engleski

IMPACT OF ANTICOAGULANT THERAPY ON THE OUTCOME IN ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATION

Oral anticoagulant therapy has the leading role in ischemic stroke prevention in patients with atrial fibrillation, but its impact on clinical outcomes has not been clearly shown. The aim of this study was to investigate the impact of oral anticoagulant therapy on stroke outcomes. This retrospective study included patients with atrial fibrillation who were hospitalized for ischemic stroke in the period from 1st January 2004. until 31st December 2010. at University Hospital “Sveti Duh” in Zagreb. Patients were divided into three groups according to prior antithrombotic therapy usage. Analysis of medical records included: demographic data, stroke risk factors, the stroke severity (National Institute of Health Stroke Scale), localization/size (Oxfordishire Stroke Classification Scale), and outcome (modified Rankin scale - mRS) of stroke. The statistical data were analyzed with univariate and bivariate statistic analysis. The study included 821 patients, whose mean of age was 77.6±8.2 years. Twenty-one per cent of patients received prior anticoagulant therapy, 30% of patients received prior antiplatelet therapy while 49% of patients were without prior antithrombotic therapy. Patients with prior anticoagulant therapy were the youngest (74.9±7.9, p<0, 0001). These patients had more often previous ischemic strokes (42.8%, p<0, 0001), hyperlipidemia (51.4%, p=0, 0002) and chronic myocardial disease (77.5%, p<0, 0001). Patients without prior antithrombotic therapy had less often previously diagnosed atrial fibrillation (59.8%, p<0, 0001) and they had the lowest risk for ischemic stroke (CHADS2=2.9±1.2, p<0, 0001). Patients with prior anticoagulant therapy had better clinical outcomes with the lowest disability levels at discharge compared to patients in other two groups, but statistically significant difference was shown only in comparison to patients with prior antiplatelet therapy (mRS 3.8±1.9 vs. 4.4±1.6, p<0, 0001). There were no statistically significant differences between groups in stroke severity, size and localization of stroke. The different INR levels in patients with prior anticoagulant therapy did not show statistically significant differences in following outcome measures: disability at discharge, mortality, stroke severity, size and localization of stroke. Our study showed that patients with prior anticoagulant therapy had better clinical outcomes and lower disability levels at discharge from hospital in comparison to patients with prior antiplatelet therapy.

Anticoagulant therapy; stroke

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