The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation（AF）is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-relate...The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation（AF）is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome（P ／ 0.001） and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were：heart failure（P = 0.045）; high systolic pressure（P = 0.039）; high blood glucose（P = 0.030）; and a high National Institutes of Health Stroke Scale（NIHSS） score（P ／ 0.001）. Moreover, high systolic pressure at admission（P = 0.007）, high blood glucose（P = 0.027）, and a high NIHSS score（P ／ 0.001） were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score（P = 0.006） and warfarin taken within 48 h before stroke onset（P = 0.032） were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.展开更多
Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.M...Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway(2013–2019).We included all consecutive patients with ICH from both registries.The main outcomes were favourable functional outcome(modified Rankin Scale 0–2)and mortality at 3 months.Results Among 11349 patients with ICH(mean age 73.6 years;47.6%women),1491(13.1%)were taking VKAs and 1205(10.6%)DOACs(95.2%factor Xa inhibitors).The median percentage of patients on prior anticoagulation was 23.7(IQR 22.6–25.1)with VKAs decreasing(from 18.3%to 7.6%)and DOACs increasing(from 3.0%to 18.0%)over time.Prior VKA therapy(n=209(22.3%);adjusted ORs(aOR),0.64;95%CI,0.49 to 0.84)and prior DOAC therapy(n=184(25.7%);aOR,0.64;95%CI,0.47 to 0.87)were independently associated with lower odds of favourable outcome compared with patients without anticoagulation(n=2037(38.8%)).Prior VKA therapy(n=720(49.4%);aOR,1.71;95%CI,1.41 to 2.08)and prior DOAC therapy(n=460(39.7%);aOR,1.28;95%CI,1.02 to 1.60)were independently associated with higher odds of mortality compared with patients without anticoagulation(n=2512(30.2%)).Conclusions The spectrum of anticoagulation-associated ICH changed over time.Compared with patients without prior anticoagulation,prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3.展开更多
基金supported by the National Natural Science Foundation of China(81230026 and 81171085)the Natural Science Foundation of Jiangsu Province,China(BL2012013)the Science Foundation of the Bureau of Health of Jiangsu Province,China(LJ201101)
文摘The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation（AF）is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome（P ／ 0.001） and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were：heart failure（P = 0.045）; high systolic pressure（P = 0.039）; high blood glucose（P = 0.030）; and a high National Institutes of Health Stroke Scale（NIHSS） score（P ／ 0.001）. Moreover, high systolic pressure at admission（P = 0.007）, high blood glucose（P = 0.027）, and a high NIHSS score（P ／ 0.001） were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score（P = 0.006） and warfarin taken within 48 h before stroke onset（P = 0.032） were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.
文摘Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway(2013–2019).We included all consecutive patients with ICH from both registries.The main outcomes were favourable functional outcome(modified Rankin Scale 0–2)and mortality at 3 months.Results Among 11349 patients with ICH(mean age 73.6 years;47.6%women),1491(13.1%)were taking VKAs and 1205(10.6%)DOACs(95.2%factor Xa inhibitors).The median percentage of patients on prior anticoagulation was 23.7(IQR 22.6–25.1)with VKAs decreasing(from 18.3%to 7.6%)and DOACs increasing(from 3.0%to 18.0%)over time.Prior VKA therapy(n=209(22.3%);adjusted ORs(aOR),0.64;95%CI,0.49 to 0.84)and prior DOAC therapy(n=184(25.7%);aOR,0.64;95%CI,0.47 to 0.87)were independently associated with lower odds of favourable outcome compared with patients without anticoagulation(n=2037(38.8%)).Prior VKA therapy(n=720(49.4%);aOR,1.71;95%CI,1.41 to 2.08)and prior DOAC therapy(n=460(39.7%);aOR,1.28;95%CI,1.02 to 1.60)were independently associated with higher odds of mortality compared with patients without anticoagulation(n=2512(30.2%)).Conclusions The spectrum of anticoagulation-associated ICH changed over time.Compared with patients without prior anticoagulation,prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3.
