Abstract WP11: The Safety of Emergent Anticoagulation in Acute Ischemic Stroke in Non-Atrial Fibrillation Indications: A Retrospective Analysis

Abstract

Introduction: Patients with acute ischemic stroke (AIS) often present with conditions that require emergent anticoagulation (AC) other than atrial fibrillation (AF). Current literature lacks guidance on the safety of administering AC when both pathologies coexist. Therefore, we tend to rely on studies investigating AF and AIS for AC recommendations. Methods: We retrospectively reviewed data for patients with AIS who had a non-AF emergent indication for AC (e.g., intraluminal floating thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, DVT and PE) within 3 days of symptom onset. We did a comparison study between a group of patients who received AC within 72 hours of stroke onset (Group A) versus those who either received it after the initial 72 hours or did not receive it at all (Group B). The primary outcome was the incidence of intracranial hemorrhage (ICH) between both groups. The secondary outcome was a composite risk of arterial and venous thromboembolic events. Results: Out of the 560 patients with AIS plus an emergent AC indication, only 88 patients (56.8% for Group A and 43.2% for Group B) met our inclusion criteria. Only 2 patients in Group A, and 1 patient in Group B had developed ICH as a complication of AC which was not statistically significant. Interestingly, Group A patients had a lower incidence of both new diagnosis (2% vs. 50%, p<0.0001) or propagation of an established DVT and/or PE. They also had a lower rate of any thromboembolic complication (2% vs. 44.7%, p<0.0001). Additionally, Group A patients had more favorable outcomes, defined as mRS 0-2 at 30 days (79.3% vs. 46.2%, p=0.40) and 90 days (73% vs 29.5%, p=0.11), and a higher 3-month survival rate (84.6% vs 64.7%, p=0.16). Conclusion: Starting AC early (i.e., within 3 days) in non-AF AIS patients with an emergent indication may be safe and carry a lower risk of thromboembolic complications than later AC.