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.
■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。