Anticoagulation-related reduction of first-ever stroke severity in Chinese patients with atrial fibrillation

Authors

Chunjuan Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Yilong Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Chunxue Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Xingquan Zhao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Liping Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Gaifen Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
David Z. Wang, INI Stroke Center & Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL, USA.Follow
Hao Li, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
Yongjun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China. Electronic address: yongjunwang1962@gmail.com.

Document Type

Article

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.

Medical Subject Headings

Adolescent; Adult; Aged; Anticoagulants (therapeutic use); Atrial Fibrillation (complications); China; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Registries; Severity of Illness Index; Stroke (complications, diagnosis, drug therapy); Treatment Outcome; Warfarin (therapeutic use); Young Adult

Publication Date

10-1-2014

Publication Title

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

E-ISSN

1532-2653

Volume

21

Issue

10

First Page

1755

Last Page

60

PubMed ID

24998862

Digital Object Identifier (DOI)

10.1016/j.jocn.2014.01.022

Recommended Citation

Wang, Chunjuan; Wang, Yilong; Wang, Chunxue; Zhao, Xingquan; Liu, Liping; Liu, Gaifen; Wang, David Z.; Li, Hao; and Wang, Yongjun, "Anticoagulation-related reduction of first-ever stroke severity in Chinese patients with atrial fibrillation" (2014). Neurology. 1759.
https://scholar.barrowneuro.org/neurology/1759