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Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin

Clinical cardiology (Mahwah, N.J.), 2017-12, Vol.40 (12), p.1347-1351 [Peer Reviewed Journal]

2017 Wiley Periodicals, Inc. ;2018 Wiley Periodicals, Inc. ;ISSN: 0160-9289 ;EISSN: 1932-8737 ;DOI: 10.1002/clc.22838 ;PMID: 29251360

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Title:
Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin
Author: Aachi, Raghav V. ; Birnbaum, Lee A. ; Topel, Christopher H. ; Seifi, Ali ; Hafeez, Shaheryar ; Behrouz, Réza
Subjects: Acute Stroke ; Administration, Oral ; Aged ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulation ; Atrial Fibrillation ; Atrial Fibrillation - blood ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Blood Coagulation - drug effects ; Brain Ischemia - drug therapy ; Brain Ischemia - epidemiology ; Brain Ischemia - etiology ; Cardiac arrhythmia ; Clinical Investigations ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; International Normalized Ratio ; Laboratories ; Male ; Prevalence ; Stroke ; Survival Rate - trends ; Treatment Outcome ; United States - epidemiology ; Warfarin ; Warfarin - administration & dosage
Is Part Of: Clinical cardiology (Mahwah, N.J.), 2017-12, Vol.40 (12), p.1347-1351
Description: Background In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence. Hypothesis Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS. Methods We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants. We then compared baseline laboratory characteristics and other baseline features among the groups. Results Patients with therapeutic INR presented with higher serum creatinine (P = 0.01) and blood urea nitrogen (P = 0.02) and lower glomerular filtration rates (P = 0.001) compared with other groups. Other laboratory parameters were not different among the 3 groups. Patients with therapeutic INR also presented with milder stroke symptoms (P = 0.01). Medical history of the 3 groups was not different, except for history of valvular heart disease, which was more prevalent in patients with therapeutic INR (P = 0.004). In‐hospital mortality rates and 90‐day disability were not different among the 3 groups. Conclusions AF patients who presented with IS on therapeutic warfarin had higher average serum creatinine and blood urea nitrogen, and lower glomerular filtration rates, compared with others. Impaired renal function may be a factor contributing to occurrence of IS in AF patients despite adequate anticoagulation. Larger, targeted studies are needed to confirm these findings.
Publisher: New York: Wiley Periodicals, Inc
Language: English
Identifier: ISSN: 0160-9289
EISSN: 1932-8737
DOI: 10.1002/clc.22838
PMID: 29251360
Source: Open Access: PubMed Central
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Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin

2017 Wiley Periodicals, Inc. ;2018 Wiley Periodicals, Inc. ;ISSN: 0160-9289 ;EISSN: 1932-8737 ;DOI: 10.1002/clc.22838 ;PMID: 29251360

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