Anticoagulation after Anterior Myocardial Infarction and the Risk of Stroke 英文参考文献.docVIP

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Anticoagulation after Anterior Myocardial Infarction and the Risk of Stroke 英文参考文献.doc

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Anticoagulation after Anterior Myocardial Infarction and the Risk of Stroke 英文参考文献

AnticoagulationafterAnteriorMyocardialInfarctionand theRiskofStroke JacobA.Udell1,2,3*,JulieT.Wang1,DavidJ.Gladstone1,2,JackV.Tu1,2 1Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, 2Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario,Canada,3DivisionofCardiovascularMedicine,DepartmentofMedicine,BrighamandWomen’sHospital,Boston,Massachusetts,UnitedStatesofAmerica Abstract Background: Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonlypatientsaredischargedondualantiplatelettherapy.Giventhefrequencyofearlycoronaryreperfusionandrisk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulationtherapyforthepreventionofstrokeafteranteriorMI. MethodsandFindings:Weperformedapopulation-basedcohortanalysisof10,383patientswhosurvivedhospitalization foranacuteMIinOntario,CanadafromApril1,1999toMarch31,2001.Theprimaryoutcomewasfour-yearischemicstroke ratescomparedbetweenanteriorandnon-anteriorMIpatients.RiskfactorsforstrokewereassessedbymultivariateCox proportional-hazards analysis. Warfarin use was determined at discharge and followed for 90 days among a subset of patients aged66 andolder (n=1483).Among the10,383 patients studied,2,942 patientssurvived hospitalization foran anteriorMIand20%weredischargedonanticoagulationtherapy.Within4years,169patients(5.7%)wereadmittedwithan ischemicstroke,halfofwhichoccurredwithin1-yearpost-MI.Therewasnosignificantdifferenceinstrokeratebetween anteriorandnon-anteriorMIpatients.Theuseofwarfarinupto90dayswasnotassociatedwithstrokeprotectionafter anterior MI (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.37–1.26). The use of angiotensin-converting-enzyme inhibitors(HR,0.65;95%CI,0.44–0.95)andbeta-blockers(HR,0.60;95%CI,0.41–0.87)wereassociatedwithasignificant decreaseinstrokerisk.Therewasnosignificantdifferenceinbleeding-relatedhospi