Logo-jrcm
J Res Clin Med. 2022;10(1): 6.
doi: 10.34172/jrcm.2022.006
  Abstract View: 43
  PDF Download: 64

Original Article

Why INR is outside the therapeutic range in patients with acuteischemic stroke and atrial fibrillation

Elyar Sadeghi Hokmabadi 1 ORCID logo, Sheida Shaafi 1 ORCID logo, Yalda Sadeghpour 1 ORCID logo, Reza Deljavan 1 ORCID logo, Javad Jalili 2* ORCID logo, Morteza Ghojazadeh 3 ORCID logo, Elyar Alizade Najmi 4, Saeid Charsouei 1 ORCID logo, Mehdi Farhoudi 1 ORCID logo

1 Tabriz Neuroscience Research Center (NRSC), Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Radiology, Imam Reza Hospital, Faculty of Medicine, Tabriz, University of Medical Sciences, Tabriz, Iran
3 Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
4 Tabriz University of Medical Sciences, Tabriz, Iran
*Corresponding Author: Javad Jalili, Email: javadjalili1979@gmail.com

Abstract

Introduction: Warfarin is still the primary drug used to prevent vascular events in patients with atrial fibrillation (AF), especially in low-income countries. Therapeutic failure and non-adherence are common causes of recurrent embolic events. The aim of this study was to investigate possible reasons why INR was outside the therapeutic range in patients presenting with acute ischemic stroke and AF.

Methods: This prospective study was performed over a ten-month period and all patients admitted with acute ischemic stroke were enrolled. Patients with AF who did not have INR within the therapeutic range (INR=2-3) at the time of admission were identified. During a face-to-face interview, the reasons for INR being outside the therapeutic range were assessed based on a prepared checklist.

Results: During the study period, 810 patients had an acute ischemic stroke, of which 177 had AF heart rhythm (22%). The median age was 76 (IQR: 71-83), and 87 (52%) were male. Of these 177 patients, 44 (25%) had a previous history of AF (“previous AF” group) and 133 (75%) were diagnosed with AF during the current hospital admission (“new AF” group). Among patients on warfarin but with INR outside the therapeutic range (29 in all), 20 (69%) did not see a physician regularly and/or did not take medication according to the physician’s instructions.

Conclusion: The most common reason for INR being outside the therapeutic range was patients lack of awareness of their heart disease (unrecognized AF). Other reasons included irregular visits to the physician and drug non-adherence.

Keywords: Cardio-embolic stroke, Atrial Fibrillation, Warfarin, Anticoagulants, Neurologic Manifestation
First Name
 
Last Name
 
Email Address
 
Comments
 
Security code


Abstract View: 44

Your browser does not support the canvas element.


PDF Download: 64

Your browser does not support the canvas element.

Submitted: 26 Feb 2021
Revision: 19 May 2021
Accepted: 23 May 2021
ePublished: 16 Apr 2022
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - Firefox Plugin)