Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke

Konstantinos N. Vemmos, Georgios Tsivgoulis, Konstantinos Spengos, Efstathios Manios, Savas Toumanidis, Nikolaos Zakopoulos, Spyridon D. Moulopoulos

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke. Objective: The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap. Methods: From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4-5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented. Results: Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7% (95% CI, 69.0-84.3) and the 5-year recurrence rate was 33.7% (95% CI, 23.3-44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95% CI, 0.27-0.70; P > 0.001) and recurrent thromboembolism (HR, 0.36; 95% CI, 0.17-0.77; P > 0.01). Conclusion: Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke.

Original languageEnglish (US)
Pages (from-to)265-273
Number of pages9
JournalAmerican Journal Geriatric Pharmacotherapy
Volume2
Issue number4
DOIs
StatePublished - Dec 1 2004
Externally publishedYes

Fingerprint

Atrial Fibrillation
Stroke
Warfarin
Aspirin
Thromboembolism
Blood Vessels
Recurrence
Mortality
Transient Ischemic Attack
Survivors
Regression Analysis
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology
  • Pharmacology (medical)
  • Pharmacology

Cite this

Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke. / Vemmos, Konstantinos N.; Tsivgoulis, Georgios; Spengos, Konstantinos; Manios, Efstathios; Toumanidis, Savas; Zakopoulos, Nikolaos; Moulopoulos, Spyridon D.

In: American Journal Geriatric Pharmacotherapy, Vol. 2, No. 4, 01.12.2004, p. 265-273.

Research output: Contribution to journalArticle

Vemmos, Konstantinos N. ; Tsivgoulis, Georgios ; Spengos, Konstantinos ; Manios, Efstathios ; Toumanidis, Savas ; Zakopoulos, Nikolaos ; Moulopoulos, Spyridon D. / Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke. In: American Journal Geriatric Pharmacotherapy. 2004 ; Vol. 2, No. 4. pp. 265-273.
@article{ef22a7590fca4c4096c5d3b99bfc3f0f,
title = "Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke",
abstract = "Background: Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke. Objective: The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap. Methods: From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4-5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented. Results: Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7{\%} (95{\%} CI, 69.0-84.3) and the 5-year recurrence rate was 33.7{\%} (95{\%} CI, 23.3-44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95{\%} CI, 0.27-0.70; P > 0.001) and recurrent thromboembolism (HR, 0.36; 95{\%} CI, 0.17-0.77; P > 0.01). Conclusion: Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke.",
author = "Vemmos, {Konstantinos N.} and Georgios Tsivgoulis and Konstantinos Spengos and Efstathios Manios and Savas Toumanidis and Nikolaos Zakopoulos and Moulopoulos, {Spyridon D.}",
year = "2004",
month = "12",
day = "1",
doi = "10.1016/j.amjopharm.2004.12.001",
language = "English (US)",
volume = "2",
pages = "265--273",
journal = "American Journal Geriatric Pharmacotherapy",
issn = "1543-5946",
publisher = "Excerpta Medica",
number = "4",

}

TY - JOUR

T1 - Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke

AU - Vemmos, Konstantinos N.

AU - Tsivgoulis, Georgios

AU - Spengos, Konstantinos

AU - Manios, Efstathios

AU - Toumanidis, Savas

AU - Zakopoulos, Nikolaos

AU - Moulopoulos, Spyridon D.

PY - 2004/12/1

Y1 - 2004/12/1

N2 - Background: Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke. Objective: The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap. Methods: From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4-5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented. Results: Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7% (95% CI, 69.0-84.3) and the 5-year recurrence rate was 33.7% (95% CI, 23.3-44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95% CI, 0.27-0.70; P > 0.001) and recurrent thromboembolism (HR, 0.36; 95% CI, 0.17-0.77; P > 0.01). Conclusion: Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke.

AB - Background: Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke. Objective: The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap. Methods: From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4-5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented. Results: Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7% (95% CI, 69.0-84.3) and the 5-year recurrence rate was 33.7% (95% CI, 23.3-44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95% CI, 0.27-0.70; P > 0.001) and recurrent thromboembolism (HR, 0.36; 95% CI, 0.17-0.77; P > 0.01). Conclusion: Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke.

UR - http://www.scopus.com/inward/record.url?scp=15044341288&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=15044341288&partnerID=8YFLogxK

U2 - 10.1016/j.amjopharm.2004.12.001

DO - 10.1016/j.amjopharm.2004.12.001

M3 - Article

C2 - 15903285

AN - SCOPUS:15044341288

VL - 2

SP - 265

EP - 273

JO - American Journal Geriatric Pharmacotherapy

JF - American Journal Geriatric Pharmacotherapy

SN - 1543-5946

IS - 4

ER -