Abstract Number: Esoc2026a392 Abnormal Glucose Metabolism and Clinical Outcomes During Anticoagulation in Atrial Fibrillation–related Ischemic Stroke: A Real-World Study

Abstract Background and aims To investigate the impact of baseline glucose metabolism abnormalities on short-term and long-term outcomes in patients with atrial fibrillation(AF)–related acute ischemic stroke (AIS) receiving anticoagulation therapy. Methods Consecutive anticoagulated AIS patients with AF were enrolled. The primary endpoint was a composite of recurrent ischemic stroke, systemic embolism, moderate-to-severe bleeding, and all-cause mortality. Cox regression models were used to examine associations of FPG and HbA1c with outcomes. Restricted cubic splines were applied to test for nonlinear trends. Patients were stratified into groups based on HbA1c, and an FPG × HbA1c interaction model was constructed. Kaplan–Meier (KM) curves were generated to illustrate cumulative event rates. Results Total 623 patients were included. Cox regression analyses showed that elevated FPG significantly increased the risk of composite outcomes at 90 days (HR=1.087, 95%CI: 1.013–1.166) and 1-year (HR=1.078, 95%CI: 1.016–1.145). In the joint model, FPG remained independently associated with the 90-day (HR=1.102, 95%CI: 1.018–1.191) and 1-year outcomes (HR=1.087, 95%CI: 1.019–1.159), whereas HbA1c categories showed no significant associations. No statistical interaction was observed between FPG and HbA1c. No significant survival differences among patients in the normal, prediabetes, and diabetes groups. Conclusions Acute hyperglycemia significantly increases short-term and long-term adverse risks in patients with AF–related AIS receiving anticoagulation therapy, and this effect is independent of chronic glycemic control status. Clinically, greater emphasis should be placed on acute-phase glucose assessment and management, rather than relying primarily on diabetes status or long-term glycemic indicators for risk stratification. Conflict of interest All author. nothing to disclose