研究者在加拿大中风注册表中筛选出2003-2008年间2162例确诊为急性缺血性中风合并急性心房颤动的患者。本研究对死亡与因复发性缺血性脑卒中、心肌梗死，严重大出血入院的基本复合终点进行了研究。与只接受口服抗凝药的患者相比，仅接受抗血小板治疗或无抗血栓治疗患者的上述复合终末事件风险增加。

   作者指出口服抗凝药可以作为心房颤动患者缺血性脑卒的二级预防措施。在这项研究中，30%的患者在出院后没有接受口服抗凝治疗，另外30%接受口服抗凝剂联合抗血小板治疗。作者认为，该结果反应出现实生活对患者的照顾与临床试验中的设置相脱节。

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   Investigators searched the Registry of the Canadian Stroke Network to identify 2162 patients who were admitted to stroke centers with acute ischemic stroke and atrial fibrillation between 2003 and 2008.  The primary outcome of the study was a composite of death or admission for recurrent ischemic stroke, myocardial infarction, or major bleeding. Compared with patients who received oral anticoagulants alone, patients who received antiplatelet therapy alone or no antithrombotic therapy had an increased risk for experiencing the primary outcome. The authors note that current guidelines recommend oral anticoagulation alone for the secondary prevention of ischemic stroke in patients with atrial fibrillation. In this study, 30% of patients received no oral anticoagulant therapy at hospital discharge, and another 30% were prescribed both an oral anticoagulant and an antiplatelet agent.

   The authors suggest that the findings reflect the disconnect in caring for patients in real-life practice and the setting of clinical trials.

   Stroke; A Journal of Cerebral Circulation