How do anticoagulated atrial fibrillation patients who suffer ischemic stroke or spontaneous intracerebral hemorrhage differ?. Issue 5 (10th May 2018)

• Record Type: Journal Article
• Authors: Lehtola, Heidi; Hartikainen, Juha; Hartikainen, Päivi; Kiviniemi, Tuomas; Nuotio, Ilpo; Palomäki, Antti; Ylitalo, Antti; Airaksinen, K.E. Juhani; Mustonen, Pirjo
• Is Part Of: Clinical cardiology. Volume 41:Issue 5(2018)
• Page Start: 608
• Page End: 614
• Publication Date: 2018-05-10
• Subjects: Anticoagulation -- Atrial Fibrillation -- Intracerebral Hemorrhage -- Stroke; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22935
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract : Background: Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC‐treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). Hypothesis: We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin. Methods: FibStroke is a multicenter, retrospective registry collating details of AF patients with ischemic stroke/TIA or intracranial hemorrhage in 2003–2012. This substudy included AF patients on OAC with first lifetime ischemic stroke/TIA or spontaneous ICH. Results: A total of 1457 patients with 1290 ischemic strokes/TIAs and 167 ICHs were identified. Of these, 553 (42.9%) strokes/TIAs and 96 (57.5%) ICHs occurred in patients with INR within therapeutic range. During OAC with therapeutic INR, congestive heart failure (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.18–4.58) and hypercholesterolemia (OR: 2.52, 95% CI: 1.51–4.19) were more common in patients with ischemic stroke/TIA, whereas a history of bleeding (OR: 0.30, 95% CI: 0.11–0.82) was less common when compared with patients with ICH. In the whole cohort, renal impairment (OR: 1.86, 95% CI: 1.23–2.80) and mechanical valve prosthesis (OR: 4.41, 95% CI: 1.32–14.7) were overrepresented in patients with stroke/TIA, whereas aspirin use (OR: 0.52, 95% CI: 0.30–0.91) and high INR (OR: 0.40, 95% CI: 0.33–0.48) were overrepresented in patients with ICH. Conclusions: In anticoagulated AF patients with therapeutic INR and first lifetime cerebrovascular event, congestive heart failure and hypercholesterolemia were associated with ischemic stroke/TIA and history of bleeding with ICH.