Clinical features of cardioembolic stroke with nonvalvular atrial fibrillation under anticoagulant therapy

Abstract

Background: We examined the clinical features of cardioembolic stroke in patients with non-valvular atrial fibrillation (NVAF) who developed cardiogenic cerebral embolism during anticoagulant therapy. Methods: Among 760 patients who suffered from cardioembolic stroke caused by NVAF and were hospitalized between April 2007 and July 2015, we retrospectively reviewed 186 who had been receiving anticoagulant therapy. Results: Of the 186 patients, 168 were being treated with warfarin and 18 with non-vitamin K-antagonist oral anticoagulants. Of the 168 warfarintreated patients, 130 had prothrombin time-international normalized ratio (PT-INR) values below the target ranges (age<70:2.0–3.0, ≥70:1.6–2.6); 8 of these patients had suffered cerebral infarction during adjustment (5 patients) or initiation (3 patients) of warfarin therapy. All three newly warfarinized patients had developed cerebral infarctions within the first week of warfarin therapy. Twelve patients had developed cerebral infarction during cessation of anticoagulant therapy. Six of these had stopped their anticoagulants due to poor medication adherence and two had been prescribed cessation by their doctors. The remaining four patients had stopped their anticoagulants for reasons associated with surgery or hospital admission; two of them were on heparin replacement. Conclusions: In oral anticoagulant therapy, special attention needs to be paid to the risk of cerebral infarction during therapy initiation or dosage adjustment. Attention also needs to be given to ensuring medication adherence.