文摘
摘要目的:我们比较治疗后临床结果与直接抗凝剂(DOAC)和维生素k拮抗剂(VKA)在最近的一次缺血性中风或TIA患者和心房纤颤(房颤)。
背景:风险和收益的早期管理DOAC最近缺血性中风或TIA后房颤患者知之甚少。
设计/方法:我们进行了一次个别病人7前瞻性群组研究的数据分析。我们包括房颤患者和一个缺血性中风或TIA开始前3个月内口服抗凝。我们分析之间的关系类型的抗凝(DOAC比VKA)与复合主要终点(复发性缺血性中风(AIS)颅内出血[我],或死亡率)使用混合效果Cox比例风险回归模型和灰色模型竞争风险;我们计算调整风险比率(人力资源)和95%置信区间(95% CI)。
结果:我们包括4912名患者(平均年龄78岁(IQR 71 - 84);其中2331名(47.5%)妇女)4739(96.5%)缺血性中风事件指数(发病署在中位数5[差- 12]);2256例(45.9%)患者接受VKA和2656年(54.1%)DOAC。从索引中值时间事件开始口服抗凝治疗5天(VKA差2 - 14),5天(DOAC差2 - 11)(p = 0.53)。有262 AIS(4.4% /年),71年我(1.2% /年)和439人死亡(7.4% /年)在5970年的总后续白细胞数量。VKA相比,DOAC治疗与降低风险的复合端点(HR 0.81, 95%可信区间0.66 - -0.98,p = 0.03)和我(HR 0.42, 95%可信区间0.25 - -0.72,p < 0.01);我们没有发现复发的风险差异的AIS (HR 0.92, 95%可信区间0.70 - -1.20,p = 0.53)和死亡率(HR 0.84, 95%可信区间0.68 - -1.04,p = 0.11)。
结论:DOAC治疗开始后平均与房颤相关的脑缺血后5天与风险降低有关贫穷的临床结果VKA相比,主要是由于我的风险较低。
披露:Seiffge博士没有披露。Paciaroni博士没有披露。威尔逊博士没有披露。甲贺博士没有披露。玛莎没有披露博士。Cappellari博士没有披露。Schaedelin博士没有披露。Shakeshaft博士没有披露。高木涉博士没有披露。Tsivgoulis博士没有披露。 Dr. Bonetti has nothing to disclose. Dr. Kallmünzer has nothing to disclose. Dr. Arihiro has nothing to disclose. Dr. Alberti has nothing to disclose. Dr. Polymeris has nothing to disclose. Dr. Ambler has nothing to disclose. Dr. Yoshimura has nothing to disclose. Dr. Venti has nothing to disclose. Dr. Bonati has nothing to disclose. Dr. Muir has nothing to disclose. Dr. Yamagami has nothing to disclose. Dr. Thilemann has nothing to disclose. Dr. Altavilla has nothing to disclose. Dr. Peters has nothing to disclose. Dr. Inoue has nothing to disclose. Dr. Bobinger has nothing to disclose. Dr. Agnelli has nothing to disclose. Dr. Brown has nothing to disclose. Dr. Sato has nothing to disclose. Dr. Acciarresi has nothing to disclose. Dr. Jager has nothing to disclose. Dr. Bovi has nothing to disclose. Dr. Schwab has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boehringer Ingelheim. Dr. Schwab has received research support from Boehringer Ingelheim. Dr. Lyrer has nothing to disclose. Dr. Caso has nothing to disclose. Dr. Toyoda has nothing to disclose. Dr. Werring has nothing to disclose. Dr. Engelter has nothing to disclose. Dr. De Marchis has nothing to disclose.
