In-hospital Outcomes of Acute Ischemic Stroke in Atrial Fibrillation Patients on Anticoagulation: A Retrospective Analysis

Abstract

ABSTRACTBackgroundLong-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). Data on the impact of AC on in-hospital stroke outcomes is lacking.MethodsThe National Inpatient Sample was used to identify adult inpatients with AF and a primary diagnosis of ischemic stroke between 2016 and 2020. Data was stratified between patients on AC users and nonusers. A multivariate regression model was used to describe the in-hospital outcomes, adjusting for significant comorbidities.ResultsA total of 655,540 patients with AF and a diagnosis of ischemic stroke were included, of which 194,560 (29.7%) were on long-term AC. Patients on AC tended to be younger (mean age, 77 vs 78), had a higher average CHA2DS2VASc score (4.48 vs 4.20), higher rates of hypertension (91% vs 88%), hyperlipidemia (64% vs 59%), and heart failure (34% vs 30%) compared to patients not on long-term AC. Use of AC was associated with decreased in-hospital mortality (aOR [95% CI]: 0.62 [0.60 - 0.63]), decreased stroke severity (mean NIHSS, 8 vs 10), decreased use of tPA (aOR 0.42 [0.41 - 0.43]), mechanical thrombectomy (aOR 0.85 [0.83 - 0.87]), hemorrhagic conversion (aOR 0.69 [0.67 - 0.70]), gastrointestinal bleeding (aOR 0.74 [0.70 - 0.77]), and discharge to skilled nursing facilities (aOR 0.90 [0.89 - 0.91]), compared to patients not on AC (P<0.001 for all comparisons).ConclusionAmong patients with AF admitted with acute ischemic stroke, AC use prior to stroke was associated with decreased in-hospital mortality, decreased stroke severity, decreased discharge to SNF, and fewer stroke-related and bleeding complications.