Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation - SAMURAI-NVAF Study -

被引：37

作者：

Yoshimura, Sohei ^{[1
,8
,9
]}

Koga, Masatoshi ^{[1
]}

Sato, Shoichiro ^{[1
]}

Todo, Kenichi ^{[3
]}

Yamagami, Hiroshi ^{[2
]}

Kumamoto, Masaya ^{[1
]}

Itabashi, Ryo ^{[4
]}

Terasaki, Tadashi ^{[5
]}

Kimura, Kazumi ^{[6
]}

Yagita, Yoshiki ^{[7
]}

Shiokawa, Yoshiaki

Kamiyama, Kenji ^{[10
]}

Okuda, Satoshi ^{[11
]}

Okada, Yasushi ^{[12
]}

Takizawa, Shunya ^{[13
]}

Hasegawa, Yasuhiro ^{[14
]}

Kameda, Tomoaki ^{[15
]}

Shibuya, Satoshi ^{[16
]}

Nagakane, Yoshinari ^{[17
]}

Ito, Yasuhiro ^{[18
]}

Matsuoka, Hideki ^{[19
]}

Takamatsu, Kazuhiro ^{[20
]}

Nishiyama, Kazutoshi ^{[21
]}

Fujita, Kyohei ^{[1
]}

Kamimura, Teppei ^{[2
]}

Ando, Daisuke ^{[1
]}

Ide, Toshihiro ^{[1
]}

Yoshimoto, Takeshi ^{[2
]}

Shiozawa, Masayuki ^{[1
]}

Matsubara, Soichiro ^{[1
]}

Yamaguchi, Yoshitaka ^{[1
]}

Kinoshita, Naoto ^{[2
]}

Matsuki, Takayuki ^{[1
]}

Takasugi, Junji ^{[2
]}

Tokunaga, Keisuke ^{[1
]}

Higashida, Kyoko ^{[2
]}

Homma, Kazunari ^{[13
]}

Kario, Kazuomi ^{[15
]}

Arihiro, Shoji ^{[1
]}

Toyoda, Kazunori ^{[1
]}

机构：

[1] Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, 5-7-1 Fujishirodai, Suita, Osaka 5658565, Japan

[2] Natl Cerebral & Cardiovasc Ctr, Dept Neurol, Suita, Osaka, Japan

[3] Kobe City Med Ctr Gen Hosp, Dept Neurol, Kobe, Hyogo, Japan

[4] Kohnan Hosp, Dept Stroke Neurol, Sendai, Miyagi, Japan

[5] Japanese Red Cross Kumamoto Hosp, Dept Neurol, Kumamoto, Japan

[6] Nippon Med Coll Hosp, Grad Sch Med, Dept Neurol Sci, Tokyo, Japan

[7] Kawasaki Med Sch, Dept Stroke Med, Kurashiki, Okayama, Japan

[8] Kyorin Univ, Dept Neurosurg, Sch Med, Mitaka, Tokyo, Japan

[9] Kyorin Univ, Stroke Ctr, Sch Med, Mitaka, Tokyo, Japan

[10] Nakamura Mem Hosp, Dept Neurosurg, Sapporo, Hokkaido, Japan

[11] NHO Nagoya Med Ctr, Dept Neurol, Nagoya, Aichi, Japan

[12] NHO Kyushu Med Ctr, Dept Neurol & Cerebrovasc Med, Fukuoka, Japan

[13] Tokai Univ, Dept Neurol, Sch Med, Isehara, Kanagawa, Japan

[14] St Marianna Univ, Dept Neurol, Sch Med, Kawasaki, Kanagawa, Japan

[15] Jichi Med Univ, Sch Med, Div Neurol, Shimotsuke, Japan

[16] South Miyagi Med Ctr, Dept Neurol, Ogawara, Japan

[17] Kyoto Second Red Cross Hosp, Dept Neurol, Kyoto, Japan

[18] TOYOTA Mem Hosp, Dept Neurol, Toyota, Japan

[19] NHO Kagoshima Med Ctr, Dept Cerebrovasc Med, Kagoshima, Japan

[20] Ohta Mem Hosp, Dept Neurol, Fukuyama, Hiroshima, Japan

[21] Kitasato Univ, Sch Med, Dept Neurol, Sagamihara, Kanagawa, Japan

来源：

CIRCULATION JOURNAL | 2018年 / 82卷 / 07期

关键词：

Acute stroke; Atrial fibrillation; Direct oral anticoagulants; Intracranial hemorrhage; Warfarin; JAPANESE PATIENTS; WARFARIN; RISK; DABIGATRAN; METAANALYSIS; MORTALITY;

D O I：

10.1253/circj.CJ-18-0067

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan. Methods and Results: NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS(2) and discharge modified Rankin Scale scores than warfarin users (P<0.0001 each). Incidences of stroke/systemic embolism (adjusted hazard ratio, 1.07; 95% CI, 0.66-1.72), all ischemic events (1.13; 0.72-1.75), and ischemic stroke/TIA (1.58; 0.95-2.62) were similar between groups. Risks of intracranial hemorrhage (0.32; 0.09-0.97) and death (0.41; 0.26-0.63) were significantly lower for DOAC users. Infection was the leading cause of death, accounting for 40% of deaths among warfarin users. Conclusions: Stroke/TIA patients receiving DOACs for secondary prevention were younger and had lower stroke severity and risk indices than those receiving warfarin. Estimated cumulative incidences of stroke and systemic embolism within 2 years were similar between warfarin and DOACs users, but those of death and intracranial hemorrhage were significantly lower among DOAC users.

引用

页码：1935 / +

页数：10

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