title: Intensity of anticoagulation and clinical outcomes in acute cardioembolic stroke: the Fukuoka Stroke Registry.
abstract: OBJECTIVE
  The relationship between the intensity of anticoagulation at the onset of acute cardioembolic stroke and clinical outcome after stroke is unclear. Here, we elucidated the relationship between prothrombin time-international normalized ratio (PT-INR) values on admission and clinical outcomes in patients with acute cardioembolic stroke.
  
  
  METHODS
  A total of 602 patients from the Fukuoka Stroke Registry in Japan who had been treated with warfarin but developed cardioembolic stroke were enrolled. The patients were classified into 3 groups according to their PT-INR values on admission: PT-INR <1.50, 411 patients; PT-INR 1.50 to 1.99, 146 patients; and PT-INR ≥2.00, 45 patients. The associations between PT-INR categories and severe neurological deficits (National Institutes of Health Stroke Scale ≥10) on admission and poor functional outcome (modified Rankin scale 4-6) at discharge were investigated using a logistic regression analysis.
  
  
  RESULTS
  Neurological deficits on admission were less severe, and functional outcome at discharge was more favorable as the PT-INR level on admission increased. The multivariate analysis revealed that severe neurological deficits were inversely associated with PT-INR on admission (PT-INR 1.50-1.99: odds ratio, 0.66; 95% confidence interval, 0.43-1.00; PT-INR ≥2.00: odds ratio, 0.41; 95% confidence interval, 0.20-0.83; compared with a reference group of PT-INR <1.50). Poor functional outcome was less likely in patients with PT-INR ≥2.00 (odds ratio, 0.20; 95% confidence interval, 0.06-0.55) after adjustment for confounders.
  
  
  CONCLUSIONS
  Prestroke PT-INR ≥2.0 is associated with favorable clinical outcomes after acute cardioembolic stroke.
authors: From the Department of Medicine and Clinical Sciences (A.N., T.A., J.H., R.M., J.K., T. Kuwashiro., H.S., T. Kitazono), Department of Health Care Administration and Management (M.K.), and Department of Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Department of Nephrology, Hypertension, and Strokology (T.A., M.K., J.K., T. Kitazono), and Emergency and Critical Care Center (H.S.), Kyushu University Hospital, Kyushu University, Fukuoka, Japan.
authors: Asako
authors: A
authors: Nakamura
authors: Tetsuro
authors: T
authors: Ago
authors: Masahiro
authors: M
authors: Kamouchi
authors: Jun
authors: J
authors: Hata
authors: Ryu
authors: R
authors: Matsuo
authors: Junya
authors: J
authors: Kuroda
authors: Takahiro
authors: T
authors: Kuwashiro
authors: Hiroshi
authors: H
authors: Sugimori
authors: Takanari
authors: T
authors: Kitazono
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006761:Hospitals; D006801:Humans; D019934:International Normalized Ratio; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011517:Prothrombin Time; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulation; clinical outcome; ischemic stroke; prothrombin time–international normalized ratio; warfarin