Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic...

Limited data exist regarding long-term prognosis in patients with nonvalvular atrial fibrillation (AF) who have survived a severe, disabling stroke.

The aim of this study was to assess long-term prognosis and its determinants in a prospective case series of stroke survivors with AF and moderate to severe handicap.

From a consecutive series of AF patients with first-ever ischemic stroke, we evaluated prospectively those with moderate to severe disability (grade 4-5 on the modified Rankin Scale) who were treated during a 5-year follow-up period with either warfarin or aspirin. Death and recurrent vascular events were documented.

Out of a pool of 438 AF patients, 191 were prospectively assessed. During a mean follow-up of 50.4 months, the cumulative 5-year mortality was 76.7% (95% CI, 69.0-84.3) and the 5-year recurrence rate was 33.7% (95% CI, 23.3-44.1). Cox regression analysis revealed that increasing age, increasing handicap, and aspirin versus warfarin were independent predictors of mortality. Prior transient ischemic attack and aspirin versus warfarin were predictors of vascular recurrence. Anticoagulation was associated with a decreased risk of death (hazard ratio [HR], 0.44; 95% CI, 0.27-0.70; P < 0.001) and recurrent thromboembolism (HR, 0.36; 95% CI, 0.17-0.77; P < 0.01).

Our results suggest that chronic anticoagulation therapy may be effective in lengthening survival and preventing recurrent thromboembolism in AF patients who have suffered a severely disabling ischemic stroke.