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BMC Neurology

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Open Access 01-12-2018 | Research article

Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study

Authors: Jiaying Zhu, Mengmeng Ma, Yijia Guo, Muke Zhou, Jian Guo, Li He

Published in: BMC Neurology | Issue 1/2018

Abstract

Background

Warfarin therapies not only are used to prevent stroke in patients with high risk of cardioembolism such as patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), but also was associated with lower stroke severity and more favorable functional outcomes in patients with acute ischemic stroke due to middle cerebral artery occlusion. It was speculated that pre-stroke warfarin may promote collateralization and result in reduced stroke severity. This study aimed to investigate the association between pre-stroke warfarin use and leptomeningeal collaterals in patients with acute ischemic stroke due to occlusion of the middle cerebral artery.

Methods

We enrolled consecutive acute ischemic stroke patients (occlusion of the middle cerebral artery within 24 h) with known history of AF and/or RHD at the neurology department of the West China Hospital from May 2011 to April 2017. Computed tomography angiography (CTA) before treatment was used to detect the thrombus. Regional leptomeningeal collateral (rLMC) score based on CTA images was used to assess collateral circulation. Prior use of warfarin was recorded. Univariate and multivariate analyses were performed to detect the association of prior warfarin use with the collateral circulation.

Results

A total of 120 patients were included; 29 (24.2%) were taking warfarin before stroke. The international normalized ratio (INR) in patients with prior warfarin use was 1.53 ± 1.00, compared with 1.02 ± 0.09 in patients without prior warfarin use (P < 0.001). Prior oral warfarin therapy was inversely associated with poor rLMC (OR = 0.07, 95%CI 0.01–0.44, P = 0.005). There were no associations between prior warfarin use and initial stroke severity or functional outcomes at 3 months.

Conclusion

Warfarin use seems improve collateralization in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

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Title: Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study
Authors: Jiaying Zhu
Mengmeng Ma
Yijia Guo
Muke Zhou
Jian Guo
Li He
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2018
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-018-1200-7

At a glance: The STEP trials

Springer Medicine

Pre-stroke warfarin enhancement of collateralization in acute ischemic stroke: a retrospective study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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