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

 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 
 Yonsei Medical Journal, Vol.56(2) : 410-417, 2015 
Journal Title
 Yonsei Medical Journal 
Issue Date
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.
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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
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
김은혜(Kim, Eun Hye)
남정모(Nam, Jung Mo) ORCID logo https://orcid.org/0000-0003-0985-0928
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
송동범(Song, Dong Beom)
이경열(Lee, Kyung Yul) ORCID logo https://orcid.org/0000-0001-5585-7739
이기정(Lee, Ki Jeong)
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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