Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation
Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the...
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| creator | Yaghi, Shadi Liberman, Ava L. Henninger, Nils Grory, Brian Mac Nouh, Amre Scher, Erica Giles, James Liu, Angela Nagy, Muhammad Kaushal, Ashutosh Azher, Idrees Fakhri, Hiba Espaillat, Kiersten Brown Asad, Syed Daniyal Pasupuleti, Hemanth Martin, Heather Tan, Jose Veerasamy, Manivannan Esenwa, Charles Cheng, Natalie Moncrieffe, Khadean Moeini-Naghani, Iman Siddu, Mithilesh Trivedi, Tushar Ishida, Koto Frontera, Jennifer Lord, Aaron Furie, Karen Keyrouz, Salah de Havenon, Adam Mistry, Eva Leon Guerrero, Christopher R. Khan, Muhib |
| description | Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF.
The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2020.104888 |
| format | Article |
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The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR <2) anticoagulation status. We used binary logistic regression models to determine factors independently associated with anticoagulation status after adjustment for pertinent confounders. In particular, we sought to determine whether atherosclerosis with 50% or more luminal narrowing in an artery supplying the infarct (a marker for a competing atherosclerotic mechanism) and small stroke size (≤ 10 mL; implying a competing small vessel disease mechanism) related to anticoagulant status.
Of the 2084 patients enrolled in the IAC study, 382 patients met the inclusion criteria. The mean age was 77.4 ± 10.9 years and 52.4% (200/382) were women. A total of 222 (58.1%) subjects presented with subtherapeutic INR. In adjusted models, small stroke size (OR 1.74 95% CI 1.10–2.76, p = 0.019) and atherosclerosis with 50% or more narrowing in an artery supplying the infarct (OR 1.96 95% CI 1.06–3.63, p = 0.031) were independently associated with INR ≥2 at the time of their index stroke.
Small stroke size (≤ 10 ml) and ipsilateral atherosclerosis with 50% or more narrowing may indicate a competing stroke mechanism. There may be important opportunities to improve stroke prevention strategies for patients with AF by targeting additional ischemic stroke mechanisms to improve patient outcomes.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2020.104888</identifier><identifier>PMID: 32414583</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anticoagulation ; Atrial fibrillation ; Predictors ; Recurrence ; Stroke</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2020-07, Vol.29 (7), p.104888-104888, Article 104888</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-eb29177b10a2339fd5ac5054b1d71ea58d3d3328d61a541aeefa861950b68aa43</citedby><cites>FETCH-LOGICAL-c519t-eb29177b10a2339fd5ac5054b1d71ea58d3d3328d61a541aeefa861950b68aa43</cites><orcidid>0000-0001-9423-6281 ; 0000-0002-3197-3062 ; 0000-0003-0031-1004 ; 0000-0002-3883-5623 ; 0000-0001-8178-8597 ; 0000-0002-2310-4609 ; 0000-0002-2906-5647 ; 0000-0001-9377-8353</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104888$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32414583$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Liberman, Ava L.</creatorcontrib><creatorcontrib>Henninger, Nils</creatorcontrib><creatorcontrib>Grory, Brian Mac</creatorcontrib><creatorcontrib>Nouh, Amre</creatorcontrib><creatorcontrib>Scher, Erica</creatorcontrib><creatorcontrib>Giles, James</creatorcontrib><creatorcontrib>Liu, Angela</creatorcontrib><creatorcontrib>Nagy, Muhammad</creatorcontrib><creatorcontrib>Kaushal, Ashutosh</creatorcontrib><creatorcontrib>Azher, Idrees</creatorcontrib><creatorcontrib>Fakhri, Hiba</creatorcontrib><creatorcontrib>Espaillat, Kiersten Brown</creatorcontrib><creatorcontrib>Asad, Syed Daniyal</creatorcontrib><creatorcontrib>Pasupuleti, Hemanth</creatorcontrib><creatorcontrib>Martin, Heather</creatorcontrib><creatorcontrib>Tan, Jose</creatorcontrib><creatorcontrib>Veerasamy, Manivannan</creatorcontrib><creatorcontrib>Esenwa, Charles</creatorcontrib><creatorcontrib>Cheng, Natalie</creatorcontrib><creatorcontrib>Moncrieffe, Khadean</creatorcontrib><creatorcontrib>Moeini-Naghani, Iman</creatorcontrib><creatorcontrib>Siddu, Mithilesh</creatorcontrib><creatorcontrib>Trivedi, Tushar</creatorcontrib><creatorcontrib>Ishida, Koto</creatorcontrib><creatorcontrib>Frontera, Jennifer</creatorcontrib><creatorcontrib>Lord, Aaron</creatorcontrib><creatorcontrib>Furie, Karen</creatorcontrib><creatorcontrib>Keyrouz, Salah</creatorcontrib><creatorcontrib>de Havenon, Adam</creatorcontrib><creatorcontrib>Mistry, Eva</creatorcontrib><creatorcontrib>Leon Guerrero, Christopher R.</creatorcontrib><creatorcontrib>Khan, Muhib</creatorcontrib><title>Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF.
The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR <2) anticoagulation status. We used binary logistic regression models to determine factors independently associated with anticoagulation status after adjustment for pertinent confounders. In particular, we sought to determine whether atherosclerosis with 50% or more luminal narrowing in an artery supplying the infarct (a marker for a competing atherosclerotic mechanism) and small stroke size (≤ 10 mL; implying a competing small vessel disease mechanism) related to anticoagulant status.
Of the 2084 patients enrolled in the IAC study, 382 patients met the inclusion criteria. The mean age was 77.4 ± 10.9 years and 52.4% (200/382) were women. A total of 222 (58.1%) subjects presented with subtherapeutic INR. In adjusted models, small stroke size (OR 1.74 95% CI 1.10–2.76, p = 0.019) and atherosclerosis with 50% or more narrowing in an artery supplying the infarct (OR 1.96 95% CI 1.06–3.63, p = 0.031) were independently associated with INR ≥2 at the time of their index stroke.
Small stroke size (≤ 10 ml) and ipsilateral atherosclerosis with 50% or more narrowing may indicate a competing stroke mechanism. There may be important opportunities to improve stroke prevention strategies for patients with AF by targeting additional ischemic stroke mechanisms to improve patient outcomes.</description><subject>Anticoagulation</subject><subject>Atrial fibrillation</subject><subject>Predictors</subject><subject>Recurrence</subject><subject>Stroke</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqVkVFvFCEUhYnR2Nr2LxieTWblwrDDvJhoY9Vkk77UZ3IH7nRZZ4cNsGv897IZbTTxxRcgcL7DyT2MvQGxAgHrt7vVLpcUv5GjREOKJ8w-5JUU8ixojTHP2CVoJRujAZ7Xs9CyUUJ3F-xVzjshALTRL9mFki202qhLlu_QlZgyx5yjC1jI8--hbHnZUsIDHUtwHOe6Rnw8TlhCnHkuWI6Zh5kf6gXNJS9MyG5L-wosMSvnOZYUcOJjGFKYFv6avRhxynTza79iX-8-Ptx-bjb3n77cvt80TkNfGhpkD103gECpVD96jU4L3Q7gOyDUxiuvlDR-DahbQKIRzRp6LYa1QWzVFXu3-B6Ow568q0ETTvaQwh7TDxsx2L9f5rC1j_FkjRSdln01-LAYuBRzTjQ-sSDsuRK7s_-qxJ4rsUsl1eT1nymeLH53UAWbRUB1FqdAyWZXh-rIh0SuWB_D__z3E28rsOY</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Yaghi, Shadi</creator><creator>Liberman, Ava L.</creator><creator>Henninger, Nils</creator><creator>Grory, Brian Mac</creator><creator>Nouh, Amre</creator><creator>Scher, Erica</creator><creator>Giles, James</creator><creator>Liu, Angela</creator><creator>Nagy, Muhammad</creator><creator>Kaushal, Ashutosh</creator><creator>Azher, Idrees</creator><creator>Fakhri, Hiba</creator><creator>Espaillat, Kiersten Brown</creator><creator>Asad, Syed Daniyal</creator><creator>Pasupuleti, Hemanth</creator><creator>Martin, Heather</creator><creator>Tan, Jose</creator><creator>Veerasamy, Manivannan</creator><creator>Esenwa, Charles</creator><creator>Cheng, Natalie</creator><creator>Moncrieffe, Khadean</creator><creator>Moeini-Naghani, Iman</creator><creator>Siddu, Mithilesh</creator><creator>Trivedi, Tushar</creator><creator>Ishida, Koto</creator><creator>Frontera, Jennifer</creator><creator>Lord, Aaron</creator><creator>Furie, Karen</creator><creator>Keyrouz, Salah</creator><creator>de Havenon, Adam</creator><creator>Mistry, Eva</creator><creator>Leon Guerrero, Christopher R.</creator><creator>Khan, Muhib</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9423-6281</orcidid><orcidid>https://orcid.org/0000-0002-3197-3062</orcidid><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid><orcidid>https://orcid.org/0000-0002-3883-5623</orcidid><orcidid>https://orcid.org/0000-0001-8178-8597</orcidid><orcidid>https://orcid.org/0000-0002-2310-4609</orcidid><orcidid>https://orcid.org/0000-0002-2906-5647</orcidid><orcidid>https://orcid.org/0000-0001-9377-8353</orcidid></search><sort><creationdate>20200701</creationdate><title>Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation</title><author>Yaghi, Shadi ; Liberman, Ava L. ; Henninger, Nils ; Grory, Brian Mac ; Nouh, Amre ; Scher, Erica ; Giles, James ; Liu, Angela ; Nagy, Muhammad ; Kaushal, Ashutosh ; Azher, Idrees ; Fakhri, Hiba ; Espaillat, Kiersten Brown ; Asad, Syed Daniyal ; Pasupuleti, Hemanth ; Martin, Heather ; Tan, Jose ; Veerasamy, Manivannan ; Esenwa, Charles ; Cheng, Natalie ; Moncrieffe, Khadean ; Moeini-Naghani, Iman ; Siddu, Mithilesh ; Trivedi, Tushar ; Ishida, Koto ; Frontera, Jennifer ; Lord, Aaron ; Furie, Karen ; Keyrouz, Salah ; de Havenon, Adam ; Mistry, Eva ; Leon Guerrero, Christopher R. ; Khan, Muhib</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-eb29177b10a2339fd5ac5054b1d71ea58d3d3328d61a541aeefa861950b68aa43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anticoagulation</topic><topic>Atrial fibrillation</topic><topic>Predictors</topic><topic>Recurrence</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Liberman, Ava L.</creatorcontrib><creatorcontrib>Henninger, Nils</creatorcontrib><creatorcontrib>Grory, Brian Mac</creatorcontrib><creatorcontrib>Nouh, Amre</creatorcontrib><creatorcontrib>Scher, Erica</creatorcontrib><creatorcontrib>Giles, James</creatorcontrib><creatorcontrib>Liu, Angela</creatorcontrib><creatorcontrib>Nagy, Muhammad</creatorcontrib><creatorcontrib>Kaushal, Ashutosh</creatorcontrib><creatorcontrib>Azher, Idrees</creatorcontrib><creatorcontrib>Fakhri, Hiba</creatorcontrib><creatorcontrib>Espaillat, Kiersten Brown</creatorcontrib><creatorcontrib>Asad, Syed Daniyal</creatorcontrib><creatorcontrib>Pasupuleti, Hemanth</creatorcontrib><creatorcontrib>Martin, Heather</creatorcontrib><creatorcontrib>Tan, Jose</creatorcontrib><creatorcontrib>Veerasamy, Manivannan</creatorcontrib><creatorcontrib>Esenwa, Charles</creatorcontrib><creatorcontrib>Cheng, Natalie</creatorcontrib><creatorcontrib>Moncrieffe, Khadean</creatorcontrib><creatorcontrib>Moeini-Naghani, Iman</creatorcontrib><creatorcontrib>Siddu, Mithilesh</creatorcontrib><creatorcontrib>Trivedi, Tushar</creatorcontrib><creatorcontrib>Ishida, Koto</creatorcontrib><creatorcontrib>Frontera, Jennifer</creatorcontrib><creatorcontrib>Lord, Aaron</creatorcontrib><creatorcontrib>Furie, Karen</creatorcontrib><creatorcontrib>Keyrouz, Salah</creatorcontrib><creatorcontrib>de Havenon, Adam</creatorcontrib><creatorcontrib>Mistry, Eva</creatorcontrib><creatorcontrib>Leon Guerrero, Christopher R.</creatorcontrib><creatorcontrib>Khan, Muhib</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yaghi, Shadi</au><au>Liberman, Ava L.</au><au>Henninger, Nils</au><au>Grory, Brian Mac</au><au>Nouh, Amre</au><au>Scher, Erica</au><au>Giles, James</au><au>Liu, Angela</au><au>Nagy, Muhammad</au><au>Kaushal, Ashutosh</au><au>Azher, Idrees</au><au>Fakhri, Hiba</au><au>Espaillat, Kiersten Brown</au><au>Asad, Syed Daniyal</au><au>Pasupuleti, Hemanth</au><au>Martin, Heather</au><au>Tan, Jose</au><au>Veerasamy, Manivannan</au><au>Esenwa, Charles</au><au>Cheng, Natalie</au><au>Moncrieffe, Khadean</au><au>Moeini-Naghani, Iman</au><au>Siddu, Mithilesh</au><au>Trivedi, Tushar</au><au>Ishida, Koto</au><au>Frontera, Jennifer</au><au>Lord, Aaron</au><au>Furie, Karen</au><au>Keyrouz, Salah</au><au>de Havenon, Adam</au><au>Mistry, Eva</au><au>Leon Guerrero, Christopher R.</au><au>Khan, Muhib</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>29</volume><issue>7</issue><spage>104888</spage><epage>104888</epage><pages>104888-104888</pages><artnum>104888</artnum><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF.
The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Consecutive patients hospitalized with acute ischemic stroke in the setting of AF were included in the IAC cohort. For this study, we only included patients who reported taking warfarin at the time of the ischemic stroke. Patients not on anticoagulation and patients who reported use of a direct oral anticoagulant were excluded. Analyses were stratified based on therapeutic (INR ≥2) versus subtherapeutic (INR <2) anticoagulation status. We used binary logistic regression models to determine factors independently associated with anticoagulation status after adjustment for pertinent confounders. In particular, we sought to determine whether atherosclerosis with 50% or more luminal narrowing in an artery supplying the infarct (a marker for a competing atherosclerotic mechanism) and small stroke size (≤ 10 mL; implying a competing small vessel disease mechanism) related to anticoagulant status.
Of the 2084 patients enrolled in the IAC study, 382 patients met the inclusion criteria. The mean age was 77.4 ± 10.9 years and 52.4% (200/382) were women. A total of 222 (58.1%) subjects presented with subtherapeutic INR. In adjusted models, small stroke size (OR 1.74 95% CI 1.10–2.76, p = 0.019) and atherosclerosis with 50% or more narrowing in an artery supplying the infarct (OR 1.96 95% CI 1.06–3.63, p = 0.031) were independently associated with INR ≥2 at the time of their index stroke.
Small stroke size (≤ 10 ml) and ipsilateral atherosclerosis with 50% or more narrowing may indicate a competing stroke mechanism. There may be important opportunities to improve stroke prevention strategies for patients with AF by targeting additional ischemic stroke mechanisms to improve patient outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32414583</pmid><doi>10.1016/j.jstrokecerebrovasdis.2020.104888</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-9423-6281</orcidid><orcidid>https://orcid.org/0000-0002-3197-3062</orcidid><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid><orcidid>https://orcid.org/0000-0002-3883-5623</orcidid><orcidid>https://orcid.org/0000-0001-8178-8597</orcidid><orcidid>https://orcid.org/0000-0002-2310-4609</orcidid><orcidid>https://orcid.org/0000-0002-2906-5647</orcidid><orcidid>https://orcid.org/0000-0001-9377-8353</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of stroke and cerebrovascular diseases, 2020-07, Vol.29 (7), p.104888-104888, Article 104888 |
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| language | eng |
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | Anticoagulation Atrial fibrillation Predictors Recurrence Stroke |
| title | Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation |
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