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 SongHui Nam Park, Ji Hoe Heo

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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

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Kim, Y. D., Lee, K. Y., Nam, H. S., Han, S. W., Lee, J. Y., Cho, H. J., Kim, G. S., Kim, S. H., Cha, M. J., Ahn, S. H., Oh, S. H., Lee, K. O., Jung, Y. H., Choi, H. Y., Han, S. D., Lee, H. S., Nam, C. M., Kim, E. H., Lee, K. J., ... Heo, J. H. (2015). Factors associated with ischemic stroke on therapeutic anticoagulation in patients with nonvalvular atrial fibrillation. Yonsei medical journal, 56(2), 410-417. https://doi.org/10.3349/ymj.2015.56.2.410