研究者在加拿大中風(fēng)注冊表中篩選出2003-2008年間2162例確診為急性缺血性中風(fēng)合并急性心房顫動的患者。本研究對死亡與因復(fù)發(fā)性缺血性腦卒中、心肌梗死，嚴重大出血入院的基本復(fù)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(fù)合終末事件風(fēng)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(yù)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(lián)合抗血小板治療。作者認為，該結(jié)果反映出現(xiàn)實生活對患者的照顧與臨床試驗中的設(shè)置相脫節(jié)。

   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