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Effect of warfarin withdrawal on thrombolytic treatment in patients with ischaemic stroke.

Authors
 Y. D. Kim  ;  J. H. Lee  ;  Y. H. Jung  ;  M.-J. Cha  ;  H. Y. Choi  ;  C. M. Nam  ;  J. H. Yang  ;  H. J. Cho  ;  H. S. Nam  ;  K.-Y. Lee  ;  J. H. Heo 
Citation
 European Journal of Neurology, Vol.18(9) : 1165-1170, 2011 
Journal Title
 European Journal of Neurology 
ISSN
 1351-5101 
Issue Date
2011
MeSH
Adult ; Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/drug therapy ; Female ; Humans ; Male ; Middle Aged ; Recovery of Function/drug effects* ; Stroke/drug therapy* ; Thrombolytic Therapy/adverse effects* ; Tissue Plasminogen Activator/adverse effects ; Urokinase-Type Plasminogen Activator/adverse effects ; Warfarin/therapeutic use*
Keywords
anticoagulation ; atrialfibrillation ; prognosis ; stroke ; thrombolysis
Abstract
BACKGROUND AND PURPOSE:   Abruptly discontinuing warfarin may induce a rebound prothrombotic state. Thrombolytic agents may also paradoxically induce prothrombotic conditions, which include platelet activation and thrombin generation. Therefore, prothrombotic states may be enhanced by withdrawing warfarin in patients under thrombolytic treatment. This study was aimed to determine whether patients with warfarin withdrawal have different clinical outcomes from those without warfarin use after thrombolytic treatment. METHODS:   A total of 148 consecutive patients with atrial fibrillation who were not on anticoagulants at admission and who received thrombolysis were included in this study. We compared the outcomes between a warfarin withdrawal group and a no-warfarin group. RESULTS:   Fourteen patients (9.5%) were included in the warfarin withdrawal group. Although baseline National Institute of Health Stroke Scale (NIHSS) scores, recanalization rates, and hemorrhage frequencies did not differ between the groups, the warfarin withdrawal group showed poorer outcomes. Increased NIHSS scores during the first 7days were more frequent in the warfarin withdrawal group (57.1% vs. 26.9%, P=0.029). The median percent improvement in NIHSS scores at 24h after thrombolysis was also lower in the warfarin withdrawal group. After adjusting for covariates, warfarin withdrawal was a strong predictor of poor functional outcome at 3months (modified Rankin score≥3) (odds ratio, 17.067, 95% CI 2.703-107.748). CONCLUSIONS:   Discontinuing warfarin was associated with early neurologic deterioration and poor long-term outcomes after thrombolytic treatment.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2011.03363.x/abstract
DOI
10.1111/j.1468-1331.2011.03363.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 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
Nam, Jung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Yang, Jae Hoon(양재훈)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Jung, Yo Han(정요한)
Cho, Han Jin(조한진)
Cha, Myoung Jin(차명진)
Choi, Hye Yoen(최혜연)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93756
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