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首页> 外文期刊>Annals of neurology >Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation
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Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation

机译：直接口服抗凝血剂与维生素K拮抗剂在心房颤动患者近期缺血性脑卒中后

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Objective We compared outcomes after treatment with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and a recent cerebral ischemia. Methods We conducted an individual patient data analysis of seven prospective cohort studies. We included patients with AF and a recent cerebral ischemia (<3 months before starting oral anticoagulation) and a minimum follow-up of 3 months. We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed-effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results We included 4,912 patients (median age, 78 years [interquartile range {IQR}, 71-84]; 2,331 [47.5%] women; median National Institute of Health Stroke Severity Scale at onset, 5 [IQR, 2-12]); 2,256 (45.9%) patients received VKAs and 2,656 (54.1%) DOACs. Median time from index event to starting oral anticoagulation was 5 days (IQR, 2-14) for VKAs and 5 days (IQR, 2-11) for DOACs (p = 0.53). There were 262 acute ischemic strokes (AISs; 4.4%/year), 71 intracranial hemorrrhages (ICHs; 1.2%/year), and 439 deaths (7.4%/year) during the total follow-up of 5,970 patient-years. Compared to VKAs, DOAC treatment was associated with reduced risks of the composite endpoint (HR, 0.82; 95% CI, 0.67-1.00; p = 0.05) and ICH (HR, 0.42; 95% CI, 0.24-0.71; p < 0.01); we found no differences for the risk of recurrent AIS (HR, 0.91; 95% CI, 0.70-1.19; p = 0.5) and mortality (HR, 0.83; 95% CI, 0.68-1.03; p = 0.09). Interpretation DOAC treatment commenced early after recent cerebral ischemia related to AF was associated with reduced risk of poor clinical outcomes compared to VKA, mainly attributed to lower risks of ICH. ANN NEUROL 2019;85:823-834.
机译：目的我们在用直接口服抗凝血剂（DOAC）和维生素K拮抗剂（VKAS）治疗后比较了心房颤动（AF）和最近的脑缺血。方法我们进行了七位前瞻性队列研究的个体患者数据分析。我们包括AF的患者和最近的脑缺血（<开始前3个月，在口服抗凝凝血前）和3个月的最低随访。我们用复合初级终点（复制缺血性脑卒序[AIS]，使用混合效应COX比例危害回归模型与复合初级终点（复发性缺血性脑卒中[AIS]，脑内出血[ICH]或死亡率）分析了抗凝血（DOAC与VKA）之间的关联;我们计算了95％置信区间（95％CIS）的调整后的危险比（HRS）。结果我们包括4,912名患者（中位年龄，78岁[四分位数范围{IQR}，71-84]; 2,331 [47.5％]妇女;中位国家卫生卒中研究所卒中严重程度，5 [IQR，2-12]） ; 2,256（45.9％）患者接受了VKA和2,656（54.1％）Doacs。从索引事件到开始口服抗凝的中位数为VKA的5天（IQR，2-14），DOAC的5天（IQR，2-11）（P = 0.53）。急性缺血性卒中（AISS; 4.4％/年），71个颅内出血（ICHS; 1.2％/年），439名死亡人数（7.4％/年），总随访5,970患者年。与VKA相比，DoAC处理与复合终点的风险降低有关（HR，0.82; 95％CI，0.67-1.00; P = 0.05）和ICH（HR，0.42; 95％CI，0.24-0.71; P <0.01 ）;我们发现没有反复性AIS的风险（HR，0.91; 95％CI，0.70-1.19; P = 0.5）和死亡率（HR，0.83; 95％CI，0.68-1.03; P = 0.09）的风险没有差异。解释Doac治疗在最近与AF相关的脑缺血早期开始，与VKA相比，与VKA相比，临床结果的风险降低，主要归因于ICH的较低风险。 Ann Neurol 2019; 85：823-834。

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