期刊
NEUROLOGY
卷 89, 期 7, 页码 687-696出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0000000000004235
关键词
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资金
- Imperial College London
- St. Mary's development fund
- National Institute for Health Research Imperial Biomedical Research Centre
- Dutch Heart Foundation [2009B046]
- Spanish Ministry of Health-Instituto de Salud Carlos III: Redes tematicas de Investigacion Cooperativa [INVICTUS RD012/0014/0002]
- Fondo Europeo de Desarrollo Regional
- Canadian Stroke Network (CSN)
- Ontario Ministry of Health and Long-Term Care (MOHLTC)
- Institute for Clinical Evaluative Sciences (ICES)
- Ontario MOHLTC
Objective: To perform a systematic review and meta-analysis of studies reporting recurrent intracranial hemorrhage (ICH) and ischemic stroke (IS) in ICH survivors with atrial fibrillation (AF) during long-term follow-up. Methods: A comprehensive literature search including MEDLINE, EMBASE, Cochrane library, clinical trials registry was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We considered studies capturing outcome events (ICH recurrence and IS) for $ 3 months and treatment exposure to vitamin K antagonists (VKAs), antiplatelet agents (APAs), or no antithrombotic medication (no-ATM). Corresponding authors provided aggregate data for IS and ICH recurrence rate between 6 weeks after the event and 1 year of follow-up for each treatment exposure. Meta-analyses of pooled rate ratios (RRs) were conducted with the inverse variance method. Results: Seventeen articles met inclusion criteria. Seven observational studies enrolling 2,452 patients were included in the meta-analysis. Pooled RR estimates for IS were lower for VKAs compared to APAs (RR = 0.45, 95% confidence interval [CI] 0.27-0.74, p = 0.002) and no-ATM (RR = 0.47, 95% CI 0.29-0.77, p 5 0.002). Pooled RR estimates for ICH recurrence were not significantly increased across treatment groups (VKA vs APA: RR 5=1.34, 95% CI 0.79-2.30, p = 0.28; VKA vs no-ATM: RR 5 0.93, 95% CI 0.45-1.90, p = 0.84). Conclusions: In observational studies, anticoagulation with VKA is associated with a lower rate of IS than APA or no-ATM without increasing ICH recurrence significantly. A randomized controlled trial is needed to determine the net clinical benefit of anticoagulation in ICH survivors with AF.
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