Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation
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...
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| Format: | Article |
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Wiley
2019-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010593 |
| _version_ | 1818393452011847680 |
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| author | Keisuke Tokunaga Masatoshi Koga Ryo Itabashi Hiroshi Yamagami Kenichi Todo Sohei Yoshimura Kazumi Kimura Shoichiro Sato Tadashi Terasaki Manabu Inoue Yoshiaki Shiokawa Masahito Takagi Kenji Kamiyama Kanta Tanaka Shunya Takizawa Masayuki Shiozawa Satoshi Okuda Yasushi Okada Tomoaki Kameda Yoshinari Nagakane Yasuhiro Hasegawa Satoshi Shibuya Yasuhiro Ito Hideki Matsuoka Kazuhiro Takamatsu Kazutoshi Nishiyama Kazuomi Kario Yoshiki Yagita Kyohei Fujita Daisuke Ando Masaya Kumamoto Shoji Arihiro Kazunori Toyoda |
| author_facet | Keisuke Tokunaga Masatoshi Koga Ryo Itabashi Hiroshi Yamagami Kenichi Todo Sohei Yoshimura Kazumi Kimura Shoichiro Sato Tadashi Terasaki Manabu Inoue Yoshiaki Shiokawa Masahito Takagi Kenji Kamiyama Kanta Tanaka Shunya Takizawa Masayuki Shiozawa Satoshi Okuda Yasushi Okada Tomoaki Kameda Yoshinari Nagakane Yasuhiro Hasegawa Satoshi Shibuya Yasuhiro Ito Hideki Matsuoka Kazuhiro Takamatsu Kazutoshi Nishiyama Kazuomi Kario Yoshiki Yagita Kyohei Fujita Daisuke Ando Masaya Kumamoto Shoji Arihiro Kazunori Toyoda |
| author_sort | Keisuke Tokunaga |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T05:45:32Z |
| format | Article |
| id | doaj.art-184917ae81a64df5a6f0331720a93bd2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T05:45:32Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-184917ae81a64df5a6f0331720a93bd22022-12-21T23:14:53ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-02-018310.1161/JAHA.118.010593Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial FibrillationKeisuke Tokunaga0Masatoshi Koga1Ryo Itabashi2Hiroshi Yamagami3Kenichi Todo4Sohei Yoshimura5Kazumi Kimura6Shoichiro Sato7Tadashi Terasaki8Manabu Inoue9Yoshiaki Shiokawa10Masahito Takagi11Kenji Kamiyama12Kanta Tanaka13Shunya Takizawa14Masayuki Shiozawa15Satoshi Okuda16Yasushi Okada17Tomoaki Kameda18Yoshinari Nagakane19Yasuhiro Hasegawa20Satoshi Shibuya21Yasuhiro Ito22Hideki Matsuoka23Kazuhiro Takamatsu24Kazutoshi Nishiyama25Kazuomi Kario26Yoshiki Yagita27Kyohei Fujita28Daisuke Ando29Masaya Kumamoto30Shoji Arihiro31Kazunori Toyoda32Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Stroke Neurology Kohnan Hospital Sendai JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Osaka University Graduate School of Medicine Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurological Science Graduate School of Medicine Nippon Medical School Tokyo JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Japanese Red Cross Kumamoto Hospital Kumamoto JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartments of Neurosurgery and Stroke Center Kyorin University School of Medicine Mitaka JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurosurgery Nakamura Memorial Hospital Sapporo JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Tokai University School of Medicine Isehara JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology NHO Nagoya Medical Center Nagoya JapanDepartment of Neurology and Cerebrovascular Medicine NHO Kyushu Medical Center Fukuoka JapanDivision of Neurology Jichi Medical University School of Medicine Shimotsuke JapanDepartment of Neurology Kyoto Second Red Cross Hospital Kyoto JapanDepartment of Neurology St Marianna University School of Medicine Kawasaki JapanDepartment of Neurology South Miyagi Medical Center Ogawara JapanDepartment of Neurology TOYOTA Memorial Hospital Toyota JapanDepartment of Cerebrovascular Medicine NHO Kagoshima Medical Center Kagoshima JapanDepartment of Neurology Brain Attack Center Ota Memorial Hospital Fukuyama JapanDepartment of Neurology Kitasato University School of Medicine Sagamihara JapanDivision of Cardiovascular Medicine Jichi Medical University School of Medicine Shimotsuke JapanDepartment of Stroke Medicine Kawasaki Medical School Kurashiki JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDivision of Stroke Care Unit National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.118.010593anticoagulationatrial fibrillationischemic strokeoutcometransient ischemic attack |
| spellingShingle | Keisuke Tokunaga Masatoshi Koga Ryo Itabashi Hiroshi Yamagami Kenichi Todo Sohei Yoshimura Kazumi Kimura Shoichiro Sato Tadashi Terasaki Manabu Inoue Yoshiaki Shiokawa Masahito Takagi Kenji Kamiyama Kanta Tanaka Shunya Takizawa Masayuki Shiozawa Satoshi Okuda Yasushi Okada Tomoaki Kameda Yoshinari Nagakane Yasuhiro Hasegawa Satoshi Shibuya Yasuhiro Ito Hideki Matsuoka Kazuhiro Takamatsu Kazutoshi Nishiyama Kazuomi Kario Yoshiki Yagita Kyohei Fujita Daisuke Ando Masaya Kumamoto Shoji Arihiro Kazunori Toyoda Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulation atrial fibrillation ischemic stroke outcome transient ischemic attack |
| title | Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation |
| title_full | Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation |
| title_fullStr | Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation |
| title_full_unstemmed | Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation |
| title_short | Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation |
| title_sort | prior anticoagulation and short or long term clinical outcomes in ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation |
| topic | anticoagulation atrial fibrillation ischemic stroke outcome transient ischemic attack |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010593 |
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