Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Feb 2019)

Prior Anticoagulation and Short‐ or Long‐Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation

  • 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

DOI
https://doi.org/10.1161/JAHA.118.010593
Journal volume & issue
Vol. 8, no. 3

Abstract

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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.

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