Early vs late anticoagulation in acute ischemic stroke with indications outside atrial fibrillation

Authors

Ammar Jum'ah, Henry Ford HealthFollow
Siyuan Fu, Henry Ford HealthFollow
Abdalla J. Albanna, Henry Ford HealthFollow
Utkarsh Agarwal, Henry Ford HealthFollow
Michael Fana, Henry Ford HealthFollow
Omar Choudhury, Henry Ford HealthFollow
Anas Idris, Henry Ford HealthFollow
Abdelrahman Elfaham, Henry Ford HealthFollow
Zahid Iqbal, Henry Ford HealthFollow
Lonni Schultz, Henry Ford HealthFollow
Katie Latack, Henry Ford HealthFollow
Megan Brady, Henry Ford HealthFollow
Dawn Scozzarri, Henry Ford HealthFollow
Ahmad R. Ramadan, Henry Ford HealthFollow

Recommended Citation

Jumah A, Fu S, Albanna AJ, Agarwal U, Fana M, Choudhury O, Idris A, Elfaham A, Iqbal Z, Schultz L, Latack K, Brady M, Scozzari D, and Ramadan AR. Early vs late anticoagulation in acute ischemic stroke with indications outside atrial fibrillation. J Stroke Cerebrovasc Dis 2024; 33(7):107757.

Document Type

Article

Publication Date

7-1-2024

Publication Title

J Stroke Cerebrovasc Dis

Abstract

BACKGROUND: Current literature lacks guidance on the safety of administering anticoagulation in acute ischemic stroke with emergent indications that require anticoagulation other than atrial fibrillation. Therefore, we tend to rely on studies investigating acute ischemic stroke in atrial fibrillation for anticoagulation recommendations.

METHODS: We retrospectively reviewed data for patients with acute ischemic stroke who had a non-atrial fibrillation emergent indication for anticoagulation (e.g., intra-arterial thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, deep vein thrombosis and pulmonary embolism) diagnosed within 3 days of acute ischemic stroke. Patients who received anticoagulation ≤ 3 days of stroke onset (Group A) were compared to those who either received it afterwards or did not receive it at all (Group B).

RESULTS: Out of the 558 patients, only 88 patients met our inclusion criteria. Of the total cohort, 55.7 % patients were males, and basic demographics were similar in both groups except for milder strokes in Group A (national institute of health stroke scale 6 vs. 12.5, p = 0.03). Only 2 patients in Group A and 1 patient in Group B developed intracranial hemorrhage, which was not statistically significant. Group A patients had a lower incidence of both new diagnosis (2 % vs. 34.2 % %, p < 0.001) and propagation of an established venous thromboembolism. They also had a lower rate of any thromboembolic complication (2 % vs. 42 %, p < 0.001).

CONCLUSION: Early anticoagulation (i.e., ≤ 3 days) in non-atrial fibrillation ischemic stroke patients with an emergent indication may be safe and carry a lower risk of thromboembolic complications than later anticoagulation.

Medical Subject Headings

Humans; Male; Female; Retrospective Studies; Aged; Ischemic Stroke; Anticoagulants; Time Factors; Middle Aged; Treatment Outcome; Risk Factors; Aged, 80 and over; Drug Administration Schedule; Time-to-Treatment; Risk Assessment; Intracranial Hemorrhages

PubMed ID

38705498

Volume

33

Issue

7

First Page

107757

Last Page

107757