The systematic search was conducted in the PubMed Database, the Embase Database and the Cochrane Database of Systematic Reviews. All types of human studies were eligible for inclusion. Outcome should be measured as either stroke severity at admission, disability or mortality obtained within the hospital stay or after discharge. Furthermore, comparison should be possible between different treatment regimens of OAT, different antithrombotic drugs or no AT. The intervention was defined as use of OAT or other types of antithrombotic therapy (AT) prior to admission. The overall research question was defined as follows: “How does preadmission OAT treatment influence the clinical outcome among patients with AF who are hospitalised with acute stroke?” The population was defined as patients hospitalised with stroke and diagnosed with AF either before or after admission. METHODĪ systematic search was conducted using the “patient, intervention, comparison, outcome” (PICO) model in the search strategy. To our knowledge, this is the first systematic review to examine the literature on this topic. We here aim to provide a systematic review elucidating the association between preadmission OAT and stroke outcomes in patients with AF. Additional insight into the safety and effectiveness of OAT in routine care settings is therefore needed. Although clinical guidelines recommend OAT for all eligible AF patients, several studies have reported insufficient use and intensity of OAT, mainly due to concerns among clinicians and patients about the safety of OAT. It is necessary to study the possible impact of OAT on stroke outcomes to fully understand the effectiveness and safety associated with this treatment. Less is known about the possible effect of preadmission OAT on stroke outcomes in patients with AF. OAT use has been shown to reduce the incidence of clinical stroke with an acceptable bleeding risk and to be three times as effective as aspirin. The efficacy of oral anticoagulation therapy (OAT) for prevention of cardioembolic stroke in patients with AF was documented in several clinical trials. Īntithrombotic therapy is the primary prevention strategy for cardioembolic stroke in patients with AF. Stroke is the most feared complication in AF patients, and AF is associated with a higher risk of an adverse outcome following a stroke. The prevalence is expected to more than double by year 2050. The prevalence of AF increases dramatically with age and affects approximately 9% of the population aged 80 years or more. Prestroke PT-INR ≥2.0 is associated with favorable clinical outcomes after acute cardioembolic stroke.Īnticoagulation clinical outcome ischemic stroke prothrombin time–international normalized ratio warfarin.Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major risk factor for ischaemic stroke. Poor functional outcome was less likely in patients with PT-INR ≥2.00 (odds ratio, 0.20 95% confidence interval, 0.06-0.55) after adjustment for confounders. The multivariate analysis revealed that severe neurological deficits were inversely associated with PT-INR on admission (PT-INR 1.50-1.99: odds ratio, 0.66 95% confidence interval, 0.43-1.00 PT-INR ≥2.00: odds ratio, 0.41 95% confidence interval, 0.20-0.83 compared with a reference group of PT-INR <1.50). Neurological deficits on admission were less severe, and functional outcome at discharge was more favorable as the PT-INR level on admission increased. The associations between PT-INR categories and severe neurological deficits (National Institutes of Health Stroke Scale ≥10) on admission and poor functional outcome (modified Rankin scale 4-6) at discharge were investigated using a logistic regression analysis. The patients were classified into 3 groups according to their PT-INR values on admission: PT-INR <1.50, 411 patients PT-INR 1.50 to 1.99, 146 patients and PT-INR ≥2.00, 45 patients. Here, we elucidated the relationship between prothrombin time-international normalized ratio (PT-INR) values on admission and clinical outcomes in patients with acute cardioembolic stroke.Ī total of 602 patients from the Fukuoka Stroke Registry in Japan who had been treated with warfarin but developed cardioembolic stroke were enrolled. The relationship between the intensity of anticoagulation at the onset of acute cardioembolic stroke and clinical outcome after stroke is unclear.
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