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Prior Anticoagulation and Short- or Long-Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2019 Feb 05; Vol. 8 (3), pp. e010593. - Publication Year :
- 2019
-
Abstract
- 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: NCT 01581502.
- Subjects :
- Administration, Oral
Aged
Anticoagulants administration & dosage
Atrial Fibrillation complications
Brain Ischemia epidemiology
Brain Ischemia etiology
Cause of Death trends
Female
Follow-Up Studies
Humans
Incidence
Ischemic Attack, Transient epidemiology
Ischemic Attack, Transient etiology
Japan epidemiology
Male
Retrospective Studies
Survival Rate trends
Time Factors
Atrial Fibrillation drug therapy
Brain Ischemia prevention & control
Ischemic Attack, Transient prevention & control
Warfarin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 8
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 30691339
- Full Text :
- https://doi.org/10.1161/JAHA.118.010593