心源性栓塞相关缺血性卒中抗凝治疗启动时机的研究进展与临床共识

Research Progress and Clinical Consensus on the Timing of Anticoagulation Therapy Initiation in Ischemic Stroke Related to Cardiogenic Embolism

摘要: 心源性栓塞(Cardiogenic Embolism, CE)后抗凝治疗的启动时机是神经心脏病学领域的核心争议点，其核心矛盾在于平衡早期卒中复发风险与出血转化风险。传统“经验性延迟”策略已被近年来高质量临床研究颠覆，形成“基于影像分层的个体化早期抗凝”新范式。本文系统梳理2022年以来的关键随机对照试验(RCT)与荟萃分析证据，结合2024年欧洲心脏病学会心房颤动管理指南(2024 ESC Guidelines for the Management of Atrial Fibrillation)、2024年美国心脏协会/美国卒中协会卒中一级预防指南(2024 Guideline for the Primary Prevention of Stroke: A Guideline from the American Heart Association/American Stroke Association)等最新推荐，从历史演变、核心证据、分层管理、特殊人群处理及未来方向五个维度，全面阐述CE后抗凝治疗时间窗的研究进展与临床实践共识，为临床决策提供循证依据。

Abstract: The timing of anticoagulation therapy initiation after Cardiogenic Embolism (CE) is a core controversy in the field of neurocardiology, with the central contradiction being balancing the risk of early stroke recurrence against the risk of hemorrhagic transformation. The traditional “empirical delayed” strategy has been overturned by high-quality clinical studies in recent years, forming a new paradigm of “image-based stratified individualized early anticoagulation”. This paper systematically reviews the key Randomized Controlled Trials (RCTs) and meta-analysis evidence since 2022, combined with the latest recommendations such as the 2024 ESC Guidelines for the Management of Atrial Fibrillation and the 2024 Guideline for the Primary Prevention of Stroke: A Guideline from the American Heart Association/American Stroke Association. From five dimensions, including historical evolution, core evidence, stratified management, management of special populations, and future directions, it comprehensively elaborates on the research progress and clinical practice consensus regarding the time window of anticoagulation therapy after CE, providing evidence-based basis for clinical decision-making.