Trained research coordinators in each hospital collected the baseline data including patient demographics, vascular risk factors, stroke severity, lab test, medication use, complication, and diagnosis at discharge. Every participant provided signed informed consent before his/her participation. The study was approved by the central Institutional Review Board at Beijing Tiantan Hospital, in compliance with the Declaration of Helsinki. Of 25,018 patients participated in CNSR II, 14,782 patients without anticoagulation therapy were eligible for the current study after excluding hemorrhagic stroke ( n = 3,246), medical history of AF or diagnosis of AF at discharge ( n = 1,822), anticoagulation therapy during hospitalization ( n = 100), missing or extreme INR value (an INR > 5.00 is considered as extreme value, n = 2,880), and loss to 1-year follow-up ( n = 2,008) ( Supplementary Fig. Briefly, the CNSR II launched in 2012 is a nationwide initiative to establish a reliable national stroke database for evaluating stroke care delivery in clinical practice and identifying areas that need further improvement compared with CNSR I in 2007 14). The CNSR II design was described in detail previously 13). The population used for this study was from China National Stroke Registry II (CNSR II). Thus, the goal of the current study was to explore the clinical significance and prognostic value of admission INR on adverse stroke outcomes including all-cause death, recurrent stroke, combined end point, and poor functional outcome in patients with acute ischemic cerebrovascular events based on the China national stroke registry phase II. We assumed that the INR would also have a prognostic value in ischemic stroke patients without AF. On the other hand, the prognostic value of INR among ischemic stroke patients without AF or without anticoagulation has not been investigated so far. However, the instantaneous change of INR after cerebral ischemia was not understood. Some researchers explored the relation between admission INR and acute infarct volume in ischemic stroke patients with preadmission warfarin use 12). Some studies found that the increased admission INR was an independent predictor of poor clinical outcomes in trauma, acute decompensated heart failure, and acute pulmonary embolism patients 9– 11). Yet, it is critical to understand the potential mechanism, which is related to the self-protection in an attempt to avoid excessive brain injury after acute ischemic stroke 8). Changes in blood coagulation function may accelerate blood clot formation or may influence clinical outcome in acute ischemic stroke patients with atrial fibrillation (AF), especially under the anticoagulation therapy 6, 7). The INR standardizing the prothrombin time has been accepted as a sensitive and reliable marker of coagulation abnormalities 3), and is widely used in the management of patients receiving anticoagulation treatment 4, 5). Almost one half of stroke survivors remain disabled, and a seventh requires the institutional care 2). Of all neurological conditions, stroke is one of the most devastating disease 1). No association between low INR (< 0.9) and any stroke outcomes was found compared with the medium group.Ĭonclusions: Increased admission INR was associated with adverse stroke outcomes among acute ischemic stroke patients without atrial fibrillation or anticoagulation therapy. 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. 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%). 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. The period of follow-up was 1 year after stroke onset. Methods: A total of 14,782 ischemic stroke patients from the China National Stroke Registry II were included in this analysis. Herein, the association between baseline INR and stroke outcomes in patients without anticoagulation therapy was investigated. Aim: The impact of international normalized ratio (INR) on prognosis after acute ischemic stroke without anticoagulation therapy is unclear.
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