Resumption of Antithrombotic Therapy Following Hemorrhagic Stroke in Patients with Atrial Fibrillation (P02.206)

Abstract

Objective: Review subsequent warfarin or antiplatelet therapy (APT) in atrial fibrillation (AF) patients with hemorrhagic stroke (HS) (intracerebral hemorrhage (ICH) or ischemic stroke (IS) with hemorrhagic transformation). Background AF patients on anti-thrombotic drugs (ATD) are at risk for HS. ATD are then discontinued with concern of HS risk balanced by IS risks. A Mayo analysis suggested AF patients with ICH had low risk of recurrent ICH when restarted on warfarin We explored HS AF patient outcomes at Loyola. Design/Methods: A retrospective review( 2004-2011) of ICH patients with history of AF on warfarin or AP where we assessed embolic risk through CHADS2 score, bleed size, and presenting INR (factors influencing post-bleed ATD choice) and recurrent HS or IS rates in surviving patients. Results: Of 73 AF admitted patients with HS, 28 died. Of the 45 survivors, 25 were on warfarin, 11 warfarin+APT, and 9 APT. Median time to post-bleed anticoagulation was 20 days (range 0-772). Median time to post-bleed APT was 7 days (range 2-21). Admission embolic risk was assessed by CHADS2. Median CHADS2 for each group was: warfarin 2.5 (range 1-5); warfarin+APT 3.0 (range 1-5); APT alone 3.0 (1-5). Median INR was: warfarin 2.2 (range 1.2-14.9), warfarin+APT 2.0 (range 1.2-12.6); APT alone 1.1 ( range 0.9-1.6). Median bleed size (cc) was: warfarin 6.35 cc warfarin + APT 1.66 cc; APT alone 20.4 cc. There was no difference in risk factors for patients restarted on APT or warfarin. There was one ICH and one IS. Both had been on warfarin prior to the initial bleed. At recurrent stroke time, neither patient was on ATDs. Conclusions: here was no difference in embolic risk for AF patients with HS on warfarin or APT in our study. Furthermore, resumption of APT or warfarin appeared equally safe. Median time to warfarin was longer than to APT, however. Disclosure: Dr. Perros has nothing to disclose. Dr. Schneck has nothing to disclose.