Key result
Previous cardioembolic ischemic stroke in Chagas disease patients on warfarin was associated with a higher proportion of INRs in the therapeutic range (57% vs 42%, p=0.025) and more minor bleeding.
Why the study?
Does previous cardioembolic ischemic stroke affect anticoagulation control and bleeding in patients with Chagas disease?
Cohort (n=42)
Does previous cardioembolic ischemic stroke affect anticoagulation control and bleeding in patients with Chagas disease?
Absolute Event Rate: 57% vs 42%
p-value: p=0.025
Patients with Chagas disease and previous cardioembolic ischemic stroke on warfarin have better INR control but a significantly higher frequency of minor bleeding compared to those without previous stroke.
May indicate better adherence post-stroke in Chagas warfarin users but raises minor bleeding; leaves open prospective validation before practice change.
To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding.
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Monteiro et al. (2018) conducted a cohort in Chagas disease with cardiac complications (n=42). Previous cardioembolic ischemic stroke (CIS) vs. No previous CIS was evaluated on Proportion of international normalized ratios within the therapeutic range (p=0.025). Previous cardioembolic ischemic stroke in Chagas disease patients on warfarin was associated with a higher proportion of INRs in the therapeutic range (57% vs 42%, p=0.025) and more minor bleeding.
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