Effect of anticoagulation on infarct volume and NISS score in patients with atrial fibrillation and ischaemic stroke

Abstract

Purpose: The aim of this study was to evaluate the use of oral anticoagulation (OAC) in patients with cardioembolic stroke due to non-valvular atrial fibrillation (NVAF). The NIHSS (National Institute of Healt Stroke Scale) score calculated by a neurologist at initial presentation and infarct volume measured semi-automatically in cm3 by Magnetic Resonance Imaging (MRI). Materials and methods: A total of 101 NVAF patients with acute ischaemic stroke were included in this retrospective study. Patients were divided into 4 groups according to OAC drug use: Non-OAC users (group 1), subtherapeutic dose warfarin users (under 70 years of age: INR≤2.0; over 70 years of age: INR≤1.6 group 2), therapeutic dose warfarin users (under 70 years of age: INR≥2.0; over 70 years of age: INR≥1.6 group 3) and therapeutic dose Non-vitamin K oral anticoagulant (NOAC) users group 4. Results: Infarct volume was calculated as 22.20 cm³ median (0.4-235 cm³ lowest-highest) for group 1; 12.95 cm³ (1.3-129 cm³) for group 2; 2.25 cm³ (0.3-89 cm³) for group 3 and 4.40 cm³ (0.2-293 cm³) for group 4 and the difference was statistically significant (p=0.039). The calculated NIHSS score was 9 (4-23) for the group 1, 8.5 (3-18) for the group 2, 6.5 (2-20) for the group 3, 5 (1-22) for the group 4 and the effect of anticoagulation use on NIHSS score was statistically significant (p=0.029). Conclusion: Anticoagulant treatment holds importance in the primary and secondary prevention of stroke and in enhancing the NIHSS score and infarct volumes among stroke patients, as evidenced in the current study.