目的:在房颤患者中,口服抗凝治疗适用于卒中/全身性栓塞的一级和二级预防.尽管在过去十年的初期,直接口服抗凝剂已被引入临床实践,其安全性和有效性高于华法林。即使是现在,也不是所有房颤患者都有足够的预防性抗凝治疗.本研究的主要目的是评估既往使用口服抗凝药对房颤患者入院卒中严重程度的影响。其他目标是,除其他外,评估2012-2021年在捷克共和国进行的HISTORY试验以及在缺血性卒中(IS)患者中使用口服抗凝药(OAC)的年度房颤患病率趋势.
方法:我们分析了2012年在ClinicalTrials.gov(标识符NCT01541163)注册的HISTORY(心脏和缺血性STROke关系研究)研究中的连续缺血性卒中患者,并进行了年度比较(详见正文)。
结果:总计,有1059名患者(55.9%为男性,平均年龄71.7±12.8)。在该时间段内,已知率没有显着差异(18.3与16.5%,P=0.442)或新检测到的AF(17.0vs.16.0%,P=0.665),但在2021年,更多已知房颤患者在IS之前接受了口服抗凝剂治疗(32.1vs.70.7%,P<0.0001),和直接口服抗凝剂(3.6vs.35.4%,P<0.0001)。多年来,房颤患者的数量没有显着变化(26.2vs.31.3%)。OAC患者在美国国立卫生研究院卒中量表(NIHSS)上的中位入院得分低于不使用口服抗凝剂的患者(6vs.16,P=0.0004),2021年。
结论:2012年至2021年期间收治的卒中患者房颤没有显著上升趋势,但2021年已知房颤患者使用口服抗凝剂和直接口服抗凝剂(DOAC)的频率明显更高。在2021年,OAC患者的入院NIHSS评分低于未使用任何抗凝药物的患者。在2012年,接受OAC治疗的患者和未接受OAC治疗的患者之间的中位入院NIHSS差异不显着(6vs.12,P=0.066)。这可能与以下事实有关:2012年DOAC的患者要少得多,被认为比华法林更有效。
OBJECTIVE: In patients with atrial fibrillation, oral anticoagulation therapy is indicated for both primary and secondary prevention of stroke/systemic embolism. Though direct oral anticoagulants with greater safety and efficacy than warfarin were introduced into clinical practice at the beginning of the last decade, even now not all patients with AF have adequate preventative anticoagulant treatment. The primary goal of this study was to evaluate the impact of prior use of oral anticoagulants on admission stroke severity in those with AF. Other aims were, inter alia, to assess the trend in atrial fibrillation prevalence in the years of the HISTORY trials 2012-2021 carried out in the Czech Republic and use of oral anticoagulants (OAC) in ischemic stroke (IS) patients.
METHODS: We analyzed consecutive ischemic stroke patients who had been enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (identifier NCT01541163) in the year 2012 and carried out a yearly comparison (detailed in the text).
RESULTS: In total, there were 1059 patients (55.9% males, mean age 71.7±12.8). There was no significant difference over the time period in rate of known (18.3 vs. 16.5%, P=0.442) or newly detected AF (17.0 vs. 16.0%, P=0.665), but sigificantly more patients with known AF were treated with oral anticoagulants before IS in the year 2021 (32.1 vs. 70.7%, P<0.0001), and direct oral anticoagulants (3.6 vs. 35.4%, P<0.0001). The number of patients with atrial fibrillation had not changed significantly over the years (26.2 vs. 31.3%). Patients on OAC had a lower median admission score on the National Institutes of Health Stroke Scale (NIHSS) than those not using an oral anticoagulant (6 vs. 16, P=0.0004) in 2021.
CONCLUSIONS: There was no significant upward trend in atrial fibrillation in stroke patients admitted between 2012 and 2021, but patients with known AF were significantly more frequently treated with oral anticoagulants and direct oral anticoagulants (DOAC) in 2021. Patients on OAC had lower admission NIHSS scores than those not using any anticoagulent in the year 2021. The difference in the median admission NIHSS between the patients on OAC and those without OAC treatment was not significant in the year 2012 (6 vs. 12, P=0.066). This might be related to the fact that substantially fewer patients in 2012 were on DOACs, which are considered more effective than warfarin.