Prior Anticoagulation and Short- or Long-Term Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients With Nonvalvular Atrial Fibrillation

被引：14

作者：

Tokunaga, Keisuke ^{[1
,23
]}

Koga, Masatoshi ^{[1
,23
]}

Itabashi, Ryo ^{[3
,24
]}

Yamagami, Hiroshi ^{[2
,23
]}

Todo, Kenichi ^{[4
,25
]}

Yoshimura, Sohei ^{[1
,23
]}

Kimura, Kazumi ^{[5
,26
]}

Sato, Shoichiro ^{[1
,23
]}

Terasaki, Tadashi ^{[6
,27
]}

Inoue, Manabu ^{[1
,23
]}

Shiokawa, Yoshiaki ^{[7
,8
,28
]}

Takagi, Masahito ^{[1
,23
]}

Kamiyama, Kenji ^{[9
,29
]}

Tanaka, Kanta ^{[1
,23
]}

Takizawa, Shunya ^{[10
,30
]}

Shiozawa, Masayuki ^{[1
,23
]}

Okuda, Satoshi ^{[11
,31
]}

Okada, Yasushi ^{[12
,32
]}

Kameda, Tomoaki ^{[13
,33
]}

Nagakane, Yoshinari ^{[15
]}

Hasegawa, Yasuhiro ^{[16
,35
]}

Shibuya, Satoshi ^{[17
,36
]}

Ito, Yasuhiro ^{[18
,37
]}

Matsuoka, Hideki ^{[19
,38
]}

Takamatsu, Kazuhiro ^{[20
,39
]}

Nishiyama, Kazutoshi ^{[21
,40
]}

Kario, Kazuomi ^{[14
,33
]}

Yagita, Yoshiki ^{[22
,41
]}

Fujita, Kyohei ^{[1
,23
]}

Ando, Daisuke ^{[1
,23
]}

Kumamoto, Masaya ^{[1
,23
]}

Arihiro, Shoji ^{[2
,23
]}

Toyoda, Kazunori ^{[1
,23
]}

Takasugi, Junji ^{[25
]}

Higashida, Kyoko ^{[25
]}

Sakamoto, Yuki ^{[26
]}

Hirano, Teruyuki ^{[28
]}

Suzuki, Rieko ^{[28
]}

Nakagawara, Jyoji ^{[29
]}

Homma, Kazunari ^{[30
]}

Tanaka, Eijirou ^{[34
]}

Akiyama, Hisanao ^{[35
]}

Mochizuki, Hiroshi ^{[36
]}

Nakashima, Takahiro ^{[38
]}

Shibazaki, Kensaku ^{[41
]}

Furui, Eisuke ^{[42
]}

Maeda, Koichiro ^{[23
]}

Endo, Kaoru ^{[23
]}

Miyagi, Tetsuya ^{[23
]}

Osaki, Masato ^{[23
]}

机构：

[1] Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, 5-7-1 Fujishirodai, Suita, Osaka 5658565, Japan

[2] Natl Cerebral & Cardiovasc Ctr, Div Stroke Care Unit, Suita, Osaka, Japan

[3] Kohnan Hosp, Dept Stroke Neurol, Sendai, Miyagi, Japan

[4] Osaka Univ, Grad Sch Med, Dept Neurol, Suita, Osaka, Japan

[5] Nippon Med Sch, Dept Neurol Sci, Grad Sch Med, Tokyo, Japan

[6] Japanese Red Cross Kumamoto Hosp, Dept Neurol, Kumamoto, Japan

[7] Kyorin Univ, Sch Med, Dept Neurosurg, Mitaka, Tokyo, Japan

[8] Kyorin Univ, Sch Med, Stroke Ctr, Mitaka, Tokyo, Japan

[9] Nakamura Mem Hosp, Dept Neurosurg, Sapporo, Hokkaido, Japan

[10] Tokai Univ, Sch Med, Dept Neurol, Isehara, Kanagawa, Japan

[11] NHO Nagoya Med Ctr, Dept Neurol, Nagoya, Aichi, Japan

[12] NHO Kyushu Med Ctr, Dept Neurol & Cerebrovasc Med, Fukuoka, Fukuoka, Japan

[13] Jichi Med Univ, Sch Med, Div Neurol, Shimotsuke, Japan

[14] Jichi Med Univ, Sch Med, Div Cardiovasc Med, Shimotsuke, Japan

[15] Kyoto Second Red Cross Hosp, Dept Neurol, Kyoto, Japan

[16] St Marianna Univ, Sch Med, Dept Neurol, Kawasaki, Kanagawa, Japan

[17] South Miyagi Med Ctr, Dept Neurol, Ogawara, Japan

[18] TOYOTA Mem Hosp, Dept Neurol, Toyota, Japan

[19] NHO Kagoshima Med Ctr, Dept Cerebrovasc Med, Kagoshima, Japan

[20] Brain Attack Ctr Ota Mem Hosp, Dept Neurol, Fukuyama, Hiroshima, Japan

[21] Kitasato Univ, Sch Med, Dept Neurol, Sagamihara, Kanagawa, Japan

[22] Kawasaki Med Sch, Dept Stroke Med, Kurashiki, Okayama, Japan

[23] Natl Cerebral & Cardiovasc Ctr, Suita, Osaka, Japan

[24] Kohnan Hosp, Sendai, Miyagi, Japan

[25] Osaka Univ, Grad Sch Med, Suita, Osaka, Japan

[26] Nippon Med Sch, Grad Sch Med, Tokyo, Japan

[27] Japanese Red Cross Kumamoto Hosp, Kumamoto, Japan

[28] Kyorin Univ, Sch Med, Mitaka, Tokyo, Japan

[29] Nakamura Mem Hosp, Sapporo, Hokkaido, Japan

[30] Tokai Univ, Sch Med, Isehara, Kanagawa, Japan

[31] NHO Nagoya Med Ctr, Nagoya, Aichi, Japan

[32] NHO Kyushu Med Ctr, Fukuoka, Fukuoka, Japan

[33] Jichi Med Univ, Sch Med, Shimotsuke, Japan

[34] Kyoto Second Red Cross Hosp, Kyoto, Japan

[35] St Marianna Univ, Sch Med, Kawasaki, Kanagawa, Japan

[36] South Miyagi Med Ctr, Ogawara, Japan

[37] TOYOTA Mem Hosp, Toyota, Japan

[38] NHO Kagoshima Med Ctr, Kagoshima, Japan

[39] Brain Attack Ctr Ota Mem Hosp, Fukuyama, Hiroshima, Japan

[40] Kitasato Univ, Sch Med, Sagamihara, Kanagawa, Japan

[41] Kawasaki Med Sch, Kurashiki, Okayama, Japan

[42] Saiseikai Toyama Hosp, Toyama, Japan

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2019年 / 8卷 / 03期

关键词：

anticoagulation; atrial fibrillation; ischemic stroke; outcome; transient ischemic attack; INTERNATIONAL NORMALIZED RATIO; ANTITHROMBOTIC TREATMENT; ORAL ANTICOAGULATION; CARDIOEMBOLIC STROKE; TROUSSEAUS-SYNDROME; SEVERITY; THERAPY; SCORE; RISK; COAGULOPATHY;

D O I：

10.1161/JAHA.118.010593

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-We aimed to clarify associations between prior anticoagulation and short-or long-term clinical outcomes in ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation. Methods and Results-A total of 1189 ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation who were hospitalized within 7 days after onset were analyzed. Of these, 813 patients (68.4%) received no prior anticoagulation, 310 (26.1%) received prior warfarin treatment with an international normalized ratio (INR) < 2 on admission, 28 (2.4%) received prior warfarin treatment with an INR >= 2 on admission, and the remaining 38 (3.2%) received prior direct oral anticoagulant treatment. Prior warfarin treatment was associated with a lower risk of death or disability at 3 months compared with no prior anticoagulation (INR < 2: adjusted odds ratio: 0.58; 95% CI, 0.42-0.81; P=0.001; INR >= 2: adjusted odds ratio: 0.40; 95% CI, 0.16-0.97; P=0.043) but was not associated with a lower risk of death or disability at 2 years. Prior warfarin treatment with an INR >= 2 on admission was associated with a higher risk of ischemic events within 2 years compared with no prior anticoagulation (adjusted hazard ratio: 2.94; 95% CI, 1.20-6.15; P=0.021). Conclusions-Prior warfarin treatment was associated with a lower risk of death or disability at 3 months but was not associated with a lower risk of death or disability at 2 years in ischemic stroke or transient ischemic attack patients with nonvalvular atrial fibrillation. Prior warfarin treatment with an INR >= 2 on admission was associated with a higher risk of ischemic events within 2 years.

引用

页数：14

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