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May 1, 2019BMC NeurologyOpen Access

Effect of warfarin versus aspirin on blood viscosity in cardioembolic stroke with atrial fibrillation: a prospective clinical trial

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Why the study?

Warfarin is an established therapy to prevent cardioembolic stroke, but its effects on whole blood viscosity had not been studied.

Does warfarin reduce whole blood viscosity compared to aspirin in patients with non-valvular atrial fibrillation and acute cardioembolic stroke?

Population

67 patients aged 56–90 years with NVAF, CHADS2 score ≥ 2, and acute mild-to-moderate cardioembolic stroke

Comparison

Warfarin vs aspirin

Design

Single-center prospective clinical trial with alternate assignment

Key result

Warfarin significantly increased the odds of reducing whole blood viscosity by more than 1 cP at a shear rate of 300/s compared to aspirin (OR 3.71) in patients with acute cardioembolic stroke and non-valvular atrial fibrillation.

Authors

CLChan-Hyuk LeeKJKeun‐Hwa JungDCDaniel J. Cho

Discussion

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Overview

Warfarin was associated with greater viscosity reduction than aspirin in acute cardioembolic stroke; leaves open hemorheological mechanisms pending randomized trials.

Study Design

Type

RCT (n=67)

Blinding

Open-label, blinded-endpoint

Randomization

Alternately assigned

Multicenter

No

Structured PICO

Does warfarin reduce whole blood viscosity compared to aspirin in patients with non-valvular atrial fibrillation and acute cardioembolic stroke?

P
Population
67 enrolled patients (56 completed) aged 56–90 years with non-valvular atrial fibrillation (NVAF), CHADS2 score ≥ 2, and acute cerebral infarction presenting with mild-to-moderate stroke (NIHSS score < 20 and modified Rankin Scale score < 4) at a single center.
I
Intervention
Warfarin titrated until international normalized ratio (INR) reached target range [2, 3]
C
Comparator
Aspirin (assessed 5 days after baseline)
O
Outcome
Post-treatment whole blood viscosity (WBV) at various shear ratessurrogate

Main Result

Effect estimate: OR 3.71 (95% CI 1.04-13.17)

p-value: p=0.043

Warfarin confers greater reductions in whole blood viscosity than aspirin in patients with acute cardioembolic stroke and atrial fibrillation, suggesting a hemorheological mechanism contributing to its antithrombotic efficacy.

Limitations

  • Relatively small sample size with modest drop rates
  • Whole blood viscosity was measured only when INR reached target ranges, limiting the ability to evaluate effects at higher concentrations
  • Single-center study conducted in Korea, which may limit generalizability to global populations

Cite This Study

Lee et al. (2019) conducted an RCT in Acute cardioembolic stroke with non-valvular atrial fibrillation (n=67). Warfarin vs. Aspirin was evaluated on Blood viscosity decrease > 1 cP at shear rate of 300/s (OR 3.71, 95% CI 1.04-13.17, p=0.043). Warfarin significantly increased the odds of reducing whole blood viscosity by more than 1 cP at a shear rate of 300/s compared to aspirin (OR 3.71) in patients with acute cardioembolic stroke and non-valvular atrial fibrillation.

synapsesocial.com/papers/6a0ba8a74f6759c6fca253afhttps://doi.org/10.1186/s12883-019-1315-5
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