Key result
In anticoagulated AF patients with therapeutic INR, congestive heart failure was associated with ischemic stroke/TIA compared to ICH (OR 2.33; 95% CI 1.18-4.58).
Why the study?
What are the differing patient characteristics between anticoagulated atrial fibrillation patients who suffer an ischemic stroke/TIA versus those who suffer an intracerebral hemorrhage?
Observational (n=1,457)
Yes
What are the differing patient characteristics between anticoagulated atrial fibrillation patients who suffer an ischemic stroke/TIA versus those who suffer an intracerebral hemorrhage?
Odds Ratio: 2.33 (95% CI 1.18–4.58)
In anticoagulated AF patients with therapeutic INR, congestive heart failure and hypercholesterolemia are associated with ischemic stroke/TIA, while a history of bleeding is associated with ICH.
CHF may help stratify ischemic versus hemorrhagic risk in anticoagulated AF; leaves open need for prospective validation before guiding decisions.
BACKGROUND: Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC-treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). HYPOTHESIS: We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin. METHODS: FibStroke is a multicenter, retrospective registry collating details of AF patients with ischemic stroke/TIA or intracranial hemorrhage in 2003-2012. This substudy included AF patients on OAC with first lifetime ischemic stroke/TIA or spontaneous ICH. RESULTS: A total of 1457 patients with 1290 ischemic strokes/TIAs and 167 ICHs were identified. Of these, 553 (42.9%) strokes/TIAs and 96 (57.5%) ICHs occurred in patients with INR within therapeutic range. During OAC with therapeutic INR, congestive heart failure (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.18-4.58) and hypercholesterolemia (OR: 2.52, 95% CI: 1.51-4.19) were more common in patients with ischemic stroke/TIA, whereas a history of bleeding (OR: 0.30, 95% CI: 0.11-0.82) was less common when compared with patients with ICH. In the whole cohort, renal impairment (OR: 1.86, 95% CI: 1.23-2.80) and mechanical valve prosthesis (OR: 4.41, 95% CI: 1.32-14.7) were overrepresented in patients with stroke/TIA, whereas aspirin use (OR: 0.52, 95% CI: 0.30-0.91) and high INR (OR: 0.40, 95% CI: 0.33-0.48) were overrepresented in patients with ICH. CONCLUSIONS: In anticoagulated AF patients with therapeutic INR and first lifetime cerebrovascular event, congestive heart failure and hypercholesterolemia were associated with ischemic stroke/TIA and history of bleeding with ICH.
No takes yet. Share an insight, caveat, or question.
Lehtola et al. (2018) conducted an observational in Atrial fibrillation (n=1,457). Congestive heart failure vs. Absence of congestive heart failure was evaluated on Ischemic stroke/TIA versus intracerebral hemorrhage during OAC with therapeutic INR (OR 2.33, 95% CI 1.18-4.58). In anticoagulated AF patients with therapeutic INR, congestive heart failure was associated with ischemic stroke/TIA compared to ICH (OR 2.33; 95% CI 1.18-4.58).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: