Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin

Raghav V. Aachi, Lee A Birnbaum, Christopher H. Topel, Ali Seifi, Shaheryar Hafeez, Reza Behrouz

Research output: Contribution to journalArticle

Abstract

Background: In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence. Hypothesis: Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS. Methods: We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants. We then compared baseline laboratory characteristics and other baseline features among the groups. Results: Patients with therapeutic INR presented with higher serum creatinine (P=0.01) and blood urea nitrogen (P=0.02) and lower glomerular filtration rates (P=0.001) compared with other groups. Other laboratory parameters were not different among the 3 groups. Patients with therapeutic INR also presented with milder stroke symptoms (P=0.01). Medical history of the 3 groups was not different, except for history of valvular heart disease, which was more prevalent in patients with therapeutic INR (P=0.004). In-hospital mortality rates and 90-day disability were not different among the 3 groups. Conclusions: AF patients who presented with IS on therapeutic warfarin had higher average serum creatinine and blood urea nitrogen, and lower glomerular filtration rates, compared with others. Impaired renal function may be a factor contributing to occurrence of IS in AF patients despite adequate anticoagulation. Larger, targeted studies are needed to confirm these findings.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StateAccepted/In press - Jan 1 2017

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Warfarin
Atrial Fibrillation
International Normalized Ratio
Stroke
Therapeutics
Blood Urea Nitrogen
Glomerular Filtration Rate
Creatinine
Heart Valve Diseases
Hospital Mortality
Serum
Anticoagulants
Multicenter Studies
Clinical Trials
Databases
Kidney
Mortality

Keywords

  • Acute Stroke
  • Anticoagulation
  • Atrial Fibrillation
  • International Normalized Ratio
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Laboratory characteristics of ischemic stroke patients with atrial fibrillation on or off therapeutic warfarin. / Aachi, Raghav V.; Birnbaum, Lee A; Topel, Christopher H.; Seifi, Ali; Hafeez, Shaheryar; Behrouz, Reza.

In: Clinical Cardiology, 01.01.2017.

Research output: Contribution to journalArticle

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abstract = "Background: In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence. Hypothesis: Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS. Methods: We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants. We then compared baseline laboratory characteristics and other baseline features among the groups. Results: Patients with therapeutic INR presented with higher serum creatinine (P=0.01) and blood urea nitrogen (P=0.02) and lower glomerular filtration rates (P=0.001) compared with other groups. Other laboratory parameters were not different among the 3 groups. Patients with therapeutic INR also presented with milder stroke symptoms (P=0.01). Medical history of the 3 groups was not different, except for history of valvular heart disease, which was more prevalent in patients with therapeutic INR (P=0.004). In-hospital mortality rates and 90-day disability were not different among the 3 groups. Conclusions: AF patients who presented with IS on therapeutic warfarin had higher average serum creatinine and blood urea nitrogen, and lower glomerular filtration rates, compared with others. Impaired renal function may be a factor contributing to occurrence of IS in AF patients despite adequate anticoagulation. Larger, targeted studies are needed to confirm these findings.",
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AU - Behrouz, Reza

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N2 - Background: In patients with atrial fibrillation (AF), despite adequate anticoagulation, ischemic stroke (IS) is an uncommon yet concerning occurrence. Hypothesis: Specific laboratory parameters may affect the efficacy of warfarin despite therapeutic international normalized ratio (INR) in patient with AF who present with IS. Methods: We used the database from a multicenter clinical trial to identify AF patients who presented with IS. We trichotomized the cohort into patients with therapeutic INR on warfarin, subtherapeutic INR on warfarin, and on no anticoagulants. We then compared baseline laboratory characteristics and other baseline features among the groups. Results: Patients with therapeutic INR presented with higher serum creatinine (P=0.01) and blood urea nitrogen (P=0.02) and lower glomerular filtration rates (P=0.001) compared with other groups. Other laboratory parameters were not different among the 3 groups. Patients with therapeutic INR also presented with milder stroke symptoms (P=0.01). Medical history of the 3 groups was not different, except for history of valvular heart disease, which was more prevalent in patients with therapeutic INR (P=0.004). In-hospital mortality rates and 90-day disability were not different among the 3 groups. Conclusions: AF patients who presented with IS on therapeutic warfarin had higher average serum creatinine and blood urea nitrogen, and lower glomerular filtration rates, compared with others. Impaired renal function may be a factor contributing to occurrence of IS in AF patients despite adequate anticoagulation. Larger, targeted studies are needed to confirm these findings.

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