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. 2019 Apr 1;26(4):378-387.
doi: 10.5551/jat.43752. Epub 2018 Oct 12.

Prognostic Value of International Normalized Ratio in Ischemic Stroke Patients without Atrial Fibrillation or Anticoagulation Therapy

Xuewei Xie  1   2   3   4 , Xianwei Wang  1   2   3   4 , Zixiao Li  1   2   3   4 , Xingquan Zhao  1   2   3   4 , Zhongrong Miao  1   2   3   4   5 , Liping Liu  1   2   3   4 , Hao Li  1   2   3   4 , Xia Meng  1   2   3   4 , Yongjun Wang  1   2   3   4 , Yilong Wang  1   2   3   4
Affiliations

Prognostic Value of International Normalized Ratio in Ischemic Stroke Patients without Atrial Fibrillation or Anticoagulation Therapy

Xuewei Xie et al. J Atheroscler Thromb. .

Abstract

Aim: The impact of international normalized ratio (INR) on prognosis after acute ischemic stroke without anticoagulation therapy is unclear. Herein, the association between baseline INR and stroke outcomes in patients without anticoagulation therapy was investigated.

Methods: A total of 14,782 ischemic stroke patients from the China National Stroke Registry Ⅱ were included in this analysis. The period of follow-up was 1 year after stroke onset. Multivariate logistic regression models were used to estimate the relationship between INR and stroke outcomes including all-cause death, recurrent stroke, composite end point, and poor functional outcome.

Results: Of 14,782 patients with stroke, all-cause death occurred in 1080 (7.3%), recurrence stroke in 538 (3.9%), combined end point in 1319 (8.9%), and poor functional outcome in 3001 (20.3%). Compared with the medium INR group (0.9-1.1), the odds ratios with confidence intervals of 95% for the high INR group (＞1.1) were 1.58 (1.32-1.98) for all-cause death, 1.40 (1.10-1.79) for stroke recurrence, 1.52 (1.29-1.79) for combined end point, and 1.21 (1.06-1.39) for poor functional outcome. No association between low INR (＜0.9) and any stroke outcomes was found compared with the medium group.

Conclusions: Increased admission INR was associated with adverse stroke outcomes among acute ischemic stroke patients without atrial fibrillation or anticoagulation therapy.

Keywords: International normalized ratio; Minor stroke; Recurrent stroke; Registries; Transient ischemic attack.

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Figures

Supplementary Fig. 1.
Supplementary Fig. 1.
Flow chart showing the patients selection from China National Stroke Registry II AF indicates atrial fibrillation; INR, international normalized ratio.
Supplementary Fig. 2.
Supplementary Fig. 2.
Rates of one-year events among patients with ischemic stroke or TIA according to INR grading category
Fig. 1.
Fig. 1.
ORs (95% CIs) for all-cause death, stroke recurrence, combined end point of recurrent stroke or death, and poor functional outcome at 1 year according to the level of INR based on a 0.05 increment, with INR of 0.95–1.00 serving as the reference group among patients with ischemic cerebrovascular events.
See this image and copyright information in PMC

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