OBJECTIVE: The level of anticoagulation at the time of stroke onset may influence the size, composition, and dissolution rate of the occlusive clot. We explored the relation between admission international normalized ratio (INR) and acute infarct volume in patients with ischemic stroke. METHODS: We studied 93 consecutive patients with preadmission warfarin use who had INR measurement and diffusion-weighted imaging performed within 24 hours of stroke onset. Ninety-three etiologic stroke subtype-matched patients without prior warfarin use served as control patients. Linear regression analysis was used to test for independence of INR as a predictor of infarct volume. RESULTS: In patients with preadmission warfarin use, admission INR was inversely correlated with lesion volume on diffusion-weighted imaging (r = -0.38). This relation was retained after adjustment for potential covariates (p = 0.014). INR less than 2.0 was associated with 3.5-fold (95% confidence interval, 2.9-4.2) greater lesion volume on diffusion-weighted imaging as compared with INR of 2.0 or more. Patients who were on therapeutic INR (>or=2.0) had smaller infarcts compared with patients without preadmission warfarin use (p = 0.001). Admission INR was inversely correlated with acute perfusion defect (r = -0.33), chronic infarct volume (r = -0.42), National Institutes of Health Stroke Scale score at admission (r = -0.27), and modified Rankin score at discharge (r = -0.28). INTERPRETATION: These results suggest that preadmission warfarin use associated with therapeutic level of anticoagulation can offer a benefit in limiting the extent of ischemic injury in an event of acute stroke.
OBJECTIVE: The level of anticoagulation at the time of stroke onset may influence the size, composition, and dissolution rate of the occlusive clot. We explored the relation between admission international normalized ratio (INR) and acute infarct volume in patients with ischemic stroke. METHODS: We studied 93 consecutive patients with preadmission warfarin use who had INR measurement and diffusion-weighted imaging performed within 24 hours of stroke onset. Ninety-three etiologic stroke subtype-matched patients without prior warfarin use served as control patients. Linear regression analysis was used to test for independence of INR as a predictor of infarct volume. RESULTS: In patients with preadmission warfarin use, admission INR was inversely correlated with lesion volume on diffusion-weighted imaging (r = -0.38). This relation was retained after adjustment for potential covariates (p = 0.014). INR less than 2.0 was associated with 3.5-fold (95% confidence interval, 2.9-4.2) greater lesion volume on diffusion-weighted imaging as compared with INR of 2.0 or more. Patients who were on therapeutic INR (>or=2.0) had smaller infarcts compared with patients without preadmission warfarin use (p = 0.001). Admission INR was inversely correlated with acute perfusion defect (r = -0.33), chronic infarct volume (r = -0.42), National Institutes of Health Stroke Scale score at admission (r = -0.27), and modified Rankin score at discharge (r = -0.28). INTERPRETATION: These results suggest that preadmission warfarin use associated with therapeutic level of anticoagulation can offer a benefit in limiting the extent of ischemic injury in an event of acute stroke.
Authors: Eva A Rocha; Ruijun Ji; Hakan Ay; Zixiao Li; Ethem Murat Arsava; Gisele S Silva; Alma Gregory Sorensen; Ona Wu; Aneesh B Singhal Journal: J Stroke Cerebrovasc Dis Date: 2019-03-29 Impact factor: 2.136
Authors: Matthew A Edwardson; Ximing Wang; Brent Liu; Li Ding; Christianne J Lane; Caron Park; Monica A Nelsen; Theresa A Jones; Steven L Wolf; Carolee J Winstein; Alexander W Dromerick Journal: Neurorehabil Neural Repair Date: 2017-01-01 Impact factor: 3.919
Authors: Shadi Yaghi; Ava L Liberman; Nils Henninger; Brian Mac Grory; Amre Nouh; Erica Scher; James Giles; Angela Liu; Muhammad Nagy; Ashutosh Kaushal; Idrees Azher; Hiba Fakhri; Kiersten Brown Espaillat; Syed Daniyal Asad; Hemanth Pasupuleti; Heather Martin; Jose Tan; Manivannan Veerasamy; Charles Esenwa; Natalie Cheng; Khadean Moncrieffe; Iman Moeini-Naghani; Mithilesh Siddu; Tushar Trivedi; Koto Ishida; Jennifer Frontera; Aaron Lord; Karen Furie; Salah Keyrouz; Adam de Havenon; Eva Mistry; Christopher R Leon Guerrero; Muhib Khan Journal: J Stroke Cerebrovasc Dis Date: 2020-05-13 Impact factor: 2.136
Authors: Yun Kyung Park; Mi Ji Lee; Jae Ha Kim; Suk Jae Kim; June Soo Kim; Soo-Youn Lee; Oh Young Bang Journal: J Stroke Date: 2015-05-29 Impact factor: 6.967