BACKGROUND AND PURPOSES: Patients with atrial fibrillation (AF) on treatment with oral anticoagulants may still suffer ischemic cerebrovascular events. The aim of this study was to evaluate the risk factors for cerebral ischemic events in warfarin-treated AF patients with an International Normalized Ratios (INR) above 1.8 on admission. METHODS: In a case-control study, cases were consecutive patients with AF who were on warfarin and who were admitted to four Italian hospitals after an acute cerebrovascular ischemic event (ischemic stroke or transient ischemic attack) with an INR above 1.8. Controls were selected from a single anticoagulation clinic and were patients with AF on adequate warfarin treatment who did not suffer cerebrovascular events. RESULTS: Cases were identified among 4785 consecutive patients with an ischemic cerebral event. 148 cases (3.1%, 21 with transient ischemic events and 127 with ischemic strokes) had AF and were taking warfarin with an INR above 1.8 on admission. On multivariate analysis, diabetes (OR 3.8; 95% CI 1.09-13.82, p=0.025), hyperlipidemia (OR 4.5; 95% CI 1.11-18.23, p=0.035) and carotid/vertebral atherosclerosis on ultrasound (OR 3.0; 95% CI 1.13-8.41, p=0.028) were independent predictors for ischemic cerebral events. The use of statins was inversely correlated with an ischemic event (OR 0.1; 95% CI 0.06-0.47. p=0.001). CONCLUSIONS: Carotid/vertebral atherosclerosis, diabetes and hyperlipidemia are associated with an increased risk for ischemic events in patients with AF on adequate warfarin treatment. Statins significantly reduce the risk of ischemic events.
BACKGROUND AND PURPOSES: Patients with atrial fibrillation (AF) on treatment with oral anticoagulants may still suffer ischemic cerebrovascular events. The aim of this study was to evaluate the risk factors for cerebral ischemic events in warfarin-treated AFpatients with an International Normalized Ratios (INR) above 1.8 on admission. METHODS: In a case-control study, cases were consecutive patients with AF who were on warfarin and who were admitted to four Italian hospitals after an acute cerebrovascular ischemic event (ischemic stroke or transient ischemic attack) with an INR above 1.8. Controls were selected from a single anticoagulation clinic and were patients with AF on adequate warfarin treatment who did not suffer cerebrovascular events. RESULTS: Cases were identified among 4785 consecutive patients with an ischemic cerebral event. 148 cases (3.1%, 21 with transient ischemic events and 127 with ischemic strokes) had AF and were taking warfarin with an INR above 1.8 on admission. On multivariate analysis, diabetes (OR 3.8; 95% CI 1.09-13.82, p=0.025), hyperlipidemia (OR 4.5; 95% CI 1.11-18.23, p=0.035) and carotid/vertebral atherosclerosis on ultrasound (OR 3.0; 95% CI 1.13-8.41, p=0.028) were independent predictors for ischemic cerebral events. The use of statins was inversely correlated with an ischemic event (OR 0.1; 95% CI 0.06-0.47. p=0.001). CONCLUSIONS: Carotid/vertebral atherosclerosis, diabetes and hyperlipidemia are associated with an increased risk for ischemic events in patients with AF on adequate warfarin treatment. Statins significantly reduce the risk of ischemic events.
Authors: Raghav V Aachi; Lee A Birnbaum; Christopher H Topel; Ali Seifi; Shaheryar Hafeez; Réza Behrouz Journal: Clin Cardiol Date: 2017-12-18 Impact factor: 2.882
Authors: Young Dae Kim; Kyung Yul Lee; Hyo Suk Nam; Sang Won Han; Jong Yun Lee; Han-Jin Cho; Gyu Sik Kim; Seo Hyun Kim; Myoung-Jin Cha; Seong Hwan Ahn; Seung-Hun Oh; Kee Ook Lee; Yo Han Jung; Hye-Yeon Choi; Sang-Don Han; Hye Sun Lee; Chung Mo Nam; Eun Hye Kim; Ki Jeong Lee; Dongbeom Song; Hui-Nam Park; Ji Hoe Heo Journal: Yonsei Med J Date: 2015-03 Impact factor: 2.759
Authors: Fabian Schaub; Alexandros A Polymeris; Sabine Schaedelin; Lisa Hert; Louisa Meya; Sebastian Thilemann; Christopher Traenka; Benjamin Wagner; David Seiffge; Henrik Gensicke; Gian Marco De Marchis; Leo Bonati; Stefan T Engelter; Nils Peters; Philippe Lyrer Journal: J Am Heart Assoc Date: 2021-12-22 Impact factor: 6.106