E-ISSN 1309-4866
Research Article
Efficacy and Safety of Warfarin Experience in a Stroke Policlinic in Stroke Patients
1 Clinic of Neurology, Bakırköy Psychiatric Training and Research Hospital, İstanbul, Turkey  
2 İstanbul University Cerrahpaşa School of Medicine, Institute of Forensic Sciences, İstanbul, Turkey  
Arch Neuropsychiatry ; : -
DOI: 10.5152/npa.2016.15951
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Key Words: Warfarin, safety, efficacy, stroke
Abstract

Introduction: Cardioembolic stroke is associated with high morbidity and mortality, with an increased risk of recurrent stroke. Oral anticoagulation is highly effective at reducing the risk of stroke and mortality compared with placebo. Our study aimed to point out the safety and efficacy of warfarin by analyzing the 20 year follow-up of patients on warfarin therapy.

 

Methods: A retrospective observational study was performed with ischemic stroke patients receiving warfarin in our stroke policlinic between 1992 and 2012. The CHADS2 scoring system was used to assess the annual risk of stroke and a bleeding risk score termed HAS-BLED scoring system was calculated to estimate the risk of bleeding.

 

Results: In our study 394 patients who were receiving warfarin therapy were included. The patients' median age was 66.35± 13.602 years. The median follow-up of the patients was 4.85± 3.572 years. During follow-up 79.9 % of the patients revealed no complication on warfarin therapy. 37 patients had hemorrhagic complications; among these; 33 were systemic complications ( including nose bleeding, hematuria, hematochezia) and 4 patients had intracerebral bleeding. The INR value related to hemorrhagic complications was ˃ 2.5 in 75.8 % of 33 patients having systemic bleeding and in 75 % of 4 patients having intracerebral bleeding. The HASBLED risk score was ˃3 in 72.7 % of the patients experiencing systemic bleeding complication. 41 patients had a recurrent ischemic stroke/ TIA during the follow-up. Of this patient group the INR value at time of recurrent ischemic stroke was < 2 in 41 patients (92.7%) and CHADS2 risk score was low in this group. 68 patients were using antiplatelet therapy with warfarin. In these group 16 patients experienced a complication during the follow-up (bleeding/ischemic); 10 patients had bleeding complications (systemic and intracerebral).

 

Conclusion: It seems that the effectiveness and safety of warfarin depends on maintaining its dose at sufficient levels to keep patient's INR within the therapeutic range. 

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