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Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation

Authors
 Young Dae Kim  ;  Kyung Yul Lee  ;  Hyo Suk Nam  ;  Sang Won Han  ;  Jong Yun Lee  ;  Han-Jin Cho  ;  Gyu Sik Kim  ;  Seo Hyun Kim  ;  Myoung-Jin Cha  ;  Seong Hwan Ahn  ;  Seung-Hun Oh  ;  Kee Ook Lee  ;  Yo Han Jung  ;  Hye-Yeon Choi  ;  Sang-Don Han  ;  Hye Sun Lee  ;  Chung Mo Nam  ;  Eun Hye Kim  ;  Ki Jeong Lee  ;  Dongbeom Song  ;  Hui-Nam Park  ;  Ji Hoe Heo 
Citation
 YONSEI MEDICAL JOURNAL, Vol.56(2) : 410-417, 2015 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2015
MeSH
Aged ; Aged, 80 and over ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications* ; Cardiovascular Diseases ; Case-Control Studies ; Cerebral Infarction/complications ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Stroke/etiology ; Stroke/prevention & control* ; Warfarin/adverse effects ; Warfarin/therapeutic use*
Keywords
Cardiac embolism ; anticoagulation ; atrial fibrillation ; cerebral infarction ; risk factors
Abstract
PURPOSE: In this study, we investigated the stroke mechanism and the factors associated with ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) who were on optimal oral anticoagulation with warfarin. MATERIALS AND METHODS: This was a multicenter case-control study. The cases were consecutive patients with NVAF who developed cerebral infarction or transient ischemic attack (TIA) while on warfarin therapy with an international normalized ratio (INR) ≥2 between January 2007 and December 2011. The controls were patients with NVAF without ischemic stroke who were on warfarin therapy for more than 1 year with a mean INR ≥2 during the same time period. We also determined etiologic mechanisms of stroke in cases. RESULTS: Among 3569 consecutive patients with cerebral infarction or TIA who had NVAF, 55 (1.5%) patients had INR ≥2 at admission. The most common stroke mechanism was cardioembolism (76.0%). Multivariate analysis demonstrated that smoking and history of previous ischemic stroke were independently associated with cases. High CHADS2 score (≥3) or CHA₂DS₂-VASc score (≥5), in particular, with previous ischemic stroke along with ≥1 point of other components of CHADS₂ score or ≥3 points of other components of CHA₂DS₂-VASc score was a significant predictor for development of ischemic stroke. CONCLUSION: NVAF patients with high CHADS₂/CHA₂DS₂-VASc scores and a previous ischemic stroke or smoking history are at high risk of stroke despite optimal warfarin treatment. Some other measures to reduce the risk of stroke would be necessary in those specific groups of patients.
Files in This Item:
T201500581.pdf Download
DOI
10.3349/ymj.2015.56.2.410
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Eun Hye(김은혜)
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Song, Dong Beom(송동범)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Lee, Ki Jeong(이기정)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139563
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