title: The impact of prior antithrombotic status on cerebral infarction in patients with atrial fibrillation.
abstract: BACKGROUND
  Anticoagulation effectively prevents cardioembolic stroke in atrial fibrillation (AF) patients, whereas it is less effective than antiplatelet therapy (AT) in noncardioembolic stroke prevention. We hypothesized that the ischemic lesion pattern and vascular patency would differ according to the antithrombotic treatment status in AF patients.
  
  
  METHODS
  The medical records of 1078 acute ischemic stroke patients with AF were retrospectively reviewed. Patients were classified according to medication at stroke onset: (1) optimal anticoagulation (OAC; international normalized ratio [INR] 1.7-3.0; n = 36); (2) suboptimal anticoagulation (SOAC; INR ≤1.7; n = 134); (3) AT (n = 285); and (4) control (no antithrombotic medication; n = 623). Imaging and clinical variables of each group were compared with that of controls.
  
  
  RESULTS
  Small cortical or single subcortical infarctions were more common in the OAC group than in controls (6% vs. 1% and 22% vs. 8%, respectively; standardized residual, 2.4 and 2.8). Multicirculatory infarctions were less common in the OAC group than in controls (0% vs. 11%; standardized residual, -2.0). Obstruction of the corresponding artery was less common in the OAC group than in controls (26.5% vs. 46.5%, P = .02). Initial neurologic severity was lower in the OAC and AT groups than in controls (P = .01 and .03, respectively). OAC and AT were independently associated with favorable functional outcome at 3-months (P = .015 and <.001, respectively).
  
  
  CONCLUSIONS
  Ischemic stroke can occur during OAC in AF patients. Small cortical or single subcortical lesions were more common than typical cardioembolic lesion patterns. OAC and AT were protective against severe neurologic deficit and independently associated with favorable outcome, but SOAC was not.
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Bum Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Hyo Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Daegu Catholic University Hospital, Daegu, Korea.
authors.forename: Youngrok
authors.initials: Y
authors.lastname: Do
authors.affiliation: Department of Neurology, Kang-Dong Sacred Hospital, Seoul, Korea.
authors.forename: Ju-Hun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chung-Ang University Medical Center, Seoul, Korea.
authors.forename: Kwang-Yeol
authors.initials: KY
authors.lastname: Park
authors.affiliation: Department of Neurology, Dong-A University Hospital, Busan, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Hahn-Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Jee-Hyun
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: Department of Neurology, Soonchunhyang Medical Center, Seoul, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Dongguk University Hospital, Ilsan, Korea.
authors.forename: Dong-Eog
authors.initials: DE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul Veterans Hospital, Seoul, Korea.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Ha
authors.affiliation: Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea.
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Sohn
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea. Electronic address: sukwon@amc.seoul.kr.
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002544:Cerebral Infarction / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000592:standards; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulation; atrial fibrillation; prognosis; stroke mechanism