Abstract
Background
Atrial fibrillation is the most common cause of embolic stroke associated to heart
disease. Oral anticoagulation with vitamin K antagonists substantially reduces this
risk.
Aims
We assessed a group of patients with prior diagnosis of atrial fibrillation who sustained
an ischemic stroke while receiving an adequate regime of oral anticoagulation.
Methods
We evaluated consecutive patients with ischemic stroke and prior diagnosis of atrial
fibrillation. We determined demographics, clinical characteristics, TOAST stroke subtypes,
CHADS2 scores, and prior or concomitant use of oral anticoagulants.
Results
We studied 112 patients. Thirty nine of them (35%) had received an adequate dose of
a vitamin K antagonist during the 24-hour period preceding the stroke. There were
no differences in demographics, vascular risk factors, CHADS2 scores, nor medications
use between patients who were or were not receiving anticoagulation. Other potential
etiologies for stroke occurrence were found in 8 (21%) anticoagulated patients, and
in 3 (4%) non-anticoagulated subjects (p < 0.01). Anticoagulated patients had a mean international normalized ratio (INR) of
2.3 ± 1.3 (median 2.05), and INR was within therapeutic ranges (i.e., ≥2) in 54% of these subjects.
Conclusions
A substantial proportion of patients with atrial fibrillation who have an ischemic
stroke are already receiving oral anticoagulation. Sub-optimal levels of anticoagulation
and additional etiologies explain, only in part, this failure. Further research is
needed to help find adequate therapeutic strategies in atrial fibrillation patients
who sustain an ischemic stroke while receiving oral anticoagulation.
Keywords
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Article info
Publication history
Published online: September 20, 2013
Accepted:
August 8,
2013
Received in revised form:
July 16,
2013
Received:
May 7,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
