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Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation.

Publication ,  Journal Article
Saeed, O; Zhang, S; Patel, SR; Jorde, UP; Garcia, MJ; Bulcha, N; Gupta, T; Xian, Y; Matsouaka, R; Shah, S; Smith, EE; Schwamm, LH; Fonarow, GC
Published in: J Card Fail
August 2021

BACKGROUND: The safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain. METHODS: Utilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC. RESULTS: A total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC.  Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p<0.01). After adjustment for clinical covariates, the likelihood of 1 year mortality was higher in those on OAC (aHR: 1.22, 95% CI 1.05-1.41, p<0.01), while no significant differences were noted for ICH (aHR: 1.34, 95% CI 0.69-2.59, p=0.38) and recurrent ischemic stroke (aHR: 0.78, 95% CI 0.54-1.15, p = 0.21).  The likelihood of all-cause bleeding (aHR: 1.59, 95% CI 1.29-1.96, p<0.01) and all-cause re-hospitalization (aHR: 1.14, 95% CI 1.02-1.27, p = 0.02) was higher for those on OAC. CONCLUSION: Initiation of OAC after an ischemic stroke in older patients with HF in the absence of atrial fibrillation is associated with death, bleeding and re-hospitalization without an associated reduction in recurrent ischemic stroke. If validated, these findings raise caution for prescribing OAC to such patients.

Duke Scholars

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

August 2021

Volume

27

Issue

8

Start / End Page

857 / 864

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Medicare
  • Ischemic Stroke
  • Humans
  • Heart Failure
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • Atrial Fibrillation
  • Anticoagulants
 

Citation

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Saeed, O., Zhang, S., Patel, S. R., Jorde, U. P., Garcia, M. J., Bulcha, N., … Fonarow, G. C. (2021). Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. J Card Fail, 27(8), 857–864. https://doi.org/10.1016/j.cardfail.2021.02.017
Saeed, Omar, Shuaiqi Zhang, Snehal R. Patel, Ulrich P. Jorde, Mario J. Garcia, Nurilign Bulcha, Tanush Gupta, et al. “Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation.J Card Fail 27, no. 8 (August 2021): 857–64. https://doi.org/10.1016/j.cardfail.2021.02.017.
Saeed O, Zhang S, Patel SR, Jorde UP, Garcia MJ, Bulcha N, et al. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. J Card Fail. 2021 Aug;27(8):857–64.
Saeed, Omar, et al. “Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation.J Card Fail, vol. 27, no. 8, Aug. 2021, pp. 857–64. Pubmed, doi:10.1016/j.cardfail.2021.02.017.
Saeed O, Zhang S, Patel SR, Jorde UP, Garcia MJ, Bulcha N, Gupta T, Xian Y, Matsouaka R, Shah S, Smith EE, Schwamm LH, Fonarow GC. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. J Card Fail. 2021 Aug;27(8):857–864.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

August 2021

Volume

27

Issue

8

Start / End Page

857 / 864

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Medicare
  • Ischemic Stroke
  • Humans
  • Heart Failure
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • Atrial Fibrillation
  • Anticoagulants