Anticoagulation-related reduction of first-ever stroke severity in Chinese patients with atrial fibrillation |
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| Affiliation: | 1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China;2. INI Stroke Center & Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL, USA;1. Department of Neurosurgery, University Hospital of Bonn, Sigmund Freud Strasse 25, 53105 Bonn, Germany;2. Department of Neuropathology, University Hospital of Bonn, Bonn, Germany;3. Department of Radiosurgery and Stereotactic Radiotherapy, MediClin Robert Janker Clinic, Bonn, Germany;1. Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA;2. Department of Pathology, University of California at San Francisco, San Francisco, CA, USA;3. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St, Suite 2210, Chicago, IL 60611-2911, USA;1. T.C. İSTANBUL Arel University, Department of Neurologic Sciences, Türkoba Mahallesi Erguvan Sokak No: 26/K, Tepekent, 34537 Büyükçekmece, Turkey;2. Istanbul Educational and Research Hospital, Istanbul, Turkey;3. T.C. Rize Tayyip Erdoğan University, Rize Merkez, Rize, Turkey;1. Department of Neurological Surgery, The Charles Clore Hospitalization Tower, West Wing Sheba Medical Center, Ramat Gan, Israel;2. Department of Pathology, Microbiology, and Immunology, 6439 Garners Ferry Rd., Building 1, Room C27, Columbia, SC 29209, USA;1. Neurosurgery Department, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK;2. School of Medicine, University of Liverpool, Liverpool, UK;3. Department of Medicine and Medical Mycology, University Hospital of South Manchester, Manchester, UK;4. Microbiology Department, Aintree University Hospital NHS Foundation, Liverpool, UK;5. Otolaryngology Department, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK;6. Otolaryngology Department, Aintree University Hospital NHS Foundation, Liverpool, UK;7. Neurosurgery Department, Beaumont Hospital, Dublin, Ireland |
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| Abstract: | ![]()
Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and warfarin related anticoagulation has been recommended as an effective treatment for stroke prevention. We aimed to determine whether pre-stroke oral anticoagulation therapy would reduce initial stroke severity in AF patients with first-ever ischemic stroke. We identified consecutive patients who developed first-ever ischemic stroke and were eligible for anticoagulation therapy from the China National Stroke Registry. Multivariate logistic analysis was used to assess the association between warfarin usage and initial stroke severity, measured by the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Of 9519 patients, 1140 (11.98%) had AF, including 440 (38.6%) without known AF before presentation, 561 (49.2%) with known AF but not taking warfarin, and 139 (12.2%) with known AF who were taking warfarin. Compared to patients with known AF but not on warfarin, the odds ratio (OR) of having a major stroke (NIHSS ⩾4) was lower in patients with known AF who were on warfarin (OR = 0.68; 95% confidence interval [CI] 0.57–0.84). The OR of developing a severe coma (GCS 3–8) was also reduced in the warfarin group (OR = 0.71; 95% CI 0.56–0.91). In conclusion, pre-stroke warfarin therapy lowered the severity of the first-ever ischemic stroke in patients with known AF. Considering its efficacy in stroke prevention and the significant under-usage of warfarin in China, the primary prevention of stroke in AF patients should be reinforced. |
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| Keywords: | Anticoagulation therapy Atrial fibrillation First-ever stroke Stroke score Warfarin |
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