Newer Anticoagulants in Patients with Atrial Fibrillation and ischemic stroke - a Two Year Experience

Objective: To describe characteristics of patients with hemorrhagic complications following anticoagulation for non valvular atrial fibrillation after ischemic stroke. Background: Anticoagulation reduces the risk of recurrent stroke in patients with atrial fibrillation. Anticoagulant initiation in the early phase after a stroke potentially increases hemorrhagic transformation. Delaying initiation will increase the risk of recurrent ischemic stroke. There are no guidelines to help predict which patients will develop hemorrhagic complications following anticoagulation. Design/Methods: In this retrospective record review, patients with ischemic stroke and non valvular atrial fibrillation admitted to a large stroke center were included. Baseline demographics, comorbid conditions and antiplatelet/anticoagulant use were recorded. Initiation of anticoagulation, timing, and choice of agent was noted. Records were reviewed for one year of follow up after the stroke and recurrent hospitalizations for hemorrhagic complications were reviewed. Results: Over a two year period, 193 patients with ischemic stroke and atrial fibrillation were reviewed [Males 91(47.2%); females 102(52.8%); mean age 78.9±11.5 years]. 18.1% had hemorrhagic conversion. Of 193 patients, 134 (69.4%) were initiated on anticoagulants during the hospital stay. The mean duration until initiation of anticoagulant was 12.6 days; median value of 5 days. The most frequently prescribed anticoagulant was Apixaban 83/134 (61.9%), followed by warfarin 42/134 (31.3%). Of the 172 patients discharged alive, only 8 (4.6%) patients were readmitted over the next year for bleeding complications. They were 4 males and 4 females, average age 78 years. Four were prescribed Apixaban (3 with low dose aspirin and 1 with ticagrelor). Two were on Warfarin (1 with dual antiplatelets and 1 with Aspirin). Two patients were not on Anticoagulation but were on dual antiplatelet therapy. Gastrointestinal hemorrhages were the most frequent. Only one had intracranial bleeding. Conclusions: Bleeding complications are uncommon among patients prescribed anticoagulants for atrial fibrillation after a stroke. Patients who bleed are commonly co-prescribed antiplatelet agents. Disclosure: Dr. Bhattacharya has nothing to disclose. Dr. Philip has nothing to disclose. Dr. Madhavan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with TiaTech USA. Dr. Madhavan has received compensation for serving on the Board of Directors of TiaTech USA.