation Trial and (2) cause of recurrent stroke by initial stroke subtype.Results-Subjects were 5 years older (95% CI 3 to 7 years), and more patients had small-vessel stroke (26% versus 14%; 95% CI 3% to 17%) compared with corresponding trial data. The duration spent in the target anticoagulation range (55% versus 59%), recurrent stroke rate (5.1% versus 3.6% per year), and major (2.3% versus 2.2% per year) or minor (9.5% versus 11.8% per year) hemorrhage races were comparable with those in patients receiving warfarin in the randomized study. Ten of 14 (71%) of embolic recurrences occurred in patients with a previous cardioembolic episode, and 8 of 11 (73%) lacunar recurrences occurred in patients with previous lacunar stroke as the qualifying event for anticoagulation (P=0.025). Only 3 of 14 cardioembolic compared with 8 of 11 lacunar recurrences occurred during adequate anticoagulation.Conclusions-Anticoagulation for secondary stroke prevention in clinical practice achieves outcomes comparable with those of randomized trials. Nearly 26% of qualifying strokes and 40% of recurrences were nonembolic; stroke subtype should be considered when making treatment decisions.