Analysis Of The Cardioembolic Stroke Severity In Patients With Atrial Fibrillation

PURPOSEPreventing cardioembolic stroke is one of the most important objectives in patients with atrial fibrillation (AF) since this will prevent the catastrophic outcome of stroke. Antiplatelet drugs, anticoagulated drugs, direct thrombin inhibitor or factor Xa inhibitor (dabigatran, rivaroxaban, or apixaban) and other regimes have all been tried in different guidelines to prevent cardioembolic stroke, but it is still controversial which one is more effective. The present analysis is set to determine which among aspirin or warfarin is more effective in preventing ischemic stroke in AF patients and also to assess the stroke severity in these patients by using the National Institutes of Health Stroke Scale (NIHSS).MATERIAL AND METHODSIn a retrospective study covering the 1-year period between March 2014 to March 2015, the medical records of all admissions to the neurology departments of the first affiliated Hospital of Dalian medical university were screened for cases of cardioembolic stroke and atrial fibrillation. Information was gathered concerning the age, sex, cardiovascular and neurological findings, clinical course, and laboratory and instrumental confirmation of cases. In particular, detailed information was obtained regarding the electrocardiogram, brain CT/MRI scan, CHA2DS2- Vase score, National Institutes of Health Stroke Scale (NIHSS), the preceding antithrombotic/anticoagulant therapy.Eighty two patients with acute cardioembolic stroke and atrial fibrillation (43 male and 39 female; mean age 73±10 years) were reviewed. They were classified in three groups according to the antithrombotic/anticoagulant drugs, which they were using prior to the onset of stroke (38 patients taking no antithrombotic therapy,25 patients on aspirin,19 patients on warfarin). The NIHSS of those three groups were calculated and compared.RESULTS(1) Among the patients admitted,88% had paroxysmal atrial fibrillation, persistant AF - 5%, permanent AF- 1% and atrial flutter - 6%.(2) Only 53% patients with atrial fibrillation were taking antithrombotics/anticoagulant to prevent cardioembolic stroke.(3) All patients with atrial flutter, permanent AF, persistant AF were taking warfarin, whereas only 13% patients with paroxysmal AF were taking warfarin, while 34% patients with paroxysmal AF were taking aspirin.(4) AF Patients on warfarin, whose INR was more than 2.3, had a minor stroke (NIHSS 0-4). AF patients on warfarin, whose INR were below 2.3 had a moderate type of stroke (NIHSS>5).(5) There were no reported cases of warfarin induced cerebral hemorrhagic stroke among those AF patients who were taking warfarin.(6) Comparison between those taking aspirin and those not taking any drugs, were not significant in terms of NIHSS (P> 0.05).(7) Patients taking warfarin prior to onset of cardioembolic stroke have a lower NIHSS (P＜0.05 and non- homogenous subset principle present).CONCLUSION1. Warfarin is more effective in the prevention of thromboembolism compared to aspirin.