PDF(Pubmed)
Abstract：
UNASSIGNED: Atrial fibrillation-related stroke (AF-stroke) is associated with an adverse prognosis, characterized by a high incidence of progression, recurrence, and hemorrhagic transformation. Our study aims to investigate the potential benefits of stratified early administration of apixaban, taking into account infarct size during the acute phase, in order to enhance functional outcomes.
UNASSIGNED: We conducted this study at a tertiary referral stroke center, enrolling acute AF-stroke patients who received apixaban during the acute phase. Infarct size was categorized as small, medium, or large based on diffusion-weighted imaging. Patients were divided into two groups: standard initiation (apixaban initiation based on guidelines, i.e., small: 4 days, medium: 7 days, large: 14 days after stroke) and early initiation (initiation before guideline recommendations) groups. We compared favorable outcomes (modified Rankin scale score ≤ 2) at 3 months post-stroke, stroke progression, early recurrence, and symptomatic hemorrhagic transformation (sHT) between the groups.
UNASSIGNED: Out of 299 AF-stroke patients, 170 (56.9%) were in the early initiation group. A favorable outcome was observed in 105 (61.8%) patients in the early initiation group and 62 (48.1%) patients in the standard initiation group (p = 0.019). Stroke progression or early recurrence occurred less frequently in the early initiation group (4.7% versus 13.2%, p = 0.007). Nevertheless, no difference in sHT was noted between the groups. Early initiation of apixaban was independently associated with favorable outcomes (odds ratio: 2.75, 95% confidence interval: 1.44-5.28, p = 0.002).
UNASSIGNED: Our findings suggest that early initiation of apixaban, tailored to infarct size, could serve as a viable strategy to enhance functional outcomes. This approach may potentially decrease stroke progression and early recurrence without elevating the risk of sHT.
UNASSIGNED: We conducted this study at a tertiary referral stroke center, enrolling acute AF-stroke patients who received apixaban during the acute phase. Infarct size was categorized as small, medium, or large based on diffusion-weighted imaging. Patients were divided into two groups: standard initiation (apixaban initiation based on guidelines, i.e., small: 4 days, medium: 7 days, large: 14 days after stroke) and early initiation (initiation before guideline recommendations) groups. We compared favorable outcomes (modified Rankin scale score ≤ 2) at 3 months post-stroke, stroke progression, early recurrence, and symptomatic hemorrhagic transformation (sHT) between the groups.
UNASSIGNED: Out of 299 AF-stroke patients, 170 (56.9%) were in the early initiation group. A favorable outcome was observed in 105 (61.8%) patients in the early initiation group and 62 (48.1%) patients in the standard initiation group (p = 0.019). Stroke progression or early recurrence occurred less frequently in the early initiation group (4.7% versus 13.2%, p = 0.007). Nevertheless, no difference in sHT was noted between the groups. Early initiation of apixaban was independently associated with favorable outcomes (odds ratio: 2.75, 95% confidence interval: 1.44-5.28, p = 0.002).
UNASSIGNED: Our findings suggest that early initiation of apixaban, tailored to infarct size, could serve as a viable strategy to enhance functional outcomes. This approach may potentially decrease stroke progression and early recurrence without elevating the risk of sHT.
摘要：
■心房颤动相关性卒中（AF-卒中）与不良预后相关，以进展发生率高为特征，复发,和出血性转化。我们的研究旨在探讨阿哌沙班分层早期给药的潜在益处，考虑到急性期的梗死面积，以增强功能成果。
■我们在三级转诊卒中中心进行了这项研究，招募急性期接受阿哌沙班治疗的急性房颤卒中患者。梗死面积被归类为小，中等,或基于扩散加权成像的大。患者分为两组：标准起始（根据指南，即，小:4天,中号：7天，大：卒中后14天）和早期开始（在指南建议之前开始）组。我们比较了卒中后3个月的有利结局（改良Rankin量表评分≤2），中风进展,早期复发,两组之间有症状的出血性转化（sHT）。
■在299名房颤卒中患者中，早期启动组170例（56.9%）。早期启动组105例（61.8％）患者和标准启动组62例（48.1％）患者观察到良好的预后（p=0.019）。早期启动组的卒中进展或早期复发发生率较低（4.7%对13.2%，p=0.007)。然而，两组间sHT无差异.阿哌沙班的早期开始与有利的结果独立相关（比值比：2.75，95％置信区间：1.44-5.28，p=0.002）。
■我们的研究结果表明，阿哌沙班的早期开始，根据梗死面积量身定做，可以作为增强功能成果的可行策略。这种方法可能会减少卒中进展和早期复发，而不会增加sHT的风险。
■我们在三级转诊卒中中心进行了这项研究，招募急性期接受阿哌沙班治疗的急性房颤卒中患者。梗死面积被归类为小，中等,或基于扩散加权成像的大。患者分为两组：标准起始（根据指南，即，小:4天,中号：7天，大：卒中后14天）和早期开始（在指南建议之前开始）组。我们比较了卒中后3个月的有利结局（改良Rankin量表评分≤2），中风进展,早期复发,两组之间有症状的出血性转化（sHT）。
■在299名房颤卒中患者中，早期启动组170例（56.9%）。早期启动组105例（61.8％）患者和标准启动组62例（48.1％）患者观察到良好的预后（p=0.019）。早期启动组的卒中进展或早期复发发生率较低（4.7%对13.2%，p=0.007)。然而，两组间sHT无差异.阿哌沙班的早期开始与有利的结果独立相关（比值比：2.75，95％置信区间：1.44-5.28，p=0.002）。
■我们的研究结果表明，阿哌沙班的早期开始，根据梗死面积量身定做，可以作为增强功能成果的可行策略。这种方法可能会减少卒中进展和早期复发，而不会增加sHT的风险。
