Patients with
known atrial fibrilation and first ischemic stroke. Assessing of
anticoagulation status [P1.055]
Virginia L. Parisi, María Lucía Rattagan, Gabriel
Persi, Emilia Gatto
Objective: to identify
the causes of first Ischemic stroke in patients with known AF.
Background: Atrial Fibrillation (AF) is a condition with significant health impact. More critically, AF can lead to serious complications including severe Ischemic strokes (IS), with increased risk of morbidity and mortality.
Although oral anticoagulants (OA) are extensively indicated in valvular and non valvular AF patients, a number of them, with no absolute contraindication, are still without OA treatment.
Design/ Methods: Retrospective analysis of our Stroke registry between January 2011-July 2014 to identify patients with first IS with known AF. The proportion of patients with and without OA were calculated and their risk stratified using the CHA2DS2-VASc and the bleeding risk with HAS-BLED. Causes of OA failure or no OA indication were also established.
Results: Over 151 first IS, 22 patients had previous AF (14.5%). Eleven were taking OA at the time of the stroke. There was no significant age difference between no OA vs OA patients (80 vs 83 y.o, Mann Whitney p=0.39). Median NIHSS at admission were 3 in OA patients and 5 in no OA (Mann-Whitney p=0.51). Of the patients with no OA, 7 had CHA2DS2-VASc criteria to be anticoagulated with no high risk for bleeding according to the HAS-BLED.
Causes of OA suspension or failure were: Surgical procedures, age and INR abnormalities.
Conclusions: This preliminary observation suggests that despite the extended evidence of the indication of primary prevention with OA in AF patients, there is still an important number of patients without treatment, being older age one of the main causes for not indicating OA although this is not a formal contraindication.
Another observation though not significant, is that patients with no OA tend to have more severe strokes as it is reported in the literature.
Background: Atrial Fibrillation (AF) is a condition with significant health impact. More critically, AF can lead to serious complications including severe Ischemic strokes (IS), with increased risk of morbidity and mortality.
Although oral anticoagulants (OA) are extensively indicated in valvular and non valvular AF patients, a number of them, with no absolute contraindication, are still without OA treatment.
Design/ Methods: Retrospective analysis of our Stroke registry between January 2011-July 2014 to identify patients with first IS with known AF. The proportion of patients with and without OA were calculated and their risk stratified using the CHA2DS2-VASc and the bleeding risk with HAS-BLED. Causes of OA failure or no OA indication were also established.
Results: Over 151 first IS, 22 patients had previous AF (14.5%). Eleven were taking OA at the time of the stroke. There was no significant age difference between no OA vs OA patients (80 vs 83 y.o, Mann Whitney p=0.39). Median NIHSS at admission were 3 in OA patients and 5 in no OA (Mann-Whitney p=0.51). Of the patients with no OA, 7 had CHA2DS2-VASc criteria to be anticoagulated with no high risk for bleeding according to the HAS-BLED.
Causes of OA suspension or failure were: Surgical procedures, age and INR abnormalities.
Conclusions: This preliminary observation suggests that despite the extended evidence of the indication of primary prevention with OA in AF patients, there is still an important number of patients without treatment, being older age one of the main causes for not indicating OA although this is not a formal contraindication.
Another observation though not significant, is that patients with no OA tend to have more severe strokes as it is reported in the literature.
- Neurology April 6, 2015 vol. 84 no. 14 Supplement P1.055
