Does warfarin help prevent ischemic stroke in patients presenting with post coronary bypass paroxysmal atrial fibrillation?

Abstract

PURPOSE:

This study examines the efficacy of warfarin in preventing ischemic stroke due to paroxysmal atrial fibrillation (PAF) after coronary artery bypass grafting (CABG).

METHODS:

Postoperative PAF occurred in 151(33.5%) of 447 patients undergoing conventional CABG. The patients were divided into two groups: group I consisting of 93 patients administered two types of antiplatelet agents and group II consisting of 58 patients treated with a single antiplatelet agent and warfarin. We compared the two groups in terms of CHADS2 score, incidence of ischemic stroke, and independent risk for stroke associated with post-CABG PAF.

RESULTS:

The group I CHADS2 score (2.24 ±1.67) was significantly lower than the group II score (2.64 ± 1.22), p = 0.0452. However, 12 patients in group I (12.9%) suffered postoperative ischemic stroke, a rate significantly higher than that of group II (1 patient, 1.7%; p = 0.0173). Any recurrence of PAF or atrial fibrillation with bradycardia was assessed at the time of stroke onset. Logistic regression analysis showed that the absence of warfarin therapy constituted a risk factor for post-CABG stroke associated with PAF (Odds 13.04, p = 0.027).

CONCLUSION:

Warfarin therapy administered concomitantly with an antiplatelet agent dramatically reduced the incidence of ischemic stroke associated with postoperative PAF.

• Authors: Mitsumasa Hata, Kenji Akiyama, Shinji Wakui, Ayako Takasaka, Akira Sezai, Motomi Shiono
• Journal: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (Ann Thorac Cardiovasc Surg) Vol. 19 Issue 3 Pg. 207-11 ( 2013) ISSN: 2186-1005 [Electronic] Japan
• PMID: 22971719 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Warfarin

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (drug therapy, etiology)
• Brain Ischemia (etiology, prevention & control)
• Coronary Artery Bypass (adverse effects)
• Drug Therapy, Combination
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Platelet Aggregation Inhibitors (therapeutic use)
• Risk Factors
• Stroke (etiology, prevention & control)
• Treatment Outcome
• Warfarin (therapeutic use)