RT期刊文章SR电子T1协会替代抗凝策略和结果在缺血性中风患者采取直接口服抗凝摩根富林明神经病学神经学乔FD Lippincott Williams &威尔金斯10.1212 SP / WNL。首页0000000000207422 10.1212 / WNL。0000000000207422 A1姚明圣文德Ip A1亏Kai刘A1 Ho Ko A1卢卡斯刘A1艾伦黄姚A1优雅于A1特里Cheuk-Fung Yip A1信义愣A1霍华德陈A1海伦陈A1文森特Mok A1 Yannie O.Y. A1大卫Seiffge A1 -秀托马斯W梁年2023 UL //www.ez-admanager.com/content/early/2023/05/24/WNL.0000000000207422.abstract AB背景和目标:缺血性中风尽管直接口服抗凝剂(DOAC)是越来越普遍,预示着随后的缺血性首页中风的风险很高。抗血栓形成的治疗方案的临床疗效和安全性之后,条件尚不清楚。我们旨在比较缺血性中风患者的结果尽管DOAC没有另一种抗血栓形成的方案,并确定在抗凝治疗缺血性中风复发的危险因素。方法:以人群为基础的倾向评分加权,回顾性队列研究中,我们比较的临床结果DOAC-to-warfarin开关,DOAC-to-DOAC开关(DOACswitch)或添加抗血小板药物,与不变DOAC方案(DOACsame) non-valvular心房纤颤(NVAF)第一缺血性中风患者尽管DOAC从2015年1月1日到2020年12月31日在香港。主要结果是复发性缺血性中风。二次结果颅内出血,急性冠脉综合征和死亡。我们进行竞争风险回归分析比较临床端点,并确定缺血性中风复发的预测在一个未加权的多变量逻辑回归模型。结果:6年的研究期间,在45946年在DOAC中风预防房颤患者,2908例缺血性中风尽管DOAC开发。2337年NVAF患者包括在最终的分析。DOACsame相比,华法林(aHR 1.96, 95%可信区间1.27 - -3.02,p = 0.002)和DOACswitch (aHR 1.62, 95%可信区间1.25 - -2.11,p < 0.001)与复发性缺血性中风的风险增加有关。 In DOACsame group, adjunctive antiplatelet agent was not associated with reduced risk of recurrent ischemic stroke. Diabetes mellitus, concurrent cytochrome P450/P-glycoprotein (CYP/P-gp) modulators and large artery atherosclerotic disease (LAD) were predictors of recurrent ischemic stroke.Discussion: In NVAF patients with ischemic stroke despite DOAC, the increased risk of recurrent ischemic stroke with switching to warfarin called for caution against such practice, while the increased ischemic stroke with DOAC-to-DOAC switch demands further studies. Adjunctive antiplatelet agent did not appear to reduce ischemic stroke relapse. As diabetes mellitus, use of CYP/P-gp modulators and LAD were predictors of recurrent ischemic stroke, further investigations should evaluate if strict glycemic control, DOAC level monitoring and routine screening for carotid and intracranial atherosclerosis may reduce ischemic stroke recurrence in these patients.Classification of Evidence: This study provides Class II evidence that in patients with non-valvular atrial fibrillation suffering an ischemic stroke while being treated with a DOAC, continuing treatment with that DOAC is more effective at preventing recurrent ischemic stroke than switching to a different DOAC or to warfarin.

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