Abstract
Introduction: Anemia is associated with increased morbidity and mortality in patients with acute ischemic stroke (AIS). However, it is unclear if management of anemia after stroke can improve outcomes. Objective: To assess the impact of anemia, and its treatment, on AIS patient outcomes. Methods: Adult AIS patients admitted to a rural academic medical center for primary stroke between 1/1/2012 - 12/31/2016 were included. Patient medical records were reviewed for relevant health information. Results: A sample of 753 patients treated for AIS was evaluated. Moderate or severe anemia (hemoglobin < 11 g/dL for both sexes) was associated with increased mortality at 6 months (57.6% [45.0-68.3], 80.3% [72.9-85.9], 86.9% [83.6-89.5] for moderate/severe, mild and no anemia, respectively; p< 0.0001). This difference in survival was still seen after adjustments for other covariables, such as age, renal insufficiency, atrial fibrillation, heart failure and diabetes mellitus, in multivariate analysis. Following AIS, only 41% (90/219) of patients with anemia had documented management of anemia. We did not detect a difference in long term survival or stroke recurrence for managed vs. unmanaged patients. However, the anemia management most often occurred in the months following stroke, while anemia had the largest impact on outcome in the initial weeks after stroke. Conclusions: This study confirmed the poor prognosis seen with moderate and severe anemia after AIS. The lack of difference in outcome for managed vs. unmanaged patients may reflect the fact that the adverse effect of anemia was greatest in the first days to weeks after stroke while management was undertaken later. Thus, more aggressive treatment of anemia in patients at risk for stroke may be beneficial. In conclusion, more investigation into the relationship between anemia treatment and stroke mortality is warranted, such as a prospective study looking at management of anemia in patients with stroke risk factors.
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