老年人心源性卒中抗凝治疗的预后

Prognostic analysis of anticoagulation therapy in elderly patients with cardioembolic stroke

摘要

目的：系统评估抗凝治疗与老年心源性卒中患者远期预后（全因死亡、卒中复发及出血事件）的关联，为老年人群的临床决策提供参考。方法：采用回顾性队列研究设计，对北京市房山区良乡医院的 567 例老年心源性卒中患者进行4年随访，主要结局指标包括全因死亡、脑卒中复发以及出血事件（包括颅内出血、消化道出血、泌尿系统出血、牙龈出血和皮肤黏膜出血）。采用多因素 Logistic 回归分析抗凝治疗与各结局指标的关联，使用 R 4.2.2软件进行统计分析。结果：共纳入 567 例老年心源性卒中患者，平均年龄（49.74%,567）岁，男性占比 18.87%例患者中142（25.04％）例患者接受了抗凝治疗。随访期内有266例死亡（粗死亡率46.91％），107例脑卒中复发（累积复发率 4.94%）， 28 例出血（累积出血率 $\mathit{O}\mathit{R}=\mathrm{0.22,95}\mathrm{\%}\mathit{C}\mathit{I}:\mathrm{0.12,0.41},\mathit{P}<0.001$）。多因素 Logistic 回归显示，接受抗凝治疗患者的死亡风险更低（ ^1*）；未发现抗凝治疗与患者脑卒中复发和出血风险的关联（$P>$0.05）。结论：抗凝治疗有利于降低老年心源性卒中患者的全因死亡风险，同时未发现抗凝治疗与卒中复发或出血风险增加相关；本研究支持在老年心源性卒中患者中考虑抗凝治疗以改善远期生存，但仍需更大样本量的前瞻性研究进一步验证结果。

Abstract

Objective：To systematically evaluate the association between anticoagulant therapy and long-term outcomes（all-cause mortality，stroke recurrence，and hemorrhage events）in elderly patients with cardiogenic stroke，thereby providing evidence for clinical decision-making. Methods：A retrospec- tive cohort study design was adopted.A total of 567 elderly patients with cardiogenic stroke from Liang- xiang Hospital in Fangshan District，Beijing，were followed up for 4 years.The primary outcomes included all-cause mortality，stroke recurrence，and hemorrhage events（including intracranial hemorrhage，gas- trointestinal bleeding，urinary system bleeding，gingival bleeding，and skin and mucosal hemorrhage）. Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome.All statistical analyses were performed using R software（version 4.2.2）. Results：A to- tal of 567 elderly patients were included in this study，with a mean age of（49.74%）years and 25.04% being male.Among them， 142 patients（46.91%）received anticoagulant therapy.During the follow-up period， 266 deaths occurred（crude mortality rate： 18.87%）， 107 patients had stroke recur-rence（cumulative recurrence incidence： 4.94%），and 28 patients experienced bleeding events（cu- mulative hemorrhage incidence： (OR=）.Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death $\mathrm{0.22,95}\mathrm{\%}\mathit{C}\mathit{I}:\mathrm{0.12,0.41},\mathit{P}<0.001$ (P>0.05)）.No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage ⩾80. Conclusion：Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke，and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage.The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with car- diogenic stroke，and larger prospective studies are still needed to further validate the findings.

关键词

心源性卒中 / 抗凝治疗 / 全因死亡 / 脑卒中复发 / 出血

Key words

Cardiogenic stroke / Anticoagulant therapy / All-cause mortality / Recurrent stroke / Hemorrhage

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基金资助

国家重点研发计划(2024YFC3606700)

国家自然科学基金(82473716)

国家自然科学基金(81230066)