Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation

Young Dae Kim, Kyung Yul Lee, Hyo Suk Nam, Sang Won Han, Jong Yun Lee, Han Jin Cho, Gyu Sik Kim, Seo Hyun Kim, Myoung Jin Cha, Seong Hwan Ahn, Seung Hun Oh, Kee Ook Lee, Yo Han Jung, Hye Yeon Choi, Sang Don Han, Hye Sun Lee, Chung Mo Nam, Eun Hye Kim, Ki Jeong Lee, Dongbeom Song & 2 others huinam pak, Jihoe Heo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: In this study, we investigated the stroke mechanism and the factors associated with ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) who were on optimal oral anticoagulation with warfarin. Materials and Methods: This was a multicenter case-control study. The cases were consecutive patients with NVAF who developed cerebral infarction or transient ischemic attack (TIA) while on warfarin therapy with an international normalized ratio (INR) ≥2 between January 2007 and December 2011. The controls were patients with NVAF without ischemic stroke who were on warfarin therapy for more than 1 year with a mean INR ≥2 during the same time period. We also determined etiologic mechanisms of stroke in cases. Results: Among 3569 consecutive patients with cerebral infarction or TIA who had NVAF, 55 (1.5%) patients had INR ≥2 at admission. The most common stroke mechanism was cardioembolism (76.0%). Multivariate analysis demonstrated that smoking and history of previous ischemic stroke were independently associated with cases. High CHADS2 score (≥3) or CHA2DS2-VASc score (≥5), in particular, with previous ischemic stroke along with ≥1 point of other components of CHADS2 score or ≥3 points of other components of CHA2DS2-VASc score was a significant predictor for development of ischemic stroke. Conclusion: NVAF patients with high CHADS2/CHA2DS2-VASc scores and a previous ischemic stroke or smoking history are at high risk of stroke despite optimal warfarin treatment. Some other measures to reduce the risk of stroke would be necessary in those specific groups of patients.

Original languageEnglish
Pages (from-to)410-417
Number of pages8
JournalYonsei medical journal
Volume56
Issue number2
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Atrial Fibrillation
Stroke
Warfarin
International Normalized Ratio
Therapeutics
Transient Ischemic Attack
Cerebral Infarction
Smoking
Case-Control Studies
Multivariate Analysis
History

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kim, Young Dae ; Lee, Kyung Yul ; Nam, Hyo Suk ; Han, Sang Won ; Lee, Jong Yun ; Cho, Han Jin ; Kim, Gyu Sik ; Kim, Seo Hyun ; Cha, Myoung Jin ; Ahn, Seong Hwan ; Oh, Seung Hun ; Lee, Kee Ook ; Jung, Yo Han ; Choi, Hye Yeon ; Han, Sang Don ; Lee, Hye Sun ; Nam, Chung Mo ; Kim, Eun Hye ; Lee, Ki Jeong ; Song, Dongbeom ; pak, huinam ; Heo, Jihoe. / Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation. In: Yonsei medical journal. 2015 ; Vol. 56, No. 2. pp. 410-417.
@article{335f995dd1664a6aaece0695c857e671,
title = "Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation",
abstract = "Purpose: In this study, we investigated the stroke mechanism and the factors associated with ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) who were on optimal oral anticoagulation with warfarin. Materials and Methods: This was a multicenter case-control study. The cases were consecutive patients with NVAF who developed cerebral infarction or transient ischemic attack (TIA) while on warfarin therapy with an international normalized ratio (INR) ≥2 between January 2007 and December 2011. The controls were patients with NVAF without ischemic stroke who were on warfarin therapy for more than 1 year with a mean INR ≥2 during the same time period. We also determined etiologic mechanisms of stroke in cases. Results: Among 3569 consecutive patients with cerebral infarction or TIA who had NVAF, 55 (1.5{\%}) patients had INR ≥2 at admission. The most common stroke mechanism was cardioembolism (76.0{\%}). Multivariate analysis demonstrated that smoking and history of previous ischemic stroke were independently associated with cases. High CHADS2 score (≥3) or CHA2DS2-VASc score (≥5), in particular, with previous ischemic stroke along with ≥1 point of other components of CHADS2 score or ≥3 points of other components of CHA2DS2-VASc score was a significant predictor for development of ischemic stroke. Conclusion: NVAF patients with high CHADS2/CHA2DS2-VASc scores and a previous ischemic stroke or smoking history are at high risk of stroke despite optimal warfarin treatment. Some other measures to reduce the risk of stroke would be necessary in those specific groups of patients.",
author = "Kim, {Young Dae} and Lee, {Kyung Yul} and Nam, {Hyo Suk} and Han, {Sang Won} and Lee, {Jong Yun} and Cho, {Han Jin} and Kim, {Gyu Sik} and Kim, {Seo Hyun} and Cha, {Myoung Jin} and Ahn, {Seong Hwan} and Oh, {Seung Hun} and Lee, {Kee Ook} and Jung, {Yo Han} and Choi, {Hye Yeon} and Han, {Sang Don} and Lee, {Hye Sun} and Nam, {Chung Mo} and Kim, {Eun Hye} and Lee, {Ki Jeong} and Dongbeom Song and huinam pak and Jihoe Heo",
year = "2015",
month = "1",
day = "1",
doi = "10.3349/ymj.2015.56.2.410",
language = "English",
volume = "56",
pages = "410--417",
journal = "Yonsei Medical Journal",
issn = "0513-5796",
publisher = "Yonsei University College of Medicine",
number = "2",

}

Kim, YD, Lee, KY, Nam, HS, Han, SW, Lee, JY, Cho, HJ, Kim, GS, Kim, SH, Cha, MJ, Ahn, SH, Oh, SH, Lee, KO, Jung, YH, Choi, HY, Han, SD, Lee, HS, Nam, CM, Kim, EH, Lee, KJ, Song, D, pak, H & Heo, J 2015, 'Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation', Yonsei medical journal, vol. 56, no. 2, pp. 410-417. https://doi.org/10.3349/ymj.2015.56.2.410

Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation. / Kim, Young Dae; Lee, Kyung Yul; Nam, Hyo Suk; Han, Sang Won; Lee, Jong Yun; Cho, Han Jin; Kim, Gyu Sik; Kim, Seo Hyun; Cha, Myoung Jin; Ahn, Seong Hwan; Oh, Seung Hun; Lee, Kee Ook; Jung, Yo Han; Choi, Hye Yeon; Han, Sang Don; Lee, Hye Sun; Nam, Chung Mo; Kim, Eun Hye; Lee, Ki Jeong; Song, Dongbeom; pak, huinam; Heo, Jihoe.

In: Yonsei medical journal, Vol. 56, No. 2, 01.01.2015, p. 410-417.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation

AU - Kim, Young Dae

AU - Lee, Kyung Yul

AU - Nam, Hyo Suk

AU - Han, Sang Won

AU - Lee, Jong Yun

AU - Cho, Han Jin

AU - Kim, Gyu Sik

AU - Kim, Seo Hyun

AU - Cha, Myoung Jin

AU - Ahn, Seong Hwan

AU - Oh, Seung Hun

AU - Lee, Kee Ook

AU - Jung, Yo Han

AU - Choi, Hye Yeon

AU - Han, Sang Don

AU - Lee, Hye Sun

AU - Nam, Chung Mo

AU - Kim, Eun Hye

AU - Lee, Ki Jeong

AU - Song, Dongbeom

AU - pak, huinam

AU - Heo, Jihoe

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Purpose: In this study, we investigated the stroke mechanism and the factors associated with ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) who were on optimal oral anticoagulation with warfarin. Materials and Methods: This was a multicenter case-control study. The cases were consecutive patients with NVAF who developed cerebral infarction or transient ischemic attack (TIA) while on warfarin therapy with an international normalized ratio (INR) ≥2 between January 2007 and December 2011. The controls were patients with NVAF without ischemic stroke who were on warfarin therapy for more than 1 year with a mean INR ≥2 during the same time period. We also determined etiologic mechanisms of stroke in cases. Results: Among 3569 consecutive patients with cerebral infarction or TIA who had NVAF, 55 (1.5%) patients had INR ≥2 at admission. The most common stroke mechanism was cardioembolism (76.0%). Multivariate analysis demonstrated that smoking and history of previous ischemic stroke were independently associated with cases. High CHADS2 score (≥3) or CHA2DS2-VASc score (≥5), in particular, with previous ischemic stroke along with ≥1 point of other components of CHADS2 score or ≥3 points of other components of CHA2DS2-VASc score was a significant predictor for development of ischemic stroke. Conclusion: NVAF patients with high CHADS2/CHA2DS2-VASc scores and a previous ischemic stroke or smoking history are at high risk of stroke despite optimal warfarin treatment. Some other measures to reduce the risk of stroke would be necessary in those specific groups of patients.

AB - Purpose: In this study, we investigated the stroke mechanism and the factors associated with ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) who were on optimal oral anticoagulation with warfarin. Materials and Methods: This was a multicenter case-control study. The cases were consecutive patients with NVAF who developed cerebral infarction or transient ischemic attack (TIA) while on warfarin therapy with an international normalized ratio (INR) ≥2 between January 2007 and December 2011. The controls were patients with NVAF without ischemic stroke who were on warfarin therapy for more than 1 year with a mean INR ≥2 during the same time period. We also determined etiologic mechanisms of stroke in cases. Results: Among 3569 consecutive patients with cerebral infarction or TIA who had NVAF, 55 (1.5%) patients had INR ≥2 at admission. The most common stroke mechanism was cardioembolism (76.0%). Multivariate analysis demonstrated that smoking and history of previous ischemic stroke were independently associated with cases. High CHADS2 score (≥3) or CHA2DS2-VASc score (≥5), in particular, with previous ischemic stroke along with ≥1 point of other components of CHADS2 score or ≥3 points of other components of CHA2DS2-VASc score was a significant predictor for development of ischemic stroke. Conclusion: NVAF patients with high CHADS2/CHA2DS2-VASc scores and a previous ischemic stroke or smoking history are at high risk of stroke despite optimal warfarin treatment. Some other measures to reduce the risk of stroke would be necessary in those specific groups of patients.

UR - http://www.scopus.com/inward/record.url?scp=84922792058&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922792058&partnerID=8YFLogxK

U2 - 10.3349/ymj.2015.56.2.410

DO - 10.3349/ymj.2015.56.2.410

M3 - Article

VL - 56

SP - 410

EP - 417

JO - Yonsei Medical Journal

JF - Yonsei Medical Journal

SN - 0513-5796

IS - 2

ER -