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Abstract Details

Managing Recurrent Ischemic Cerebrovascular Events in Patients with Atrial Fibrillation Compliant with Oral Anticoagulant Therapy
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:30 PM-6:30 PM)
Patients with AF still have an appreciable risk of AIS or TIA despite compliance with OAC. Yet little is known about the best management options in this population.

To evaluate if oral anticoagulant therapy change (OAC change) or adding antiplatelet therapy to anticoagulation (AC+AP) in patients with nonvalvular atrial fibrillation (AF) and acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite OAC compliance, is associated with lower risk of recurrent cerebrovascular events compared to patients that continued the same anticoagulant regimen.

We reviewed all consecutive patients with AF on OAC that presented with AIS/TIA to our tertiary academic stroke center between 2011-2021. Baseline characteristics, type of index event, antithrombotic therapy before and after index event, subsequent recurrent AIS/TIA or major bleeding events were extracted. Fisher’s exact or Log-rank tests and logistic regression models were used to compare outcomes between OAC unchange vs OAC change, and AC+AP vs AC only groups.

185 patients (mean age 78.3 ± 12 years) were included. 61% were males and 79 (42.7%) had AIS at index event. 17 (9%) had OAC change and 100 (79%) received AP+AC. 39 (21.15%) had recurrent AIS/TIA, and 28 (15.1%) had major bleeding following the index event. No significant difference was observed between OAC unchange versus OAC change groups regarding recurrent AIS/TIA (HR = 0.607, 95% CI: 0.229-1.609, p = 0.316) or major bleeding events (OR = 1.541, 95% CI: 0.391-10.299, p = 0.586). Additionally, no significant difference was observed between AC+AP versus AC groups regarding recurrent AIS/TIA (HR= 0.863, 95% CI: 0.430-1.732, p = 0.679) or major bleeding events (OR= 0.894, 95% CI: 0.377-2.135, p = 0.798).

In patients with AF and acute ischemic cerebrovascular events despite OAC compliance, changing anticoagulant or adding antiplatelet agent may not decrease risk of future cerebrovascular events.
Ehab Yaser Khaled Harahsheh, MBBS (Mayo Clinic College of Medicine)
Dr. Harahsheh has nothing to disclose.
Omer Elshaigi Mr. Elshaigi has nothing to disclose.
Nour Sami Ahmad Alhayek, MD (Mayo Clinic) Dr. Alhayek has nothing to disclose.
Vanesa Vanderhye Vanesa Vanderhye has nothing to disclose.
Cumara Barahona O'Carroll, MD, FAAN (Mayo Clinic) Dr. O'Carroll has nothing to disclose.
Oana Maria Dumitrascu, MD (Mayo Clinic) Dr. Dumitrascu has nothing to disclose.