Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study  

作　　者：Angelos Sharobeam Longting Lin Christina Lam Carlos Garcia-Esperon Yash Gawarikar Ronak Patel Matthew Lee-Archer Andrew Wong Michael Roizman Amanda Gilligan Andrew Lee Kee Meng Tan Susan Day Christopher Levi Stephen M Davis Mark Parsons Bernard Yan 

机构地区：[1]Melbourne Brain Centre at Royal Melbourne Hospital,Parkville,Victoria,Australia [2]University of New South Wales South Western Sydney Clinical School,Liverpool,New South Wales,Australia [3]Department of Neurology,John Hunter Hospital,Newcastle,New South Wales,Australia [4]Department of Neurology,Calvary Public Hospital,Canberra,Australian Capital Territory,Australia [5]Department of Neurology,Northern Hospital Epping,Epping,Victoria,Australia [6]Department of Neurology,Royal Brisbane and Women's Hospital,Herston,Queensland,Australia [7]The University of Queensland School of Medicine,Herston,Queensland,Australia [8]Neurosciences Clinical Institute,Epworth Healthcare,Richmond,Virginia,Australia [9]Department of Neurology,Austin Health,University of Melbourne,Heidelberg,Victoria,Australia [10]Flinders University College of Medicine and Public Health,Adelaide,South Australia,Australia [11]Department of Neurology,Gold Coast University Hospital,Southport,Queensland,Australia [12]The University of Sydney Northern Clinical School,St Leonards,New South Wales,Australia [13]Department of Neurology and Neurophysiology,Liverpool Hospital,Liverpool,New South Wales,Australia

出　　处：《Stroke & Vascular Neurology》2024年第1期30-37,I0034,共9页卒中与血管神经病学（英文）

摘　　要：Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic lesions.We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(<4days)vs late(≥4days)anticoagulation.We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.Methods A prospective multicentre,observational cohort study was performed at 11 Australian stroke centres.Clinical and MRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two authors.Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.Results We recruited 276 patients of whom 208 met the eligibility criteria.The average age was 74.2 years(SD±10.63),and 79(38%)patients were female.Median National Institute of Health Stroke Scale score was 5(IQR 1–12).Median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation timing.Conclusion Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF patients.There is no increased rate of haemorrhage with early anticoagulation.These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe,but randomised c

关 键 词：PATIENTS LESIONS ISCHAEMIC 

分 类 号：R743.3[医药卫生—神经病学与精神病学]