title: Ischaemic stroke in patients treated with oral anticoagulants.
abstract: BACKGROUND
  Cardioembolic stroke is associated with poorer outcomes. Prevention is based on oral anticoagulant (OAC) therapy. Haemorrhage is the main complication of OACs, which are sometimes ineffective.
  
  
  METHODS
  We retrospectively reviewed 1014 consecutive patients who suffered an ischaemic stroke between 2011 and 2013, analysing those who were receiving OAC treatment at stroke onset (107 patients in total) with special attention to aetiology, outcomes, and INR value in the acute phase.
  
  
  RESULTS
  The mean age (SD) was 71.9 (10) years. Patients had been treated with OACs for 5.9 (5.5) years; 98.1% of them were being treated for heart disease. INR was <2 in 77 patients (72%), and 30 patients (28%) had an INR≥2. Nine patients (8.4%) had INR values within the therapeutic range. According to TOAST classification criteria, 88.8% of strokes were cardioembolic and 1.9% were atherothrombotic. Anticoagulation therapy was discontinued in 48 patients (44.9%) due to haemorrhagic transformation (24 patients), extensive infarction (23), or endarterectomy (1). Therapy was resumed in 24 patients (50%) after a mean lapse of 36 days. This was not possible in the remaining patients because of death or severe sequelae. New OACs (NOACs) were prescribed to 9 patients (18.7% of all potential candidates). At 3 months, patients with INR>1.7 in the acute phase exhibited better outcomes than patients with INR≤1.7 (mRS 0-2 in 62% vs 30.8%; death in 10% vs 38.4%; P=.0004).
  
  
  CONCLUSIONS
  Some patients taking OACs suffer ischaemic strokes that are usually cardioembolic, especially if INR is below the therapeutic range. OACs can be resumed without complications, and NOACs are still underused. Despite cases in which treatment is ineffective, outcomes are better when INR is above 1.7 at stroke onset.
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España. Electronic address: lcano@bellvitgehospital.cat.
authors.forename: L M
authors.initials: LM
authors.lastname: Cano
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Cardona
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: H
authors.initials: H
authors.lastname: Quesada
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Lara
authors.affiliation: Servicio de Neurología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Rubio
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulantes orales; Cardioembolic stroke; Cociente internacional normalizado; Ictus cardioembólico; Ictus isquémico; International normalized ratio; Ischaemic stroke; Oral anticoagulants