在以人群为基础的卒中登记中,10年来口服抗凝剂相关脑出血的流行病学和结果

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-06-01 Epub Date: 2023-12-24 DOI:10.1177/17474930231218594
Francesca Gabriele, Matteo Foschi, Francesco Conversi, Davide Ciuffini, Federica De Santis, Berardino Orlandi, Federico De Santis, Raffaele Ornello, Simona Sacco
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引用次数: 0

摘要

背景:近年来,由于直接口服抗凝剂(DOACs)作为维生素K拮抗剂(vka)的替代品的可用性以及房颤的检测增加,普通人群抗凝剂的使用发生了变化。重要的是要有最新的流行病学数据,以了解这种变化如何影响脑出血(ICH)的发生和结局。患者和方法:我们的前瞻性基于人群的登记包括2011年1月至2020年12月首次发生脑出血的患者。口服抗凝剂(OAC)相关的脑出血被定义为在服用DOAC或VKAs后48小时内发生的脑出血,与入院时测量的国际标准化比率无关。结果:我们纳入了748例首次ICH,其中108例(14.4%)与oac相关。其中,75例(69.4%)发生在VKA, 33例(30.6%)发生在DOAC。OAC-ICH的发生率随时间稳定(p=0.226)。在OAC-ICH中,我们观察到DOAC-ICH的总发病率增加(P为趋势)。结论:2011年至2020年期间,OAC-ICH的总发病率没有变化,但OAC-ICH从主要与vka相关转变为主要与doac相关。OAC-ICH患者的死亡率高于非OAC-ICH患者。
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Epidemiology and outcomes of intracerebral hemorrhage associated with oral anticoagulation over 10 years in a population-based stroke registry.

Background: Recent years have seen a change in the use of anticoagulants in the general population due to the availability of direct oral anticoagulants (DOACs) as an alternative to vitamin K antagonists (VKAs) and increased detection of atrial fibrillation. It is important to have updated epidemiological data to understand how this change is impacting on the occurrence and outcome of intracerebral hemorrhage (ICH).

Patients and methods: Our prospective population-based registry included patients with first-ever ICH occurring from January 2011 to December 2020. Oral anticoagulants (OAC)-related ICH was defined as an ICH occurring within 48 h from the intake of DOAC or VKAs, regardless of the measured international normalized ratio on hospital admission.

Results: We included 748 first-ever ICH, of whom 108 (14.4%) were OAC-related. Specifically, 75 (69.4%) ICHs occurred on VKA and 33 (30.6%) on DOAC. The incidence of oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) was stable over time (p = 0.226). Among OAC-ICHs, we observed an increase in the overall incidence of DOAC-ICH (p for trend < 0.001) which overcome that of VKA-ICH in 2020 (incidence rate ratio (IRR) 4.71, 95% confidence interval (CI): 1.22-33.54; p = 0.022). Patients with OAC-ICH showed higher 30-day case fatality rates than those with non-OAC-ICH (48.1% vs 34.1%; p = 0.007).

Conclusion: No changes over time were detected in the incidence of OAC-ICH, but throughout the study period, there was a change in OAC-ICH from mostly VKA-related to mostly DOAC-related. Mortality in patients with OAC-ICH was higher than in patients with non-OAC-ICH.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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