Antithrombotic treatment at onset of stroke with atrial fibrillation, functional outcome, and fatality: a systematic review and meta-analysis

作者：Hannon Niamh; Arsava Ethem M; Audebert Heinrich J; Ay Hakan; Crowe Morgan; Ni Chroinin Danielle; Furie Karen; McGorrian Catherine; Molshatzki Noa; Murphy Sean; Noone Imelda; O'Donnell Martin; Schenkel Johannes; Tan Kit M; Tanne David; Kelly Peter J^*

来源：International Journal of Stroke, 2015, 10(6): 808-814.

DOI：10.1111/ijs.12473

• anticoagulation
• atrial fibrillation
• prevention
• stroke
• warfarin

BackgroundIn atrial fibrillation-associated stroke, conflicting data exist regarding association between therapeutic vitamin K-antagonist anticoagulation (International Normalized Ratio 2-3) and early death and functional outcome, and few data exist relating to late outcome in ischemic and haemorrhagic atrial fibrillation-stroke.
AimWe performed a systematic review and meta-analysis of oral anticoagulation at stroke onset, death and functional outcome.
MethodsWe performed a systematic review, searching multiple sources. Studies were included if outcomes in atrial fibrillation-associated stroke were reported stratified by pre-stroke antithrombotic status, with documented International Normalized Ratio at onset. Outcomes were survival and good functional outcome (modified Rankin score 0-2) at discharge/30 days, and at one-year.
ResultsOf eight studies (3552 patients) in ischemic stroke, International Normalized Ratio2 compared with other treatments (International Normalized Ratio<2, antiplatelet, or no antithrombotic) was associated with good outcome [pooled odds ratio 19 (95% confidence interval) 15-25, P<0001] and improved survival at 30 daysdischarge (pooled odds ratio for death 04, confidence interval 02-05, P<0001). The net benefit remained after inclusion of haemorrhagic stroke (odds ratio for good outcome 189, confidence interval 145-246, P<0001). At one-year, improved functional outcome for International Normalized Ratio2 (pooled odds ratio 17, confidence interval 10-27, P=004) and survival (odds ratio for death 05, confidence interval 04-08, P=0001) were also observed.
ConclusionsTherapeutic International Normalized Ratio at stroke onset was associated with early and late improved survival and functional recovery suggesting sustained benefit for warfarin anticoagulation for stroke outcome in atrial fibrillation patients. Long-term outcome data following stroke in patients taking new oral anticoagulants is required.

• 出版日期2015-8