Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: A population study

Niamh Hannon, Elizabeth Callaly, Alan Moore, Danielle Ní Chróinín, Orla Sheehan, Michael Marnane, Áine Merwick, Lorraine Kyne, Joseph Duggan, Patricia M E McCormack, Eamon Dolan, Gloria Crispino-O'Connell, Dawn Harris, Gillian Horgan, David Williams, Peter J. Kelly

Research output: Contribution to journalArticle

Abstract

Background and Purpose-Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic). Methods-We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke. Results-One hundred seventy-five patients had atrial fibrillation-associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17% of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivariable analysis, therapeutic INR was associated with improved late survival after ischemic stroke (adjusted 2-year odds ratio for death=0.08; 95% CI, 0.01 to 0.78; P=0.03). This survival benefit persisted when patients with hemorrhagic stroke were included (2-year survival; 70.5% therapeutic INR, 14.3% nontherapeutic INR; log-rank P

Original languageEnglish (US)
Pages (from-to)2503-2508
Number of pages6
JournalStroke
Volume42
Issue number9
DOIs
StatePublished - Sep 2011
Externally publishedYes

Fingerprint

Atrial Fibrillation
Stroke
Survival
Population
International Normalized Ratio
Therapeutics
National Institutes of Health (U.S.)
Odds Ratio

Keywords

  • anticoagulation
  • atrial fibrillation
  • stroke prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation : A population study. / Hannon, Niamh; Callaly, Elizabeth; Moore, Alan; Ní Chróinín, Danielle; Sheehan, Orla; Marnane, Michael; Merwick, Áine; Kyne, Lorraine; Duggan, Joseph; McCormack, Patricia M E; Dolan, Eamon; Crispino-O'Connell, Gloria; Harris, Dawn; Horgan, Gillian; Williams, David; Kelly, Peter J.

In: Stroke, Vol. 42, No. 9, 09.2011, p. 2503-2508.

Research output: Contribution to journalArticle

Hannon, N, Callaly, E, Moore, A, Ní Chróinín, D, Sheehan, O, Marnane, M, Merwick, Á, Kyne, L, Duggan, J, McCormack, PME, Dolan, E, Crispino-O'Connell, G, Harris, D, Horgan, G, Williams, D & Kelly, PJ 2011, 'Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: A population study', Stroke, vol. 42, no. 9, pp. 2503-2508. https://doi.org/10.1161/STROKEAHA.110.602235
Hannon, Niamh ; Callaly, Elizabeth ; Moore, Alan ; Ní Chróinín, Danielle ; Sheehan, Orla ; Marnane, Michael ; Merwick, Áine ; Kyne, Lorraine ; Duggan, Joseph ; McCormack, Patricia M E ; Dolan, Eamon ; Crispino-O'Connell, Gloria ; Harris, Dawn ; Horgan, Gillian ; Williams, David ; Kelly, Peter J. / Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation : A population study. In: Stroke. 2011 ; Vol. 42, No. 9. pp. 2503-2508.
@article{a37bc5ab76674a889360b3176e40f391,
title = "Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: A population study",
abstract = "Background and Purpose-Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic). Methods-We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke. Results-One hundred seventy-five patients had atrial fibrillation-associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17{\%} of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivariable analysis, therapeutic INR was associated with improved late survival after ischemic stroke (adjusted 2-year odds ratio for death=0.08; 95{\%} CI, 0.01 to 0.78; P=0.03). This survival benefit persisted when patients with hemorrhagic stroke were included (2-year survival; 70.5{\%} therapeutic INR, 14.3{\%} nontherapeutic INR; log-rank P",
keywords = "anticoagulation, atrial fibrillation, stroke prevention",
author = "Niamh Hannon and Elizabeth Callaly and Alan Moore and {N{\'i} Chr{\'o}in{\'i}n}, Danielle and Orla Sheehan and Michael Marnane and {\'A}ine Merwick and Lorraine Kyne and Joseph Duggan and McCormack, {Patricia M E} and Eamon Dolan and Gloria Crispino-O'Connell and Dawn Harris and Gillian Horgan and David Williams and Kelly, {Peter J.}",
year = "2011",
month = "9",
doi = "10.1161/STROKEAHA.110.602235",
language = "English (US)",
volume = "42",
pages = "2503--2508",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation

T2 - A population study

AU - Hannon, Niamh

AU - Callaly, Elizabeth

AU - Moore, Alan

AU - Ní Chróinín, Danielle

AU - Sheehan, Orla

AU - Marnane, Michael

AU - Merwick, Áine

AU - Kyne, Lorraine

AU - Duggan, Joseph

AU - McCormack, Patricia M E

AU - Dolan, Eamon

AU - Crispino-O'Connell, Gloria

AU - Harris, Dawn

AU - Horgan, Gillian

AU - Williams, David

AU - Kelly, Peter J.

PY - 2011/9

Y1 - 2011/9

N2 - Background and Purpose-Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic). Methods-We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke. Results-One hundred seventy-five patients had atrial fibrillation-associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17% of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivariable analysis, therapeutic INR was associated with improved late survival after ischemic stroke (adjusted 2-year odds ratio for death=0.08; 95% CI, 0.01 to 0.78; P=0.03). This survival benefit persisted when patients with hemorrhagic stroke were included (2-year survival; 70.5% therapeutic INR, 14.3% nontherapeutic INR; log-rank P

AB - Background and Purpose-Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic). Methods-We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke. Results-One hundred seventy-five patients had atrial fibrillation-associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17% of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivariable analysis, therapeutic INR was associated with improved late survival after ischemic stroke (adjusted 2-year odds ratio for death=0.08; 95% CI, 0.01 to 0.78; P=0.03). This survival benefit persisted when patients with hemorrhagic stroke were included (2-year survival; 70.5% therapeutic INR, 14.3% nontherapeutic INR; log-rank P

KW - anticoagulation

KW - atrial fibrillation

KW - stroke prevention

UR - http://www.scopus.com/inward/record.url?scp=80052419702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052419702&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.602235

DO - 10.1161/STROKEAHA.110.602235

M3 - Article

C2 - 21778447

AN - SCOPUS:80052419702

VL - 42

SP - 2503

EP - 2508

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -