Intensity of anticoagulation and clinical outcomes in acute cardioembolic stroke the Fukuoka stroke Registry

Asako Nakamura, Tetsuro Ago, Masahiro Kamouchi, Jun Hata, Ryu Matsuo, Junya Kuroda, Takahiro Kuwashiro, Hiroshi Sugimori, Takanari Kitazono

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background and Purpose: The relationship between the intensity of anticoagulation at the onset of acute cardioembolic stroke and clinical outcome after stroke is unclear. Here, we elucidated the relationship between prothrombin time-international normalized ratio (PT-INR) values on admission and clinical outcomes in patients with acute cardioembolic stroke. Methods: A total of 602 patients from the Fukuoka Stroke Registry in Japan who had been treated with warfarin but developed cardioembolic stroke were enrolled. The patients were classified into 3 groups according to their PT-INR values on admission: PT-INR <1.50, 411 patients; PT-INR 1.50 to 1.99, 146 patients; and PT-INR ≥2.00, 45 patients. The associations between PT-INR categories and severe neurological deficits (National Institutes of Health Stroke Scale ≥10) on admission and poor functional outcome (modified Rankin scale 4-6) at discharge were investigated using a logistic regression analysis. Results: Neurological deficits on admission were less severe, and functional outcome at discharge was more favorable as the PT-INR level on admission increased. The multivariate analysis revealed that severe neurological deficits were inversely associated with PT-INR on admission (PT-INR 1.50-1.99: odds ratio, 0.66;95% confidence interval, 0.43-1.00; PT-INR ≥2.00: odds ratio, 0.41;95% confidence interval, 0.20-0.83; compared with a reference group of PT-INR <1.50). Poor functional outcome was less likely in patients with PT-INR ≥2.00 (odds ratio, 0.20;95% confidence interval, 0.06-0.55) after adjustment for confounders. Conclusions: Prestroke PT-INR ≥2.0 is associated with favorable clinical outcomes after acute cardioembolic stroke.

Original languageEnglish
Pages (from-to)3239-3242
Number of pages4
JournalStroke
Volume44
Issue number11
DOIs
Publication statusPublished - Nov 1 2013

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International Normalized Ratio
Prothrombin Time
Registries
Stroke
Odds Ratio
Confidence Intervals
National Institutes of Health (U.S.)
Warfarin
Japan
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Intensity of anticoagulation and clinical outcomes in acute cardioembolic stroke the Fukuoka stroke Registry. / Nakamura, Asako; Ago, Tetsuro; Kamouchi, Masahiro; Hata, Jun; Matsuo, Ryu; Kuroda, Junya; Kuwashiro, Takahiro; Sugimori, Hiroshi; Kitazono, Takanari.

In: Stroke, Vol. 44, No. 11, 01.11.2013, p. 3239-3242.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose: The relationship between the intensity of anticoagulation at the onset of acute cardioembolic stroke and clinical outcome after stroke is unclear. Here, we elucidated the relationship between prothrombin time-international normalized ratio (PT-INR) values on admission and clinical outcomes in patients with acute cardioembolic stroke. Methods: A total of 602 patients from the Fukuoka Stroke Registry in Japan who had been treated with warfarin but developed cardioembolic stroke were enrolled. The patients were classified into 3 groups according to their PT-INR values on admission: PT-INR <1.50, 411 patients; PT-INR 1.50 to 1.99, 146 patients; and PT-INR ≥2.00, 45 patients. The associations between PT-INR categories and severe neurological deficits (National Institutes of Health Stroke Scale ≥10) on admission and poor functional outcome (modified Rankin scale 4-6) at discharge were investigated using a logistic regression analysis. Results: Neurological deficits on admission were less severe, and functional outcome at discharge was more favorable as the PT-INR level on admission increased. The multivariate analysis revealed that severe neurological deficits were inversely associated with PT-INR on admission (PT-INR 1.50-1.99: odds ratio, 0.66;95{\%} confidence interval, 0.43-1.00; PT-INR ≥2.00: odds ratio, 0.41;95{\%} confidence interval, 0.20-0.83; compared with a reference group of PT-INR <1.50). Poor functional outcome was less likely in patients with PT-INR ≥2.00 (odds ratio, 0.20;95{\%} confidence interval, 0.06-0.55) after adjustment for confounders. Conclusions: Prestroke PT-INR ≥2.0 is associated with favorable clinical outcomes after acute cardioembolic stroke.",
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AU - Nakamura, Asako

AU - Ago, Tetsuro

AU - Kamouchi, Masahiro

AU - Hata, Jun

AU - Matsuo, Ryu

AU - Kuroda, Junya

AU - Kuwashiro, Takahiro

AU - Sugimori, Hiroshi

AU - Kitazono, Takanari

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