title: Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: a population study.
abstract: OBJECTIVE
  Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic).
  
  
  METHODS
  We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke.
  
  
  RESULTS
  One hundred seventy-five patients had atrial fibrillation-associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17% of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivariable analysis, therapeutic INR was associated with improved late survival after ischemic stroke (adjusted 2-year odds ratio for death=0.08; 95% CI, 0.01 to 0.78; P=0.03). This survival benefit persisted when patients with hemorrhagic stroke were included (2-year survival; 70.5% therapeutic INR, 14.3% nontherapeutic INR; log-rank P<0.001; odds ratio for death=0.27; 95% CI, 0.09 to 0.88; P=0.03). Admission INR was inversely correlated with early and late modified Rankin Scale score (2-year Spearman ρ=-0.65; P<0.0003). An INR of 2 to 3 at ischemic stroke onset was associated with greater early (72 hours to 28 days) modified Rankin Scale score improvement (P=0.04) and good functional outcome (modified Rankin Scale score=0 to 2) at 1 year (adjusted odds ratio=4.8; 95% CI, 1.45 to 23.8; P=0.04).
  
  
  CONCLUSIONS
  In addition to improving short-term outcome in selected hospital-treated patient groups, therapeutic anticoagulation may provide important benefits for long-term stroke outcomes in unselected populations.
authors.affiliation: Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Nelson Street, Mater University Hospital, Dublin 7, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Hannon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Callaly
authors.forename: Alan
authors.initials: A
authors.lastname: Moore
authors.forename: Danielle
authors.initials: D
authors.lastname: Ní Chróinín
authors.forename: Orla
authors.initials: O
authors.lastname: Sheehan
authors.forename: Michael
authors.initials: M
authors.lastname: Marnane
authors.forename: Aine
authors.initials: A
authors.lastname: Merwick
authors.forename: Lorraine
authors.initials: L
authors.lastname: Kyne
authors.forename: Joseph
authors.initials: J
authors.lastname: Duggan
authors.forename: Patricia M E
authors.initials: PM
authors.lastname: McCormack
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Gloria
authors.initials: G
authors.lastname: Crispino-O'Connell
authors.forename: Dawn
authors.initials: D
authors.lastname: Harris
authors.forename: Gillian
authors.initials: G
authors.lastname: Horgan
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin