Clinical Factors Associated with Stroke Recurrence in Atrial Fibrillation Patients

Authors

DOI:

https://doi.org/10.30872/

Keywords:

Warfarin, atrial fibrillation, recurrent stroke, dose switching, body mass index

Abstract

Recurrent stroke in patients with atrial fibrillation (AF) remains a significant clinical problem despite warfarin therapy. This study aimed to identify clinical factors associated with recurrent stroke in AF patients receiving warfarin. A retrospective cohort study was conducted on 50 patients diagnosed with ischemic stroke and atrial fibrillation who received warfarin for at least one year at Dr. Sardjito General Hospital Yogyakarta and Dr. Moewardi General Hospital Surakarta between 2015 and 2019. Bivariate and multivariate logistic regression analyses were performed to assess the association between various clinical factors and stroke recurrence. Eleven patients (22%) experienced recurrent stroke. On bivariate analysis, warfarin dose switching, dose variation, and body mass index were associated with stroke recurrence. However, multivariate analysis (both conventional logistic regression and Firth’s penalized logistic regression) did not confirm these three variables as statistically significant independent predictors. The wide confidence intervals that included the value of 1 in both models reflect the limited sample size and number of events. Mean INR value (p=0.06) and frequency of INR monitoring (p=0.27) were also not significantly associated with recurrent stroke. These findings are exploratory and indicate that INR monitoring alone is insufficient as a primary predictor. A more comprehensive therapeutic management approach is needed, including efforts to maintain warfarin dose stability and consideration of patient characteristics such as body mass index, as well as prospective studies with larger sample sizes.

Author Biographies

  • Lailla Affianti Fauzi, Yogyakarta State University

    Department of Indonesian Traditional Medicine, Faculty of Vocational Studies, Yogyakarta State University, Yogyakarta, Indonesia

  • Erna Kristin, Universitas Gadjah Mada

    Department of Pharmacology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

  • Rizaldy Taslim Pinzon, Duta Wacana Christian University

    Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia

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Published

2026-09-30

Issue

Vol. 7 No. 3 (2026): J. Sains Kes.

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Articles

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How to Cite

[1]
L. A. Fauzi, E. Kristin, and R. T. Pinzon, “Clinical Factors Associated with Stroke Recurrence in Atrial Fibrillation Patients”, J. Sains. Kes, vol. 7, no. 3, pp. 72–81, Sep. 2026, doi: 10.30872/.

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