Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation. Issue 3 (5th February 2019)

• Record Type: Journal Article
• Authors: Tokunaga, Keisuke; Koga, Masatoshi; Itabashi, Ryo; Yamagami, Hiroshi; Todo, Kenichi; Yoshimura, Sohei; Kimura, Kazumi; Sato, Shoichiro; Terasaki, Tadashi; Inoue, Manabu; Shiokawa, Yoshiaki; Takagi, Masahito; Kamiyama, Kenji; Tanaka, Kanta; Takizawa, Shunya; Shiozawa, Masayuki; Okuda, Satoshi; Okada, Yasushi; Kameda, Tomoaki; Nagakane, Yoshinari; Hasegawa, Yasuhiro; Shibuya, Satoshi; Ito, Yasuhiro; Matsuoka, Hideki; Takamatsu, Kazuhiro; Nishiyama, Kazutoshi; Kario, Kazuomi; Yagita, Yoshiki; Fujita, Kyohei; Ando, Daisuke; Kumamoto, Masaya; Arihiro, Shoji; Toyoda, Kazunori;
• Other Names: Takasugi Junji investigator.; Higashida Kyoko investigator.; Sakamoto Yuki investigator.; Hirano Teruyuki investigator.; Suzuki Rieko investigator.; Nakagawara Jyoji investigator.; Homma Kazunari investigator.; Tanaka Eijirou investigator.; Akiyama Hisanao investigator.; Mochizuki Hiroshi investigator.; Nakashima Takahiro investigator.; Shibazaki Kensaku investigator.; Furui Eisuke investigator.; Maeda Koichiro investigator.; Endo Kaoru investigator.; Miyagi Tetsuya investigator.; Osaki Masato investigator.; Kobayashi Junpei investigator.; Okata Takuya investigator.; Takizawa Hotake investigator.; Matsuki Takayuki investigator.; Kinoshita Naoto investigator.; Matsubara Soichiro investigator.; Ide Toshihiro investigator.; Yoshimoto Takeshi investigator.; Kamimura Teppei investigator.; Kikuno Muneaki investigator.; Mizoguchi Tadataka investigator.; Sato Takeo investigator.; Nagatsuka Kazuyuki investigator.; Minematsu Kazuo investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 3(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-02-05
• Subjects: anticoagulation -- atrial fibrillation -- ischemic stroke -- outcome -- transient ischemic attack; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.010593
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: We aimed to clarify associations between prior anticoagulation and short‐ or long‐term clinical outcomes in ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation. Methods and Results: A total of 1189 ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation who were hospitalized within 7 days after onset were analyzed. Of these, 813 patients (68.4%) received no prior anticoagulation, 310 (26.1%) received prior warfarin treatment with an international normalized ratio (INR) <2 on admission, 28 (2.4%) received prior warfarin treatment with an INR ≥2 on admission, and the remaining 38 (3.2%) received prior direct oral anticoagulant treatment. Prior warfarin treatment was associated with a lower risk of death or disability at 3 months compared with no prior anticoagulation (INR <2: adjusted odds ratio: 0.58; 95% CI, 0.42–0.81; P =0.001; INR ≥2: adjusted odds ratio: 0.40; 95% CI, 0.16–0.97; P =0.043) but was not associated with a lower risk of death or disability at 2 years. Prior warfarin treatment with an INR ≥2 on admission was associated with a higher risk of ischemic events within 2 years compared with no prior anticoagulation (adjusted hazard ratio: 2.94; 95% CI, 1.20–6.15; P =0.021). Conclusions: Prior warfarin treatment was associated with a lower risk of death or disability at 3 months but was not associated with a lower risk of death or disability at 2 years in ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation. Prior warfarin treatment with an INR ≥2 on admission was associated with a higher risk of ischemic events within 2 years. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01581502.