研究者在加拿大中風注冊表中篩選出2003-2008年間2162例確診為急性缺血性中風合并急性心房顫動的患者。本研究對死亡與因復發性缺血性腦卒中、心肌梗死，嚴重大出血入院的基本復合終點進行了研究。與只接受口服抗凝藥的患者相比，僅接受抗血小板治療或無抗血栓治療患者的上述復合終末事件風險增加。
作者指出口服抗凝藥可以作為心房顫動患者缺血性腦卒的二級預防措施。在這項研究中，30%的患者在出院后沒有接受口服抗凝治療，另外30%接受口服抗凝劑聯合抗血小板治療。作者認為，該結果反應出現實生活對患者的照顧與臨床試驗中的設置相脫節。
TAKE-HOME MESSAGE
Investigators searched the Registry of the Canadian Stroke Network to
identify 2162 patients who were admitted to stroke centers with acute
ischemic stroke and atrial fibrillation between 2003 and 2008. The
primary outcome of the study was a composite of death or admission for
recurrent ischemic stroke, myocardial infarction, or major bleeding.
Compared with patients who received oral anticoagulants alone, patients
who received antiplatelet therapy alone or no antithrombotic therapy had
an increased risk for experiencing the primary outcome. The authors
note that current guidelines recommend oral anticoagulation alone for
the secondary prevention of ischemic stroke in patients with atrial
fibrillation. In this study, 30% of patients received no oral
anticoagulant therapy at hospital discharge, and another 30% were
prescribed both an oral anticoagulant and an antiplatelet agent.
The authors suggest that the findings reflect the disconnect in
caring for patients in real-life practice and the setting of clinical
trials.
Stroke; A Journal of Cerebral Circulation