Abstract TMP91: Prediction of Recurrent Embolism and Major Hemorrhage in Patients With Acute Stroke and Atrial Fibrillation by Risk Stratification Schema: The Alessa Score Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maurizio Paciaroni ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Acute Stroke ◽  
Area Under The Curve ◽  
Major Hemorrhage ◽  
Ischemic Event ◽  
Atrial Enlargement ◽  
Recurrent Ischemic Event ◽  
Ischemic Events

Background: We aim to derive and validate a score that predicts early ischemic events or major hemorrhage in acute stroke patients with atrial fibrillation (AF). Methods and results: The derivation cohort consisted of 854 patients with acute ischemic stroke and AF (mean age 76.3 y, 46.6% M) included between January 2012 and March 2014. Older age (HR 1.06 for each additional year, p=0.0025) and severe atrial enlargement (HR 2.05, p= 0.027) resulted being predictors for recurrent ischemic event (stroke, TIA, systemic embolism) within 90 days from acute stroke. Small infarct size (≤1.5 cm) was inversely correlated with both severe bleeding (HR 0.39, p=0.03) and recurrent ischemic events (HR 0.44, p=0.01). Considering the magnitude of the effect, we assigned 2 points to age ≥80 y; 1 point to 70-79 y; 1 point to presence of ischemic index lesion >1.5 cm; 1 point to severe atrial enlargement (ALESSA score). An increase in this score was associated with recurrent ischemic event but not major hemorrhage. A logistic regression with the ROC graph procedure (C-statistic) showed an area under the curve of 0.697 (0.632-0.763), p=0.0001 for ischemic outcome event and 0.585 (0.493-0.678), p=0.47 for major hemorrhage. On multivariate analysis, ALESSA >2 was associated with recurrent ischemic event (OR: 2.5, 95% CI 1.4-4.4, p=0.001) but not major hemorrhage (OR: 1.1, 95% CI 0.5-2.4, p=0.9). The validation cohort included 994 patients with acute stroke and AF (mean age 75.8 y, 46.0% M) included between April 2014 and June 2016. Also in this cohort, a higher ALESSA score was associated with recurrent ischemic event but not major hemorrhage. Logistic regression with the ROC graph procedure showed an area under the curve of 0.646 (0.529-0.763), p=0.009 for recurrent ischemic event and 0.407 (0.275-0.540), p=0.14 for major hemorrhage. On multivariate analysis, ALESSA >2 barely lacked being significantly correlated with recurrent ischemic event (OR: 2.07, 95% CI 0.93-4.67, p=0.07). Conclusions: A higher ALESSA score is associated with a higher risk of recurrent ischemic event but not with major hemorrhage. Therefore, patients with acute stroke and AF and an ALESSA score >2 may be candidates for early anticoagulation treatment. Further validations of this schema need to be performed.

scholarly journals Is Leukocytosis a Predictor for Recurrence of Ischemic Events after Coronary Artery Bypass Graft Surgery? A Cohort Study

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Farid Rashidi ◽  
Peiman Jamshidi ◽  
Marziah Kheiri ◽  
Shadi Ashrafizadeh ◽  
Amir Ashrafizadeh ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Arterial Graft ◽  
Enzyme Release ◽  
Ischemic Event ◽  
Cabg Surgery ◽  
Recurrent Ischemic Event ◽  
Wbc Count ◽  
Ischemic Events

Objective. Studies have shown that inflammation plays an important role in pathogenesis of coronary artery disease. The present study was designed to evaluate the role of high WBC count before CABG in predicting the risk of ischemic events after CABG. Methods and Results. This prospective study was carried out on 380 patients who underwent CABG surgery. Ninety seven patients (25.5%) had recurrent ischemic event. Mean WBC count before CABG surgery in patients with recurrent ischemic event was 7267 mic/lit ± 1863, which was significantly higher than the others, with a mean WBC count of 6721 mic/lit ± 1734 (P=0.011). Patients with a WBC count more than 6000 mic/lit were at the highest risk for recurrent ischemic event (OR = 2.11, 95% CI = 1.18–3.44, P=0.009). After adjustment for age, sex, family history, smoking, hyperlipidemia, Logestic Euro score, post opretive enzyme release (CK.mb), arterial graft and BMI, the relationship between the group with WBC count higher than 6000 mic/lit and recurrent of ischemic event remained significant (OR = 2.25, 95% CI = 1.2 to 4, P=0.005). Conclusions. High WBC count before CABG surgery is an independent risk factor for ischemic events one year after the surgery.

Abstract 197: Do the CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED Scores Predict Recurrent Stroke and GI Bleeding in Patients with Acute Ischemic Stroke or TIA and Atrial Fibrillation?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Frank L Silver ◽  
Melissa Stamplecoski ◽  
Jiming Fang ◽  
Moira K Kapral
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Major Bleeding ◽  
Hemorrhagic Stroke ◽  
Hospital Admissions ◽  
Recurrent Stroke ◽  
Simple Random Sample ◽  
Major Hemorrhage ◽  
One Year

Background: In patients with atrial fibrillation (AF) the CHADS 2 and CHA 2 DS 2 -VASc score are used to provide a risk for subsequent stroke and the HAS-BLED score for hemorrhage. These scores were derived from large cohorts of patients with AF, however, only 8 - 25% of the patients had a past history of stroke. We wanted to determine whether these prediction scores had utility in patients with AF who have had a recent stroke or TIA. Methods: We selected patients with AF and a first stroke or TIA from the 2002-3, 2004-5, 2008-9 and 2010-11 Ontario Stroke Audits (OSA). The OSA includes data from a simple random sample of 15 - 20% of stroke and TIA patients presenting to all Ontario hospitals identified using ICD-10 diagnostic codes I60, I61, I63, I64, H34.1 and G45. Recurrent ischemic stroke, hemorrhagic stroke and major GI hemorrhage were obtained by linking the OSA data to administrative databases for hospital admissions in the subsequent year. Results: There were 3,960 patients with AF in the OSA who were discharged alive following their first acute stroke or TIA. The median age was 80. At discharge 41% of the patients were prescribed anticoagulants, 24% antiplatelet therapy, 25% both and 9% were prescribed no antithrombotic therapy. The one year readmission rate for stroke was 5.3% (including 0.4% hemorrhagic stroke) and 1.9% for major hemorrhage. Multivariable logistic regression models did not show any significant association between the CHADS 2 and CHA 2 DS 2 -VASc scores and the risk of recurrent stroke. The HAS-BLED score failed to predict hemorrhagic stroke or major bleeding and the risk of major bleeding for the entire group at one year was low (1.9%). Patients prescribed anticoagulants at discharge had fewer recurrent strokes (OR 0.55; 95% CI 0.34 - 0.90, p=0.02), a lower one year mortality (OR 0.42; 95% CI 0.31 - 0.56, p <0.001) and the same risk of major bleeding as compared to patients not receiving anticoagulants. Conclusions: The CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores did not predict recurrent stroke or hemorrhage in patients following an acute stroke or TIA. Anticoagulation at discharge was associated with a lower risk of recurrent stroke and death without a significant increase in the risk of major hemorrhage.

Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

2020 ◽  
Vol 49 (6) ◽  
pp. 619-624
Author(s):  
Keisuke Tokunaga ◽  
Masatoshi Koga ◽  
Sohei Yoshimura ◽  
Yasushi Okada ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Left Atrial ◽  
Nonvalvular Atrial Fibrillation ◽  
Ischemic Event ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Ischemic Events

<b><i>Background:</i></b> The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). <b><i>Methods:</i></b> Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. <b><i>Results:</i></b> A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). <b><i>Conclusion:</i></b> Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

scholarly journals Relationship between tongue pressure and dysphagia diet in patients with acute stroke

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252837
Author(s):  
Masahiro Nakamori ◽  
Kenichi Ishikawa ◽  
Eiji Imamura ◽  
Haruna Yamamoto ◽  
Keiko Kimura ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Stroke ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Oral Intake ◽  
Tongue Pressure ◽  
Objective Method ◽  
Optimal Cutoff ◽  
Non Invasive ◽  
Swallowing Assessment

A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.

New opportunities to optimize antithrombotic therapy for secondary stroke prevention

2019 ◽  
Vol 14 (3) ◽  
pp. 220-222 ◽  
Author(s):  
Anthony S Kim ◽  
J Donald Easton
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischaemic Attack ◽  
Stroke Prevention ◽  
Dual Antiplatelet Therapy ◽  
Secondary Stroke Prevention ◽  
Short Term ◽  
Major Hemorrhage ◽  
Ischaemic Attack

Stroke symptoms can be unsettling, even when symptoms resolve, but focusing on stroke prevention can be empowering provided that effective interventions for appropriate patient populations are available. Current options include interventions for symptomatic carotid artery stenosis, anticoagulation for atrial fibrillation, high-dose statins, new oral anticoagulants, new developments in atrial fibrillation detection, and new therapeutics are in development. For antiplatelet therapy, aspirin monotherapy is effective but dual antiplatelet therapy with the combination of aspirin and clopidogrel increases hemorrhage risks over the long term that outweigh potential benefits. In the short term though, both the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trials have shown a benefit of short-term dual-antiplatelet therapy, though the increased major hemorrhage risk seen in POINT could justify applying dual-antiplatelet therapy to just the first 21 days. Furthermore, since clopidogrel is a prodrug that must be metabolized to have antiplatelet activity, it is not surprising that the treatment effect in CHANCE was limited to patients who were not carriers of loss-of-function alleles for clopidogrel metabolism. Ticagrelor, an antiplatelet agent which failed to meet its primary endpoint as monotherapy compared to aspirin in the Acute Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (SOCRATES) trial, is currently being tested as combination therapy with aspirin compared to aspirin alone in Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES). These developments along with improvements to the infrastructure to perform rapid evaluations and to apply intensive secondary stroke prevention interventions hold continued promise for the future.

scholarly journals Do gliosarcomas have distinct imaging features on routine MRI?

2021 ◽  
pp. 197140092110123
Author(s):  
Christoph J Maurer ◽  
Irina Mader ◽  
Felix Joachimski ◽  
Ori Staszewski ◽  
Bruno Märkl ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Regression Model ◽  
Logistic Regression Model ◽  
External Validation ◽  
Area Under The Curve ◽  
Training Dataset ◽  
Validation Dataset ◽  
Imaging Features ◽  
Age And Sex

Purpose The aim of this study was the development and external validation of a logistic regression model to differentiate gliosarcoma (GSC) and glioblastoma multiforme (GBM) on standard MR imaging. Methods A univariate and multivariate analysis was carried out of a logistic regression model to discriminate patients histologically diagnosed with primary GSC and an age and sex-matched group of patients with primary GBM on presurgical MRI with external validation. Results In total, 56 patients with GSC and 56 patients with GBM were included. Evidence of haemorrhage suggested the diagnosis of GSC, whereas cystic components and pial as well as ependymal invasion were more commonly observed in GBM patients. The logistic regression model yielded a mean area under the curve (AUC) of 0.919 on the training dataset and of 0.746 on the validation dataset. The accuracy in the validation dataset was 0.67 with a sensitivity of 0.85 and a specificity of 0.5. Conclusions Although some imaging criteria suggest the diagnosis of GSC or GBM, differentiation between these two tumour entities on standard MRI alone is not feasible.

scholarly journals Association Between Apelin and Atrial Fibrillation in Patients With High Risk of Ischemic Stroke

2021 ◽  
Vol 8 ◽  
Author(s):  
Allan Bohm ◽  
Peter Snopek ◽  
Lubomira Tothova ◽  
Branislav Bezak ◽  
Nikola Jajcay ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
High Risk ◽  
Area Under The Curve ◽  
Study Groups ◽  
Diagnostic Value ◽  
Screening Tools ◽  
Bivariate Analysis ◽  
Control Group ◽  
Timely Initiation

Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke.Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood.Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p &lt; 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131.Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.

scholarly journals Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Stroke ◽  
2019 ◽  
Vol 50 (8) ◽  
pp. 2168-2174 ◽  
Author(s):  
Maurizio Paciaroni ◽  
Giancarlo Agnelli ◽  
Valeria Caso ◽  
Giorgio Silvestrelli ◽  
David Julian Seiffge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Low Dose ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Interquartile Range ◽  
Off Label ◽  
Cerebrovascular Events ◽  
Atrial Enlargement ◽  
Ischemic Events

Background and Purpose— Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non–vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods— Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results— Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95–5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63–9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83–3.16), and CHA 2 DS 2 -VASc score (OR, 1.72 for each point increase; 95% CI, 1.58–1.88) were associated with ischemic events. Among the CHA 2 DS 2 -VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33–0.61). Conclusions— In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA 2 DS 2 -VASc score were associated with increased risk of cerebrovascular events.

scholarly journals Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing

2015 ◽  
Vol 88 (4) ◽  
pp. 500-512
Author(s):  
Mirela Cristina Stamate ◽  
Nicolae Todor ◽  
Marcel Cosgarea
Keyword(s):  
Hearing Loss ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Multivariate Analyses ◽  
Area Under The Curve ◽  
Pure Tone Audiometry ◽  
Hearing Level ◽  
Impaired Hearing

ABSTRACT:Background & aim: The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but the extent that they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The study aims to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches.Patients and methods: The study included 105 adult subjects with normal hearing and hearing loss that underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developped to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of the each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves curves and to estimate the areas under the curves in order to compare different multivariate analyses.Results: Each of the three multivariate analyses provides high values of the area under the curves. Each otoacoustic emission test presents small differences for the value of the area under the curve, but transient otoacoustic emissions seems to be the most powerful predictive for the hearing level for the right ear and distorsion products for the left ear. Adding demographic variables, the value of the area under the curve is similar for both ears, but we found out that tinnitus is a strong predictive variable only for the left ear. Our multivariate analyses revealed that age is a predictor factor of the auditory status for both ears. In our study, gender had no predictive value for hearing level in any of the multivariate analyses. Our study also confirms that the combination of age and distorsion products can better predict hearing level than distorsion products alone. We have found out that the otoacoustic emissions tests have improved performance for both ears when using the multivariate analysis which combines transient otoacoustic emissions and distortion products data.Conclusion: Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies.Key words: otoacoustic emissions, multivariate analyses, logistic regression, hearing loss, receiver operating curves.

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

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