Katarina Dakay1, Andrew D Chang1, Morgan Hemendinger1, Shawna Cutting1, Ryan A McTaggart2, Mahesh V Jayaraman2, Antony Chu3, Nikhil Panda3, Christopher Song3, Alexander Merkler4, Gino Gialdini4, Benjamin Kummer5, Michael P Lerario6, Hooman Kamel4, Mitchell S V Elkind7, Karen L Furie1, Shadi Yaghi8. 1. Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island. 2. Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, the Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Neurological Surgery, the Warren Alpert Medical School of Brown University, Providence, Rhode Island. 3. Department of Internal Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 4. Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York. 5. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York. 6. Department of Neurology, New York Presbyterian Queens, Flushing, New York. 7. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. 8. Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
Abstract
BACKGROUND: Despite anticoagulation therapy, ischemic stroke risk in atrial fibrillation (AF) remains substantial. We hypothesize that left atrial enlargement (LAE) is more prevalent in AF patients admitted with ischemic stroke who are therapeutic, as opposed to nontherapeutic, on anticoagulation. METHODS: We included consecutive patients with AF admitted with ischemic stroke between April 1, 2015, and December 31, 2016. Patients were divided into two groups based on whether they were therapeutic (warfarin with an international normalized ratio ≥ 2.0 or non-vitamin K oral anticoagulant with uninterrupted use in the prior 2 weeks) versus nontherapeutic on anticoagulation. Univariable and multivariable models were used to estimate associations between therapeutic anticoagulation and clinical factors, including CHADS2 score and LAE (none/mild versus moderate/severe). RESULTS: We identified 225 patients during the study period; 52 (23.1%) were therapeutic on anticoagulation. Patients therapeutic on anticoagulation were more likely to have a larger left atrial diameter in millimeters (45.6 ± 9.2 versus 42.3 ± 8.6, P = .032) and a higher CHADS2 score (2.9 ± 1.1 versus 2.4 ± 1.1, P = .03). After adjusting for the CHADS2 score, patients who had a stroke despite therapeutic anticoagulation were more likely to have moderate to severe LAE (odds ratio, 2.05; 95% confidence interval, 1.01-4.16). CONCLUSION: LAE is associated with anticoagulation failure in AF patients admitted with an ischemic stroke. This provides indirect evidence that LAE may portend failure of anticoagulation therapy in patients with AF; further studies are needed to delineate the significance of this association and improve stroke prevention strategies.
BACKGROUND: Despite anticoagulation therapy, ischemic stroke risk in atrial fibrillation (AF) remains substantial. We hypothesize that left atrial enlargement (LAE) is more prevalent in AFpatients admitted with ischemic stroke who are therapeutic, as opposed to nontherapeutic, on anticoagulation. METHODS: We included consecutive patients with AF admitted with ischemic stroke between April 1, 2015, and December 31, 2016. Patients were divided into two groups based on whether they were therapeutic (warfarin with an international normalized ratio ≥ 2.0 or non-vitamin K oral anticoagulant with uninterrupted use in the prior 2 weeks) versus nontherapeutic on anticoagulation. Univariable and multivariable models were used to estimate associations between therapeutic anticoagulation and clinical factors, including CHADS2 score and LAE (none/mild versus moderate/severe). RESULTS: We identified 225 patients during the study period; 52 (23.1%) were therapeutic on anticoagulation. Patients therapeutic on anticoagulation were more likely to have a larger left atrial diameter in millimeters (45.6 ± 9.2 versus 42.3 ± 8.6, P = .032) and a higher CHADS2 score (2.9 ± 1.1 versus 2.4 ± 1.1, P = .03). After adjusting for the CHADS2 score, patients who had a stroke despite therapeutic anticoagulation were more likely to have moderate to severe LAE (odds ratio, 2.05; 95% confidence interval, 1.01-4.16). CONCLUSION: LAE is associated with anticoagulation failure in AFpatients admitted with an ischemic stroke. This provides indirect evidence that LAE may portend failure of anticoagulation therapy in patients with AF; further studies are needed to delineate the significance of this association and improve stroke prevention strategies.
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: Shadi Yaghi; Nils Henninger; James A Giles; Christopher Leon Guerrero; Eva Mistry; Ava L Liberman; Daniyal Asad; Angela Liu; Muhammad Nagy; Ashutosh Kaushal; Idrees Azher; Brian Mac Grory; Hiba Fakhri; Kiersten Brown Espaillat; Hemanth Pasupuleti; Heather Martin; Jose Tan; Manivannan Veerasamy; Charles Esenwa; Natalie Cheng; Khadean Moncrieffe; Iman Moeini-Naghani; Mithilesh Siddu; Erica Scher; Tushar Trivedi; Karen L Furie; Salah G Keyrouz; Amre Nouh; Adam de Havenon; Muhib Khan; Eric E Smith; M Edip Gurol Journal: J Neurol Neurosurg Psychiatry Date: 2021-04-26 Impact factor: 13.654
Authors: Jean Jacques Noubiap; Ulrich Flore Nyaga; Aude Laetitia Ndoadoumgue; Jan René Nkeck; Anderson Ngouo; Jean Joel Bigna Journal: Glob Heart Date: 2020-05-18