Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke
| Autor: | Efstathios Manios, Georgios Tsivgoulis, Konstantinos Spengos, Nikolaos Zakopoulos, Spyridon D. Moulopoulos, Konstantinos Vemmos, S. T. Toumanidis |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Severity of Illness Index Brain Ischemia Modified Rankin Scale Thromboembolism Internal medicine Atrial Fibrillation Recurrent thromboembolism Secondary Prevention medicine Humans Pharmacology (medical) Prospective Studies Stroke Aged Aspirin business.industry Proportional hazards model Hazard ratio Age Factors Warfarin Anticoagulants Atrial fibrillation Prognosis medicine.disease Cardiology Female Geriatrics and Gerontology business Follow-Up Studies medicine.drug |
| Zdroj: | The American Journal of Geriatric Pharmacotherapy. 2:265-273 |
| ISSN: | 1543-5946 |
| DOI: | 10.1016/j.amjopharm.2004.12.001 |
| Popis: | Background: Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke. Objective: The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap. Methods: From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4–5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented. Results: Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7% (95% CI, 69.0–84.3) and the 5-year recurrence rate was 33.7% (95% CI, 23.3–44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95% CI, 0.27–0.70; P Conclusion: Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke. |
| Databáze: | OpenAIRE |
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