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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (3): 536-542. doi: 10.19723/j.issn.1671-167X.2026.03.013

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Prognostic analysis of anticoagulation therapy in elderly patients with cardioembolic stroke

Qingwei MENG1, Meng FAN2, Huangda GUO3, Hanyu ZHANG3, Mengying WANG4,5, Siyue WANG3, Hexiang PENG6, Xueheng WANG3, Tianjiao HOU3, Xueying QIN3,4, Dafang CHEN3,4, Jing LI3,4, Yiqun WU3,4, Tao WU3,4,*(), Hongbo CHEN1,*(), Yonghua HU3,4   

  1. 1. Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing 102400, China
    2. Human Resources Center, Aerospace Center Hospital, Beijing 100049, China
    3. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    4. Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Beijing 100191, China
    5. Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing 100191, China
    6. Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha 410013, China
  • Received:2025-11-12 Online:2026-06-18 Published:2026-04-24
  • Contact: Tao WU, Hongbo CHEN
  • Supported by:
    the National Key Research and Development Program of China(2024YFC3606700); the National Natural Science Foundation of China(82473716); the National Natural Science Foundation of China(81230066)

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Abstract:

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.

Key words: Cardiogenic stroke, Anticoagulant therapy, All-cause mortality, Recurrent stroke, Hemorrhage

CLC Number: 

  • R181.3

Table 1

Baseline information of patients with cardiogenic stroke"

Characteristics Anticoagulated (n=142) Not anticoagulated (n=425) P value
Age/years, $\bar x \pm s$ 69.99±9.46 75.24±9.43 < 0.001
Gender, n (%) 0.827
  Female 212 (49.88) 73 (51.41)
  Male 213 (50.12) 69 (48.59)
Smoking, n (%) 58 (41.13) 180 (42.45) 0.860
Drinking, n (%) 28 (20.29) 74 (18.41) 0.718
Hypertension, n (%) 104 (74.82) 349 (82.12) 0.079
Diabetes, n (%) 38 (27.34) 141 (33.25) 0.232
Antiplatelet drugs, n (%) 12 (8.96) 294 (70.33) < 0.001
CHA2DS2-VASc, M (P25, P75) 4 (3, 5) 5 (4, 6) < 0.001
HAS-BLED, M (P25, P75) 3 (2, 3) 3 (3, 3) < 0.001
INR, M (P25, P75) 1.10 (1.04, 1.35) 1.07 (1.02, 1.15) < 0.001
TC/mmol/L, $\bar x \pm s$ 4.06±0.84 4.29±0.97 0.033
TG/mmol/L, $\bar x \pm s$ 1.23±0.82 1.15±0.64 0.379
HDL-C/mmol/L, $\bar x \pm s$ 1.31±0.39 1.36±0.37 0.030
LDL-C/mmol/L, $\bar x \pm s$ 2.14±0.71 2.29±0.76 0.026

Table 2

Association between anticoagulant therapy and mortality risk in patients with cardiogenic stroke"

Model OR (95%CI) P value
Model 1 0.48 (0.31, 0.73) < 0.001
Model 2 0.22 (0.12, 0.38) < 0.001
Model 3 0.22 (0.12, 0.42) < 0.001
Model 3 (IPTW method) 0.21 (0.09, 0.50) < 0.001

Table 3

Association between anticoagulant therapy and mortality risk in subgroups of cardioembolic stroke patients"

Variable OR (95%CI) P value P for interaction
Gender 0.465
  Male 0.19 (0.06, 0.51) 0.002
  Female 0.23 (0.10, 0.54) < 0.001
Smoking 0.921
  Yes 0.21 (0.07, 0.63) 0.006
  No 0.21 (0.09, 0.47) < 0.001
Drinking 0.243
  Yes 0.41 (0.03, 5.41) 0.507
  No 0.20 (0.10, 0.39) < 0.001
Hypertension 0.976
  Yes 0.24 (0.11, 0.49) < 0.001
  No 0.16 (0.04, 0.61) 0.010
Diabetes 0.822
  Yes 0.17 (0.05, 0.52) 0.003
  No 0.25 (0.11, 0.56) < 0.001

Table 4

Association between anticoagulant therapy and recurrent stroke risk in cardioembolic stroke patients"

Model OR (95%CI) P value
Model 1 2.71 (1.71, 4.29) < 0.001
Model 2 2.27 (1.22, 4.24) 0.010
Model 3 1.87 (0.94, 3.75) 0.077
Model 3 (IPTW method) 2.34 (0.99, 5.56) 0.053
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