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Rate of antithrombotic drug use and clinical outcomes according to CHADS2 scores in patients with an initial cardioembolic stroke who had nonvalvular atrial fibrillation.

AbstractBACKGROUND:
This study investigated the relationship between CHADS2 scores and the rate of antithrombotic drug use and clinical outcomes in patients with an initial cardioembolic stroke who had nonvalvular atrial fibrillation (NVAF).
METHODS:
In 234 patients (135 men and 99 women; mean age [± SD] 76 ± 11 years) with initial cardiogenic cerebral embolism with NVAF who were admitted to our hospital between April 2007 and March 2011, the CHADS2 score, use of warfarin, and clinical outcomes were retrospectively investigated.
RESULTS:
CHADS2 scores were as follows: 0 points, n = 21 (9%); 1 point, n = 72 (31%); 2 points, n = 92 (39%); 3 points, n = 47 (20%); and 4 points, n = 2 (1%). The overall warfarin use rate was low (14.1%; n = 33), and it was significantly (P = .023) lower for paroxysmal atrial fibrillation (8%) than for chronic atrial fibrillation (18.5%). The clinical outcomes evaluated by the modified Rankin Scale (mRS) score after 3 months were: CHADS2 score 0 points, mRS 0 to 2 (81%) and 3 to 6 (19%); 1 point, mRS 0 to 2 (46%) and 3 to 6 (54%); 2 points, mRS 0 to 2 (46%) and 3 to 6 (54%); and ≥ 3 points, mRS 0 to 2 (29%) and 3 to 6 (71%). The clinical outcome worsened as the CHADS2 score increased (P = .002). Logistic regression analysis revealed that being ≥ 75 years of age and having a high National Institutes of Health Stroke Scale (NIHSS) score on admission were related to a poor outcome (P < .001).
CONCLUSIONS:
The overall warfarin use rate was low in initial cardioembolic stroke patients with NVAF. Clinical outcomes deteriorated with increases in the CHADS2 score, age ≥ 75 years, and NIHSS score on admission were related to a poor clinical outcome.
AuthorsIchiro Deguchi, Hiroshi Ogawa, Yasuko Ohe, Manabu Nemoto, Norio Tanahashi
JournalJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 22 Issue 6 Pg. 846-50 (Aug 2013) ISSN: 1532-8511 [Electronic] United States
PMID22819543 (Publication Type: Journal Article)
CopyrightCopyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Fibrinolytic Agents
  • Warfarin
Topics
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation (complications, diagnosis, drug therapy)
  • Chi-Square Distribution
  • Disability Evaluation
  • Drug Utilization Review (trends)
  • Female
  • Fibrinolytic Agents (therapeutic use)
  • Heart Diseases (diagnosis, etiology, prevention & control)
  • Humans
  • Intracranial Embolism (diagnosis, etiology, prevention & control)
  • Logistic Models
  • Male
  • Patient Admission
  • Patient Selection
  • Practice Patterns, Physicians' (trends)
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stroke (diagnosis, etiology, prevention & control)
  • Time Factors
  • Treatment Outcome
  • Warfarin (therapeutic use)

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