Key result
Preadmission therapeutic anticoagulation in NVAF patients with ischemic stroke resulted in smaller median infarct volume (8 ml) compared to subtherapeutic anticoagulation (142 ml, p=0.010).
Why the study?
Does preadmission therapeutic anticoagulation reduce cerebral infarct volume in patients with nonvalvular atrial fibrillation who suffer an ischemic stroke?
Cohort (n=68)
No
Does preadmission therapeutic anticoagulation reduce cerebral infarct volume in patients with nonvalvular atrial fibrillation who suffer an ischemic stroke?
Absolute Event Rate: 8% vs 142%
p-value: p=0.010
Preadmission therapeutic anticoagulation in patients with nonvalvular atrial fibrillation is associated with smaller cerebral infarct volumes and better neurological outcomes upon ischemic stroke presentation.
May support anticoagulation adherence in NVAF; leaves open randomized confirmation of clinical benefit.
AIM: We investigated the influence of preadmission anticoagulation on infarct volume in patients with nonvalvular atrial fibrillation (NVAF). METHODS: Data were collected on consecutive ischemic stroke patients with NVAF admitted to Osaka University Hospital between 2004 and 2011. Patients were divided into 3 groups: the no-anticoagulation group, the subtherapeutic anticoagulation group [admission prothrombin time international normalized ratio (PT-INR) <1.6], and the therapeutic anticoagulation group (PT-INR ≥1.6). In analyses of neurological outcome, we excluded patients with a modified Rankin Scale (mRS) score of >1 before onset. RESULTS: Of the 68 patients, 45 were classified into the no-anticoagulation group, 9 into the subtherapeutic group, and 14 into the therapeutic group. The median value of infarct volume was 60 (interquartile range 9-176), 142 (64-184), and 8 (3-46) ml in each group, respectively. Infarct volume in the therapeutic group was significantly smaller than in the subtherapeutic group (p = 0.010), and tended to be smaller than in the no-anticoagulation group (p = 0.086). National Institute of Health Stroke Scale score at admission, and mRS score at discharge were significantly reduced in the therapeutic group compared with those in the other groups (p = 0.028 and p = 0.017, respectively). CONCLUSION: Therapeutic anticoagulation reduces infarct volume and improves neurological outcome after ischemic stroke in patients with NVAF.
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Matsumoto et al. (2011) conducted a cohort in Ischemic stroke with nonvalvular atrial fibrillation (n=68). Therapeutic anticoagulation vs. Subtherapeutic anticoagulation (PT-INR <1.6) or no anticoagulation was evaluated on Infarct volume (p=0.010). Preadmission therapeutic anticoagulation in NVAF patients with ischemic stroke resulted in smaller median infarct volume (8 ml) compared to subtherapeutic anticoagulation (142 ml, p=0.010).
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