Left Atrial Enlargement and Anticoagulation Status in Patients with Acute Ischemic Stroke and Atrial Fibrillation
| Autor: | Christopher Song, Nikhil Panda, Michael P Lerario, Shawna Cutting, Andrew D Chang, Katarina Dakay, Shadi Yaghi, Karen L. Furie, Mahesh V Jayaraman, Antony Chu, Hooman Kamel, Morgan Hemendinger, Ryan A McTaggart, Benjamin R Kummer, Mitchell S.V. Elkind, Gino Gialdini, Alexander E Merkler |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Administration Oral Cardiomegaly 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation Odds Ratio medicine Left atrial enlargement Humans In patient International Normalized Ratio Treatment Failure Stroke Acute ischemic stroke Aged Retrospective Studies Aged 80 and over business.industry Rehabilitation Warfarin Anticoagulants Atrial fibrillation Odds ratio medicine.disease United States Confidence interval Cross-Sectional Studies Logistic Models Multivariate Analysis Cardiology Female Surgery Neurology (clinical) Drug Monitoring Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 27:192-197 |
| ISSN: | 1052-3057 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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