December 24, 2023Open Access

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

Structured PICO

Does prior long-term anticoagulation reduce in-hospital mortality and stroke severity in patients with atrial fibrillation admitted with acute ischemic stroke?

Population

655,540 adult inpatients with atrial fibrillation and a primary diagnosis of ischemic stroke between 2016 and 2020 from the National Inpatient Sample.

Intervention

Long-term anticoagulation (AC) therapy prior to admission.

Comparator

No long-term anticoagulation therapy prior to admission.

Outcome

In-hospital mortality.hard clinical

In AF patients who suffer an ischemic stroke, prior anticoagulation use is associated with less severe strokes, lower in-hospital mortality, and fewer bleeding complications.

Abstract

ABSTRACT Background Long-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. Methods The 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. Results A 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). Conclusion Among 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.

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