Atrial Fibrillation and Stroke: Predictors of Anticoagulation Therapy Modification (P6-5.010)

Abstract

<h3>Objective:</h3> Analyze predictors of therapy modification in patients with atrial fibrillation (AF) experiencing stroke despite adequate anticoagulation (AC) for secondary stroke prevention. <h3>Background:</h3> The ideal strategy to treat persons with AF experiencing stroke despite adequate AC with direct-acting anticoagulants (DOACs) or vitamin K antagonists (VKAs) is not known. <h3>Design/Methods:</h3> Patients admitted between 2012 and 2021 at our hospital with stroke despite AC for AF were enrolled. Baseline characteristics including National Institute of Health Stroke Scale (NIHSS), AC therapy, modified Rankin Scale (mRS), occurrence of intracerebral hemorrhage (ICH) on first image, and discharge antithrombotic therapy were collected. Logistic regression analyses were performed to identify factors associated with the decision to change AC after stroke. <h3>Results:</h3> 595 patients were included. Of these, 291 (48.9%) were on DOACs therapy and 125 (43%) had their AC modified from DOACs at discharge (16% switched to warfarin, 58.4% to no AC and 25.6% to antiplatelet agents or enoxaparin). Of the 304 patients using VKAs, 53% had their discharge antithrombotic modified, with 26% switched to DOACs. Therapy change in patients on DOACs was associated with older age (OR 1.04, 95%CI 1.01–1.06), higher admission NIHSS (OR 1.06, 95%CI 1.03–1.10), discharge mRS ≥3 (OR 3.51, 95%CI 1.98–6.49), and ICH (OR 5.67, 95%CI 2.99–11.35). For warfarin, therapy change was associated with older age (OR 1.03, 95%CI 1.01 1.06), higher NIHSS (OR 1.04, 95%CI 1.00–1.07), heart failure (OR 1.90, 95%CI 1.13–3.27) and ICH (OR 3.81, 95%CI 1.93–8.14). Patients discharged with DOACs, compared to those with warfarin, were more likely to be younger, had higher rates of cardiovascular risk factors and ICH, and lower admission NIHSS. <h3>Conclusions:</h3> Older age, more severe strokes, and occurrence of ICH were associated with the decision to change or stop AC. Variation in practice exists and further research is needed to assess the clinical impact of antithrombotic therapy modification in this population. <b>Disclosure:</b> Mrs. Carvalho de Oliveira has nothing to disclose. Mr. Webb has nothing to disclose. Dr. Ponciano has nothing to disclose. Prof. Farias Da Guarda has nothing to disclose. Ms. Yilmaz has nothing to disclose. An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (Education) with Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals. Dr. Asad has nothing to disclose.