Abstract
BackgroundWarfarin is evidence-based therapy for the prevention of cardioembolic stroke, but has not been studied for its effects on whole blood viscosity (WBV). This study investigated the effect of warfarin versus aspirin on WBV in patients presenting with non-valvular atrial fibrillation (NVAF) and acute cardioembolic stroke.MethodsWe enrolled patients with acute cerebral infarction, aged 56–90 years who had NVAF, CHADS2 score ≥ 2, presenting with mild-to-moderate stroke (National Institute of Health Stroke Scale (NIHSS) score < 20 and modified Rankin Scale (2mRS) score < 4) in a single center. The patients were alternately assigned to warfarin or aspirin groups. Post-treatment WBV was assessed after international normalized ratio (INR) reached target range [2, 3] for patients in the warfarin group, and 5 days after baseline in the aspirin group.ResultsTotal 67 patients were included, and 56 completed this study (33 warfarin and 23 aspirin). Compared to baseline values, warfarin reduced post-treatment BV at all shear rates. The BV reductions greater than 1 cP measured at shear rates of 300, 150, 5, and 1 s− 1 were independently and significantly associated with warfarin treatment compared to aspirin after adjusting for age, sex, CHA2DS2-VASc scores, and baseline hematocrit.ConclusionsWarfarin confers greater reductions in BV than aspirin in patients with acute cardioembolic stroke. BV could be a useful method to estimate thrombotic risk in patients receiving warfarin.Trial registrationKCT0001291, Date of Registration: 2014-12-01
Highlights
Warfarin is evidence-based therapy for the prevention of cardioembolic stroke, but has not been studied for its effects on whole blood viscosity (WBV)
This study investigated the effects of warfarin and aspirin on blood viscosity in cardioembolic ischemic stroke patients with non-valvular atrial fibrillation (NVAF)
Blood viscosity of warfarin and aspirin There was no significant difference of baseline levels of WBV between the two groups (Table 2)
Summary
Patient population This is a prospective, alternately assigned, open-label and blinded-endpoint clinical trial. Patients with severe stroke with high NIHSS often have large ischemic stroke [15], and have an increased risk of hemorrhagic transformation. Patients were alternately assigned according to the order of enrollment, and the warfarin group was set to open-label study for appropriate INR control. In a previous study using scanning capillary viscometer in patients classified as high-risk for cardiovascular disease based on a Framingham risk equivalent of > 20%, standard deviation of mean WBV levels at low shear rate (5/s) were reported as 2.42 cP [18]. We enrolled 50 subjects to detect a change of one standard deviation (SD) in mean low-shear blood viscosity or 25 subjects in each of 2 arms using 90% power and a type 1 error rate of 5%. Statistical analysis was performed by the third-party statistician and conducted using SAS (SAS, Cary, NC) and SPSS Statistics 20 (SPSS, Chicago, IL)
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