title: Adequacy of preadmission oral anticoagulation with vitamin K antagonists and ischemic stroke severity and outcome in patients with atrial fibrillation.
abstract: It is unclear whether vitamin K antagonists affect stroke severity and outcome in patients with atrial fibrillation (AF). We aimed to evaluate this association. We prospectively studied 539 consecutive patients admitted with acute ischemic stroke (41.2 % males, age 78.9 ± 6.6 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was assessed with dependency rates at discharge (modified Rankin scale 2-5) and with in-hospital mortality. 177 patients had a history of AF. The median NIHSS at admission did not differ between patients on acenocoumarol with INR 2.0-3.0, on acenocoumarol with INR < 2.0, on single antiplatelet treatment, on dual antiplatelet treatment, or on no treatment [4 (range 0-26), 13 (0-39), 8 (0-33), 3 (2-23) and 7 (0-33), respectively; p = 0.433]. Dependency rates were lower in patients on acenocoumarol with INR 2.0-3.0 or on dual antiplatelet treatment than in those on acenocoumarol with INR < 2.0, single antiplatelet treatment, or no treatment (20.0, 22.2, 61.5, 58.7 and 68.0 %, respectively; p = 0.024). Independent predictors of dependency were age, NIHSS at admission and history of ischemic stroke. In-hospital mortality did not differ between patients on acenocoumarol with INR 2.0-3.0, on acenocoumarol with INR < 2.0, on single antiplatelet treatment, on dual antiplatelet treatment, or on no treatment (7.7, 18.2, 16.1, 16.7 and 22.2 %, respectively; p = 0.822). In conclusion, optimally anticoagulated patients with AF have more favorable functional outcome after stroke and a trend for less severe stroke whereas patients with subtherapeutic anticoagulation have similar stroke severity and outcome with those on no treatment.
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece. ktziomalos@yahoo.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Giampatzis
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Stella D
authors.initials: SD
authors.lastname: Bouziana
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Marianna
authors.initials: M
authors.lastname: Spanou
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Kostaki
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Papadopoulou
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Dourliou
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Areti
authors.initials: A
authors.lastname: Sofogianni
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Savopoulos
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
authors.forename: Apostolos I
authors.initials: AI
authors.lastname: Hatzitolios
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage / Q000493:pharmacokinetics; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics; D001241:Aspirin / Q000008:administration & dosage / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D002545:Brain Ischemia / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D000074:Acenocoumarol; D001241:Aspirin
keywords: Acenocoumarol; Aspirin; Ischemic stroke; Stroke severity; Vitamin K antagonists; Warfarin