Abstract WP273: Selection of Antithrombotic Therapy in Patients with Atrial Fibrillation who Experience an Ischemic Stroke While on Anticoagulant Therapy
Wang, D; Obrien, E; Xian, Y; Sherrod, C; Chan, P; Laskowitz, D; Peterson, E; Fonarow, G; Schwamm, L; Smith, E; Bhatt, D; Ayodele, I; Matsouaka, R
Published in: Stroke
Anticoagulation therapy plays a pivotal role in stroke prevention for people with atrial fibrillation. Despite its efficacy, some patients still have an ischemic stroke while on therapy. Since it remains unclear how best to modify risk in these cases and guidance for clinical decision-making is limited, understanding real-world patterns is crucial for improving outcomes.
Using data from the Get With The Guidelines-Stroke Registry between 2016 and 2023, we assessed the real-world strategies clinicians use for ischemic stroke patients with atrial fibrillation who experience stroke despite being on anticoagulation therapy. Multivariate logistic regression models with generalized estimating equations were used to identify factors associated with changes in oral anticoagulants (OAC).
Of 60,334 ischemic stroke patients with atrial fibrillation who were taking OAC but were not on antiplatelet prior to stroke, 14.4% were taking warfarin with subtherapeutic INR, 8.9% therapeutic warfarin, and 76.7% direct oral anticoagulant (DOAC) prior to stroke (4.7% dabigatran, 20.4% rivaroxaban, and 51.6% apixaban). The distribution of discharge antithrombotics is shown in the
. Among patients taking DOAC prior to stroke, 83.3% remained on the same DOAC at discharge, of whom 45.5% added an antiplatelet agent. Among patients on warfarin, 37.0% switched to DOAC at discharge. For those who remained on warfarin, 47.8% added an antiplatelet agent. Patients on warfarin with subtherapeutic INR (aOR 1.86), dabigatran (aOR 1.58), or rivaroxaban (aOR 1.09) were more likely to switch OACs, while those on apixaban (aOR 0.27) were less likely to switch as compared with those on warfarin with therapeutic INR prior to stroke.
Among people with AF who were anticoagulated prior to hospitalization for ischemic stroke, switching OACs or adding an antiplatelet agent is common. Understanding the factors influencing treatment selection after stroke underscores the need for a prospective study of treatment strategies and could support the development of personalized antithrombotic strategies to reduce recurrent stroke risk.
