Abstract: Objective To investigate the current status of anticoagulant therapy in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) in Jiaxing. Methods This retrospective analysis enrolled the AIS inpatients with AF in Jiaxing between January 2016 and December 2020 from the Computer Analysing System to Improve Stroke Management Quality Evaluation-Ⅱ (CASE-Ⅱ) stroke registration database. The patients were divided into anticoagulation group and non-anticoagulation group according to whether they received anticoagulants or not at discharge. The baseline characteristics of the two groups were compared, and multivariate logistic regression analysis was used to determine the influencing

factors for using anticoagulants at discharge. The influencing factors for using anticoagulants in the

patients with AF and high stroke risk (CHA2DS2-VASc≥2 points) were analyzed. Results A total of 2005 patients were included, with a mean age of 77±8 years old and 979 (48.8%) males. The median baseline NIHSS was 5 (2-13). 83.9% (1525/1817) of them received antithrombotic drugs at discharge, of which 41.3% (750/1817) received anticoagulants. Age (OR 0.964, 95%CI 0.952-0.976), baseline NIHSS score (OR 0.935, 95%CI 0.920-0.951), the length of hospital stay (OR 1.045, 95%CI 1.025-1.066), deep vein thrombosis (OR 2.797, 95%CI 1.472- 5.311), any intracranial hemorrhage during hospitalization (OR 0.085, 95%CI 0.038-0.188), gastrointestinal hemorrhage (OR 0.503, 95%CI 0.257-0.985) and pneumonia (OR 0.646, 95%CI 0.488-0.856) were independent influencing factors for receiving anticoagulation at discharge. Only 16.0% (153/954) of the AF patients with high stroke risk received anticoagulation, and younger (OR 0.957, 95%CI 0.938-0.975), lower systolic blood pressure (OR 0.985, 95%CI 0.977-0.993) and history of stroke/TIA (OR 2.773, 95%CI 1.954-3.936) were independent protective factors for receiving anticoagulation in the AF patients with high stroke risk. Conclusions The anticoagulation rate of AIS patients with AF in Jiaxing was low. Yonger, lower baseline NIHSS score, longer length of hospital stay, and deep vein thrombosis were positive influencing factors for anticoagulation, and any intracranial hemorrhage during hospitalization, gastrointestinal hemorrhage and pneumonia were negative influencing factors for anticoagulation.

Key words: Acute ischemic stroke; Atrial fibrillation; Anticoagulant therapy; Jiaxing

摘要： 目的 调查嘉兴地区急性缺血性卒中合并心房颤动患者的抗凝治疗现状。 方法 回顾性分析2016年1月-2020年12月基于CT临床数据采集系统对卒中医疗质量改进的研究登 记库-Ⅱ（computer analysing system to improve stroke management quality evaluation-Ⅱ，CASE-Ⅱ）中的 嘉兴地区卒中中心登记的急性缺血性卒中合并心房颤动住院患者的信息。根据患者出院是否带有抗 凝药物分为出院抗凝组与出院未抗凝组，比较两组患者的基本特征，采用logistic回归分析出院抗凝 药物使用的影响因素；并进一步在既往诊断心房颤动且卒中高危（CHA2DS2-VASc≥2分）患者亚群中分 析抗凝药物使用的影响因素。 结果 共纳入患者2005例，平均年龄77±8岁，男性979例（48.8%），NIHSS中位评分5（2～13）分。 无抗血栓治疗禁忌证患者1817例，出院时带抗血栓药物比例为83.9%（1525/1817），其中抗凝药 物比例为41.3%（750/1817）。年龄（OR 0.964，95%CI 0.952～0.976），基线NIHSS评分（OR 0.935， 95%CI 0.920～0.951），住院时间（OR 1.045，95%CI 1.025～1.066），深静脉血栓（OR 2.797， 95%CI 1.472～5.311），住院期间是否发生任意的颅内出血（OR 0.085，95%CI 0.038～0.188）、消化 道出血（OR 0.503，95%CI 0.257～0.985）、肺炎（OR 0.646，95%CI 0.488～0.856）是急性缺血性卒中 合并心房颤动患者出院接受抗凝治疗与否的独立影响因素。既往诊断心房颤动且卒中高危患者接受 抗凝治疗比例仅为16.0%（153/954），低龄（OR 0.957，95%CI 0.938～0.975）、低收缩压（OR 0.985， 95%CI 0.977～0.993）、卒中/TIA病史（OR 2.773，95%CI 1.954～3.936）是其接受抗凝治疗的独立保护 因素。 结论 嘉兴地区急性缺血性卒中合并心房颤动患者的抗凝治疗率较低，低龄、低基线NIHSS评分、 长住院时间、合并深静脉血栓的患者更多接受抗凝治疗，住院期间发生颅内出血、消化道出血和肺炎 的患者更少接受抗凝治疗。

关键词: 急性缺血性卒中; 心房颤动; 抗凝治疗; 嘉兴