Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation
We aimed to assess the prevalence of prior anticoagulation therapy (warfarin or non-vitamin K antagonist oral anticoagulants [NOACs]) among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China and investigate the associations between prior anticoagulation therapy and initi...
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| Veröffentlicht in: | International journal of cardiology 2023-08, Vol.385, p.62-70 |
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| container_title | International journal of cardiology |
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| creator | Zhou, Lue Li, Yapeng Yang, Xin Gu, Hongqiu Duan, Yanran Fu, Hang Wang, Anran Liu, Kai Gao, Yuan Song, Bo Li, Yusheng Jiang, Yingyu Zhang, Jing Wang, Chunjuan Wang, Meng Li, Zixiao Xu, Yuming Wang, Chengzeng Wang, Yongjun |
| description | We aimed to assess the prevalence of prior anticoagulation therapy (warfarin or non-vitamin K antagonist oral anticoagulants [NOACs]) among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China and investigate the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
We included consecutive patients with AIS and known history of AF admitted to hospitals in the China Stroke Center Alliance (CSCA) program from January 2019 to July 2019. Multivariate logistic regression analyses were performed to determine the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
Of 7181 patients (median [IQR] age, 75.0 [68.0–81.0] years; 48.7% men), 700 (9.7%), 129 (1.8%), and 255 (3.6%) patients received prior subtherapeutic warfarin (international normalized ratio [INR] |
| doi_str_mv | 10.1016/j.ijcard.2023.05.051 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2821640159</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0167527323007453</els_id><sourcerecordid>2821640159</sourcerecordid><originalsourceid>FETCH-LOGICAL-c362t-dfb3533f53ad044f83b70607b923655ba21d5a736e81e29da3502d45c3eb62373</originalsourceid><addsrcrecordid>eNp9kd2KFDEQhYMo7rj6BiK59KbH_HQ63TeCLOsPLHij1yGdVJyM0502Sa_Ma_jE1tC7XgoFCeE7dSp1CHnN2Z4z3r077uPR2ez3ggm5ZwqLPyE73uu24Vq1T8kOMd0ooeUVeVHKkTHWDkP_nFxJLZRWXOzIn9sQwFWaAl1yTJnauUaX7I_1ZGtMM60HyHY5U7yWmtNPoAXuIcd6RtTTODeHVJZY7Ymmtbo0QcFHuqAa5lro71gP1Lq1Ao3FHWCK7rHRRW9rjigNcczxtFm-JM-CPRV49XBek-8fb7_dfG7uvn76cvPhrnGyE7XxYZRKyqCk9axtQy9HzTqmx0HITqnRCu6V1bKDnoMYvJWKCd8qJ2HshNTymrzd-i45_VqhVDPhhIBTzJDWYkQveNcyrgZE2w11OZWSIRhc1mTz2XBmLmmYo9nSMJc0DFNYHGVvHhzWcQL_T_S4fgTebwDgP-8jZFMcrs2BjxlTMT7F_zv8BRw1oCc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2821640159</pqid></control><display><type>article</type><title>Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Zhou, Lue ; Li, Yapeng ; Yang, Xin ; Gu, Hongqiu ; Duan, Yanran ; Fu, Hang ; Wang, Anran ; Liu, Kai ; Gao, Yuan ; Song, Bo ; Li, Yusheng ; Jiang, Yingyu ; Zhang, Jing ; Wang, Chunjuan ; Wang, Meng ; Li, Zixiao ; Xu, Yuming ; Wang, Chengzeng ; Wang, Yongjun</creator><creatorcontrib>Zhou, Lue ; Li, Yapeng ; Yang, Xin ; Gu, Hongqiu ; Duan, Yanran ; Fu, Hang ; Wang, Anran ; Liu, Kai ; Gao, Yuan ; Song, Bo ; Li, Yusheng ; Jiang, Yingyu ; Zhang, Jing ; Wang, Chunjuan ; Wang, Meng ; Li, Zixiao ; Xu, Yuming ; Wang, Chengzeng ; Wang, Yongjun</creatorcontrib><description>We aimed to assess the prevalence of prior anticoagulation therapy (warfarin or non-vitamin K antagonist oral anticoagulants [NOACs]) among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China and investigate the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
We included consecutive patients with AIS and known history of AF admitted to hospitals in the China Stroke Center Alliance (CSCA) program from January 2019 to July 2019. Multivariate logistic regression analyses were performed to determine the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
Of 7181 patients (median [IQR] age, 75.0 [68.0–81.0] years; 48.7% men), 700 (9.7%), 129 (1.8%), and 255 (3.6%) patients received prior subtherapeutic warfarin (international normalized ratio [INR] <2.0), therapeutic warfarin (INR ≥2.0), and NOACs therapy, respectively. A total of 6499 patients had a preadmission CHA2DS2-VASc score ≥ 2, among whom 94.6% were not adequately anticoagulated. Compared with no prior anticoagulation therapy, prior NOACs therapy was associated with reduced risk of moderate or severe stroke at admission (odds ratio [95% CI], 0.64 [0.43–0.94], P = 0.023) and in-hospital mortality or discharge against medical advice (DAMA) (0.46 [0.24–0.86], P = 0.015). However, no significant association was observed between prior therapeutic warfarin therapy and stroke severity or in-hospital mortality or DAMA.
Among patients with AIS and AF in China, the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high. Prior NOACs therapy was associated with reduced stroke severity and less in-hospital mortality or DAMA.
•By retrospectively analyzed the data from the China Stroke Center Alliance (CSCA) program, we found that the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China.•Prior NOACs therapy was associated with reduced stroke severity at admission and lower odds of in-hospital mortality among patients with AIS and AF.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2023.05.051</identifier><identifier>PMID: 37257512</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Administration, Oral ; Aged ; Anticoagulants - adverse effects ; Anticoagulation ; Atrial fibrillation ; Atrial Fibrillation - epidemiology ; Female ; Hospitals ; Humans ; Ischemic Stroke ; Male ; Risk Factors ; Stroke - epidemiology ; Stroke severity ; Warfarin - adverse effects</subject><ispartof>International journal of cardiology, 2023-08, Vol.385, p.62-70</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-dfb3533f53ad044f83b70607b923655ba21d5a736e81e29da3502d45c3eb62373</citedby><cites>FETCH-LOGICAL-c362t-dfb3533f53ad044f83b70607b923655ba21d5a736e81e29da3502d45c3eb62373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2023.05.051$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37257512$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhou, Lue</creatorcontrib><creatorcontrib>Li, Yapeng</creatorcontrib><creatorcontrib>Yang, Xin</creatorcontrib><creatorcontrib>Gu, Hongqiu</creatorcontrib><creatorcontrib>Duan, Yanran</creatorcontrib><creatorcontrib>Fu, Hang</creatorcontrib><creatorcontrib>Wang, Anran</creatorcontrib><creatorcontrib>Liu, Kai</creatorcontrib><creatorcontrib>Gao, Yuan</creatorcontrib><creatorcontrib>Song, Bo</creatorcontrib><creatorcontrib>Li, Yusheng</creatorcontrib><creatorcontrib>Jiang, Yingyu</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Wang, Chunjuan</creatorcontrib><creatorcontrib>Wang, Meng</creatorcontrib><creatorcontrib>Li, Zixiao</creatorcontrib><creatorcontrib>Xu, Yuming</creatorcontrib><creatorcontrib>Wang, Chengzeng</creatorcontrib><creatorcontrib>Wang, Yongjun</creatorcontrib><title>Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>We aimed to assess the prevalence of prior anticoagulation therapy (warfarin or non-vitamin K antagonist oral anticoagulants [NOACs]) among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China and investigate the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
We included consecutive patients with AIS and known history of AF admitted to hospitals in the China Stroke Center Alliance (CSCA) program from January 2019 to July 2019. Multivariate logistic regression analyses were performed to determine the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
Of 7181 patients (median [IQR] age, 75.0 [68.0–81.0] years; 48.7% men), 700 (9.7%), 129 (1.8%), and 255 (3.6%) patients received prior subtherapeutic warfarin (international normalized ratio [INR] <2.0), therapeutic warfarin (INR ≥2.0), and NOACs therapy, respectively. A total of 6499 patients had a preadmission CHA2DS2-VASc score ≥ 2, among whom 94.6% were not adequately anticoagulated. Compared with no prior anticoagulation therapy, prior NOACs therapy was associated with reduced risk of moderate or severe stroke at admission (odds ratio [95% CI], 0.64 [0.43–0.94], P = 0.023) and in-hospital mortality or discharge against medical advice (DAMA) (0.46 [0.24–0.86], P = 0.015). However, no significant association was observed between prior therapeutic warfarin therapy and stroke severity or in-hospital mortality or DAMA.
Among patients with AIS and AF in China, the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high. Prior NOACs therapy was associated with reduced stroke severity and less in-hospital mortality or DAMA.
•By retrospectively analyzed the data from the China Stroke Center Alliance (CSCA) program, we found that the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China.•Prior NOACs therapy was associated with reduced stroke severity at admission and lower odds of in-hospital mortality among patients with AIS and AF.</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulation</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemic Stroke</subject><subject>Male</subject><subject>Risk Factors</subject><subject>Stroke - epidemiology</subject><subject>Stroke severity</subject><subject>Warfarin - adverse effects</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd2KFDEQhYMo7rj6BiK59KbH_HQ63TeCLOsPLHij1yGdVJyM0502Sa_Ma_jE1tC7XgoFCeE7dSp1CHnN2Z4z3r077uPR2ez3ggm5ZwqLPyE73uu24Vq1T8kOMd0ooeUVeVHKkTHWDkP_nFxJLZRWXOzIn9sQwFWaAl1yTJnauUaX7I_1ZGtMM60HyHY5U7yWmtNPoAXuIcd6RtTTODeHVJZY7Ymmtbo0QcFHuqAa5lro71gP1Lq1Ao3FHWCK7rHRRW9rjigNcczxtFm-JM-CPRV49XBek-8fb7_dfG7uvn76cvPhrnGyE7XxYZRKyqCk9axtQy9HzTqmx0HITqnRCu6V1bKDnoMYvJWKCd8qJ2HshNTymrzd-i45_VqhVDPhhIBTzJDWYkQveNcyrgZE2w11OZWSIRhc1mTz2XBmLmmYo9nSMJc0DFNYHGVvHhzWcQL_T_S4fgTebwDgP-8jZFMcrs2BjxlTMT7F_zv8BRw1oCc</recordid><startdate>20230815</startdate><enddate>20230815</enddate><creator>Zhou, Lue</creator><creator>Li, Yapeng</creator><creator>Yang, Xin</creator><creator>Gu, Hongqiu</creator><creator>Duan, Yanran</creator><creator>Fu, Hang</creator><creator>Wang, Anran</creator><creator>Liu, Kai</creator><creator>Gao, Yuan</creator><creator>Song, Bo</creator><creator>Li, Yusheng</creator><creator>Jiang, Yingyu</creator><creator>Zhang, Jing</creator><creator>Wang, Chunjuan</creator><creator>Wang, Meng</creator><creator>Li, Zixiao</creator><creator>Xu, Yuming</creator><creator>Wang, Chengzeng</creator><creator>Wang, Yongjun</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230815</creationdate><title>Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation</title><author>Zhou, Lue ; 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We included consecutive patients with AIS and known history of AF admitted to hospitals in the China Stroke Center Alliance (CSCA) program from January 2019 to July 2019. Multivariate logistic regression analyses were performed to determine the associations between prior anticoagulation therapy and initial stroke severity and in-hospital outcomes.
Of 7181 patients (median [IQR] age, 75.0 [68.0–81.0] years; 48.7% men), 700 (9.7%), 129 (1.8%), and 255 (3.6%) patients received prior subtherapeutic warfarin (international normalized ratio [INR] <2.0), therapeutic warfarin (INR ≥2.0), and NOACs therapy, respectively. A total of 6499 patients had a preadmission CHA2DS2-VASc score ≥ 2, among whom 94.6% were not adequately anticoagulated. Compared with no prior anticoagulation therapy, prior NOACs therapy was associated with reduced risk of moderate or severe stroke at admission (odds ratio [95% CI], 0.64 [0.43–0.94], P = 0.023) and in-hospital mortality or discharge against medical advice (DAMA) (0.46 [0.24–0.86], P = 0.015). However, no significant association was observed between prior therapeutic warfarin therapy and stroke severity or in-hospital mortality or DAMA.
Among patients with AIS and AF in China, the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high. Prior NOACs therapy was associated with reduced stroke severity and less in-hospital mortality or DAMA.
•By retrospectively analyzed the data from the China Stroke Center Alliance (CSCA) program, we found that the proportion of patients with inadequate anticoagulation prior to stroke remained substantially high among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) in China.•Prior NOACs therapy was associated with reduced stroke severity at admission and lower odds of in-hospital mortality among patients with AIS and AF.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37257512</pmid><doi>10.1016/j.ijcard.2023.05.051</doi><tpages>9</tpages></addata></record> |
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| ispartof | International journal of cardiology, 2023-08, Vol.385, p.62-70 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Administration, Oral Aged Anticoagulants - adverse effects Anticoagulation Atrial fibrillation Atrial Fibrillation - epidemiology Female Hospitals Humans Ischemic Stroke Male Risk Factors Stroke - epidemiology Stroke severity Warfarin - adverse effects |
| title | Effect of prior anticoagulation therapy on stroke severity and in-hospital outcomes in patients with acute ischemic stroke and atrial fibrillation |
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