Background and Purpose- Ischemic stroke associated with nonvalvular atrial fibrillation (NVAF) despite prior anticoagulation may indicate underlying problems that nullify the stroke-preventing effects of oral anticoagulants. We aimed to evaluate the risk for recurrent stroke in patients with NVAF with prior anticoagulation, compared with that in patients without prior anticoagulation. Methods- This study comprised pooled individual patient data on NVAF-associated acute ischemic stroke or transient ischemic attack from 2011 to 2014 arising from the Clinical Research Collaboration for Stroke in Korea (15 South Korean stroke centers) and the Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-NVAF registry (18 Japanese stroke centers). Data on 4841 eligible patients from the Clinical Research Collaboration for Stroke in Korea registry were pooled with data on all patients (n=1192) in the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry. The primary outcome was recurrent ischemic stroke. The secondary outcomes were hemorrhagic stroke and all-cause death. Outcome events were captured up to 1 year after the index event. Results- Among the 6033 patients in the full cohort, 5645 patients were analyzed, of whom 1129 patients (20.0%) had received prior anticoagulation. Median age was 75 years (interquartile range, 69-81 years), and 2649 patients (46.9%) were women. Follow-up data of 4617 patient-years (median follow-up 365 days, interquartile range 335-365 days) were available. The cumulative incidence of recurrent ischemic stroke in patients with prior anticoagulation was 5.3% (60/1129), compared with the 2.9% (130/4516) incidence in patients without prior anticoagulation. The risk for recurrent ischemic stroke was higher in patients with prior anticoagulation than in those without (multivariable Cox shared-frailty model, hazard ratio 1.50 [95% CI, 1.02-2.21]). No significant differences in the risks for hemorrhagic stroke and mortality were seen between the 2 groups. Conclusions- The risk for recurrent ischemic stroke may be higher in NVAF-associated stroke patients with prior anticoagulation than in those without prior anticoagulation. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01581502.

中文翻译：

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房颤相关的缺血性卒中患者先有抗凝治疗，复发性卒中的风险较高。

背景与目的：尽管事先进行了抗凝治疗，但与非瓣膜性心房颤动（NVAF）相关的缺血性中风可能表明潜在的问题使口服抗凝剂的中风预防作用无效。我们旨在评估先有抗凝治疗的NVAF患者与未先抗凝治疗的患者再次发生中风的风险。方法-这项研究收集了2011年至2014年间由韩国中风临床研究合作组织（15个韩国中风中心）和具有紧急风险的中风急性管理引起的NVAF相关急性缺血性中风或短暂性脑缺血发作的患者个体数据因子评估和改善-NVAF注册中心（18个日本卒中中心）。将来自韩国卒中临床研究协作组的4841名合格患者的数据与所有具有急性危险因素评估和改进NVAF登记的卒中急性治疗中的所有患者（n = 1192）进行汇总。主要结局是复发性缺血性中风。次要结果是出血性中风和全因死亡。结果事件是在索引事件后长达1年内捕获的。结果-在整个队列的6033例患者中，分析了5645例患者，其中1129例患者（20.0％）接受了抗凝治疗。中位年龄为75岁（四分位间距为69-81岁），女性为2649名患者（占46.9％）。有4617个患者年的随访数据（中位随访365天，四分位间距335-365天）。接受过抗凝治疗的患者复发性缺血性卒中的累积发生率为5.3％（60/1129），而没有接受抗凝治疗的患者为2.9％（130/4516）。既往接受抗凝治疗的患者复发缺血性卒中的危险性高于未接受抗凝治疗的患者（多变量Cox共享脆弱模型，危险比1.50 [95％CI，1.02-2.21]）。两组之间出血性中风的风险和死亡率没有显着差异。结论-既往接受抗凝治疗的NVAF相关卒中患者复发缺血性卒中的风险可能高于未接受抗凝治疗的患者。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01581502。未经事先抗凝治疗的患者发生率为9％（130/4516）。既往接受抗凝治疗的患者复发缺血性卒中的危险性高于未接受抗凝治疗的患者（多变量Cox共享脆弱模型，危险比1.50 [95％CI，1.02-2.21]）。两组之间出血性中风的风险和死亡率没有显着差异。结论-既往接受抗凝治疗的NVAF相关卒中患者复发缺血性卒中的风险可能高于未接受抗凝治疗的患者。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01581502。未经事先抗凝治疗的患者发生率为9％（130/4516）。既往接受抗凝治疗的患者复发缺血性卒中的危险性高于未接受抗凝治疗的患者（多变量Cox共享脆弱模型，危险比1.50 [95％CI，1.02-2.21]）。两组之间出血性中风的风险和死亡率没有显着差异。结论-既往接受抗凝治疗的NVAF相关卒中患者复发缺血性卒中的风险可能高于未接受抗凝治疗的患者。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01581502。两组之间出血性中风的风险和死亡率没有显着差异。结论-既往接受抗凝治疗的NVAF相关卒中患者复发缺血性卒中的风险可能高于未接受抗凝治疗的患者。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01581502。两组之间出血性中风的风险和死亡率没有显着差异。结论-既往接受抗凝治疗的NVAF相关卒中患者复发缺血性卒中的风险可能高于未接受抗凝治疗的患者。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01581502。