Objective: To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making.
Methods: A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2).
Results: A total of 567 elderly patients were included in this study, with a mean age of (73.92±9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05).
Conclusion: Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.
目的: 系统评估抗凝治疗与老年心源性卒中患者远期预后(全因死亡、卒中复发及出血事件)的关联，为老年人群的临床决策提供参考。
方法: 采用回顾性队列研究设计，对北京市房山区良乡医院的567例老年心源性卒中患者进行4年随访，主要结局指标包括全因死亡、脑卒中复发以及出血事件(包括颅内出血、消化道出血、泌尿系统出血、牙龈出血和皮肤黏膜出血)。采用多因素Logistic回归分析抗凝治疗与各结局指标的关联，使用R 4.2.2软件进行统计分析。
结果: 共纳入567例老年心源性卒中患者，平均年龄(73.92±9.70)岁，男性占比49.74%，567例患者中142(25.04%)例患者接受了抗凝治疗。随访期内有266例死亡(粗死亡率46.91%)，107例脑卒中复发(累积复发率18.87%)，28例出血(累积出血率4.94%)。多因素Logistic回归显示，接受抗凝治疗患者的死亡风险更低(OR=0.22, 95%CI：0.12, 0.41, P < 0.001)；未发现抗凝治疗与患者脑卒中复发和出血风险的关联(P>0.05)。
结论: 抗凝治疗有利于降低老年心源性卒中患者的全因死亡风险，同时未发现抗凝治疗与卒中复发或出血风险增加相关；本研究支持在老年心源性卒中患者中考虑抗凝治疗以改善远期生存，但仍需更大样本量的前瞻性研究进一步验证结果。
Keywords: All-cause mortality; Anticoagulant therapy; Cardiogenic stroke; Hemorrhage; Recurrent stroke.