Abstract
Objective: The efficacy of warfarin therapy correlates with the Time in Therapeutic Range (TTR). This study aimed to investigate the efficacy and target achievement rates in patients using warfarin who were followed up in stroke outpatient clinics. Methods: In this study, 103 patients who had been under warfarin treatment were retrospectively evaluated. Duration and indications for warfarin use, thrombotic or hemorrhagic complications were recorded. Target INR value was 3.0-3.5 in patients with mechanical valves and 2.0-3.0 in those using warfarin for other indications. Results: In this study, 103 patients with a mean age of 67.14±14.19, 47 men and 56 women, were included. Indications for warfarin use, respectively, were non-valvular atrial fibrillation (AF) in 61.6% of the patients, akinetic/hypokinetic segment on echocardiography (ECHO) in 12.62%, thrombophilia in 8.74%, metallic prosthetic valve in 3.88%, frequent transient ischemic attacks in 6.79%, a hypokinetic segment on ECHO with atrial fibrillation in 5.82% and vertebral artery dissection in 0.87%. 46.8% of the patients were determined to be in good control, with a mean TTR of 64.09%; also, TTR was 100% in 36.8% of them. Minor/major hemorrhagic event was noted in 10 patients (9.70%), two of whom had an intracerebral hemorrhage. Conclusion: The mean TTR value detected in this study is considerably higher than the rate reported in our country. Findings of this study suggest that close monitoring is paramount of importance and vital in patients with stroke. Regular monitoring of stroke patients using warfarin will be beneficial in terms of informing patients, providing optimal anticoagulation and preventing complications.
Highlights
Ischemic stroke is one of the diseases that may cause high mortality and morbidity worldwide
Indications for warfarin use, respectively, were non-valvular atrial fibrillation (AF) in 61.6% of the patients, akinetic/hypokinetic segment on echocardiography (ECHO) in 12.62%, thrombophilia in 8.74%, metallic prosthetic valve in 3.88%, frequent transient ischemic attacks in 6.79%, a hypokinetic segment on ECHO with atrial fibrillation in 5.82% and vertebral artery dissection in 0.87%. 46.8% of the patients were determined to be in good control, with a mean Therapeutic Range (TTR) of 64.09%; TTR was 100% in 36.8% of them
Our single-center study’s main limitations, where we evaluated the treatment efficacy with TTR in patients with ischemic cerebrovascular disease using warfarin due to different etiologies, are the small number of patients included in the retrospective setup of this research
Summary
Ischemic stroke is one of the diseases that may cause high mortality and morbidity worldwide. In the acute phase of stroke, appropriate treatment can be determined for secondary prevention by revealing etiological reasons [1]. Cardioembolic strokes (CE) have accounted for approximately 20-40% of all strokes, with arterial dissections being one of the common etiological causes in young stroke patients [2, 3]. In the medical treatment of arterial dissection, in which impairment of arterial wall integrity, intramural thrombus development causes transient ischemic attack or ischemic cerebrovascular disease, anticoagulation has been among the treatment options despite no consensus exists [4]. Cerebral venous thrombosis (CVT) is a rare cause of stroke, it should definitely be considered in young stroke etiology [5]. In the presence of prothrombotic genetic features that predispose to recurrent CVT, long-term anticoagulation should ideally be planned [6]
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