A322 JACC April 1, 2014 Volume 63, Issue 12 Arrhythmias and Clinical EP INTRACRANIAL BLEEDINGS AND ISCHEMIC STROKES DURING WARFARIN TREATMENT IN PATIENTS WITH ATRIAL FIBRILLATION: THE FIBSTROKE STUDY Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:45 a.m. Session Title: Arrhythmias and Clinical EP: State of the Art Anticoagulation for Atrial Fibrillation Abstract Category: 4. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1109-112 Authors: Antti Palomaki, Pirjo Mustonen, Tuija Vasankari, Ilpo Nuotio, Antti Ylitalo, Jussi Jaakkola, Riho Luite, Paivi Hartikainen, Juha Hartikainen, Juhani Airaksinen, Keski-Suomi Central Hospital, Jyvaskyla, Finland, Turku University Hospital, Turku, Finland Background: Anticoagulation therapy with warfarin is effective in the prevention of ischemic strokes in patients with atrial fibrillation (AF) but predisposes to intracranial bleedings. Methods: In this retrospective study data from 1,867 patients with a history of AF and ischemic stroke, transient ischemic attack (TIA) or intracranial bleeding during 2003-2012 was analyzed. A total of 596 out of the 1,867 patients suffered 158 intracranial bleeds, 452 ischemic strokes and 151 TIA while on warfarin treatment. Results: The international normalized ratio (INR) was above the therapeutic range in 31.6 % of the cases with intracranial bleeding, and 34.8 % of the bleeds were fatal within 1 month (Table). In patients with an ischemic event INR was < 2.0 in 45.6% of the cases. Patients who suffered an ischemic event had a higher CHA2DS2VASc score than patients who suffered an intracranial bleeding, but there was no difference in the HASBLED score. Severe renal insufficiency was more common in patients with intracranial bleeding. Conclusion: Over-anticoagulation was common in patients with intracranial bleeding and under-anticoagulation in patients with an ischemic event. Severe renal insufficiency was more common in patients with intracranial bleeding. HASBLED score was unable to identify patients who developed intracranial hemorrhage. Intracranial bleedings, TIA episodes and ischemic strokes during warfarin treatment Intracranial bleeding n (%) Ischemic stroke or TIA n (%) p N (% of all events) 158 (20.8) 452 (59.4) Ischemic strokes and 151 (19.8) TIA Age, yr (95% CI) 78.6 (77.3-79.8) 77.4 (76.7-78.7) .12 Female gender 77 (48.7) 320 (53.1) .33 CHA2DS2VASc score (95% CI) 3.80 (3.57-4.04) 4.12 (3.99-4.25) .03 INR < 2.0 22 (13.9) 275 (45.6) <.001 INR > 3.0 50 (31.6) 51 (8.5) <.001 HASBLED score (95% CI) 2.40 (2.23-2.57) 2.27 (2.19-2.34) .17 HASBLED ≥ 3 62 (39.2) 232 (38.5) .86 Aspirin 17 (10.8) 85 (14.1) .32 Previous stroke or TIA 47 (29.9) 248 (41.3) .01 History of bleeding 9 (5.7) 21 (3.5) .28 Alcohol abuse 6 (3.8) 9 (1.5) .061 GFR < 30 (ml/min) 11 (7.3) 17 (3.0) .015 Death in 1 month after stroke 54 (34.8) After ischemic stroke 55 (12.2) <.0001

INTRACRANIAL BLEEDINGS AND ISCHEMIC STROKES DURING WARFARIN TREATMENT IN PATIENTS WITH ATRIAL FIBRILLATION: THE FIBSTROKE STUDY

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Page 1: INTRACRANIAL BLEEDINGS AND ISCHEMIC STROKES DURING WARFARIN TREATMENT IN PATIENTS WITH ATRIAL FIBRILLATION: THE FIBSTROKE STUDY

A322JACC April 1, 2014

Volume 63, Issue 12

Arrhythmias and Clinical EP

intracraniaL bLEEdings and ischEmic strokEs during warfarin trEatmEnt in patiEnts with atriaL fibriLLation: thE fibstrokE study

Poster ContributionsHall CSaturday, March 29, 2014, 10:00 a.m.-10:45 a.m.

Session Title: Arrhythmias and Clinical EP: State of the Art Anticoagulation for Atrial FibrillationAbstract Category: 4. Arrhythmias and Clinical EP: AF/SVTPresentation Number: 1109-112

Authors: Antti Palomaki, Pirjo Mustonen, Tuija Vasankari, Ilpo Nuotio, Antti Ylitalo, Jussi Jaakkola, Riho Luite, Paivi Hartikainen, Juha Hartikainen, Juhani Airaksinen, Keski-Suomi Central Hospital, Jyvaskyla, Finland, Turku University Hospital, Turku, Finland

background: Anticoagulation therapy with warfarin is effective in the prevention of ischemic strokes in patients with atrial fibrillation (AF) but predisposes to intracranial bleedings.

methods: In this retrospective study data from 1,867 patients with a history of AF and ischemic stroke, transient ischemic attack (TIA) or intracranial bleeding during 2003-2012 was analyzed. A total of 596 out of the 1,867 patients suffered 158 intracranial bleeds, 452 ischemic strokes and 151 TIA while on warfarin treatment.

results: The international normalized ratio (INR) was above the therapeutic range in 31.6 % of the cases with intracranial bleeding, and 34.8 % of the bleeds were fatal within 1 month (Table). In patients with an ischemic event INR was < 2.0 in 45.6% of the cases. Patients who suffered an ischemic event had a higher CHA2DS2VASc score than patients who suffered an intracranial bleeding, but there was no difference in the HASBLED score. Severe renal insufficiency was more common in patients with intracranial bleeding.

conclusion: Over-anticoagulation was common in patients with intracranial bleeding and under-anticoagulation in patients with an ischemic event. Severe renal insufficiency was more common in patients with intracranial bleeding. HASBLED score was unable to identify patients who developed intracranial hemorrhage.

Intracranial bleedings, TIA episodes and ischemic strokes during warfarin treatment

Intracranial bleedingn (%)

Ischemic stroke or TIAn (%)

N (% of all events) 158 (20.8) 452 (59.4) Ischemic strokes and 151 (19.8) TIAAge, yr (95% CI) 78.6 (77.3-79.8) 77.4 (76.7-78.7) .12Female gender 77 (48.7) 320 (53.1) .33CHA2DS2VASc score (95% CI) 3.80 (3.57-4.04) 4.12 (3.99-4.25) .03INR < 2.0 22 (13.9) 275 (45.6) <.001INR > 3.0 50 (31.6) 51 (8.5) <.001HASBLED score (95% CI) 2.40 (2.23-2.57) 2.27 (2.19-2.34) .17HASBLED ≥ 3 62 (39.2) 232 (38.5) .86Aspirin 17 (10.8) 85 (14.1) .32Previous stroke or TIA 47 (29.9) 248 (41.3) .01History of bleeding 9 (5.7) 21 (3.5) .28Alcohol abuse 6 (3.8) 9 (1.5) .061GFR < 30 (ml/min) 11 (7.3) 17 (3.0) .015Death in 1 month after stroke 54 (34.8) After ischemic stroke 55 (12.2) <.0001