International Stroke Conference 2025  /  Risk Factors and Prevention Posters I  /  Selection of Antithrombotic Therapy in Patients with Atrial Fibrillation who Experience an Ischemic Stroke While on Anticoagulant Therapy
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American Heart Association

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Final ID: WP273

Selection of Antithrombotic Therapy in Patients with Atrial Fibrillation who Experience an Ischemic Stroke While on Anticoagulant Therapy

Abstract Body: Introduction: Anticoagulation therapy plays a pivotal role in stroke prevention for people with atrial fibrillation. Despite its efficacy, some patients still have an ischemic stroke while on therapy. Since it remains unclear how best to modify risk in these cases and guidance for clinical decision-making is limited, understanding real-world patterns is crucial for improving outcomes.

Methods: Using data from the Get With The Guidelines-Stroke Registry between 2016 and 2023, we assessed the real-world strategies clinicians use for ischemic stroke patients with atrial fibrillation who experience stroke despite being on anticoagulation therapy. Multivariate logistic regression models with generalized estimating equations were used to identify factors associated with changes in oral anticoagulants (OAC).

Results: Of 60,334 ischemic stroke patients with atrial fibrillation who were taking OAC but were not on antiplatelet prior to stroke, 14.4% were taking warfarin with subtherapeutic INR, 8.9% therapeutic warfarin, and 76.7% direct oral anticoagulant (DOAC) prior to stroke (4.7% dabigatran, 20.4% rivaroxaban, and 51.6% apixaban). The distribution of discharge antithrombotics is shown in the Figure. Among patients taking DOAC prior to stroke, 83.3% remained on the same DOAC at discharge, of whom 45.5% added an antiplatelet agent. Among patients on warfarin, 37.0% switched to DOAC at discharge. For those who remained on warfarin, 47.8% added an antiplatelet agent. Patients on warfarin with subtherapeutic INR (aOR 1.86), dabigatran (aOR 1.58), or rivaroxaban (aOR 1.09) were more likely to switch OACs, while those on apixaban (aOR 0.27) were less likely to switch as compared with those on warfarin with therapeutic INR prior to stroke.

Conclusion:
Among people with AF who were anticoagulated prior to hospitalization for ischemic stroke, switching OACs or adding an antiplatelet agent is common. Understanding the factors influencing treatment selection after stroke underscores the need for a prospective study of treatment strategies and could support the development of personalized antithrombotic strategies to reduce recurrent stroke risk.
  • Wang, Duanduan  ( Duke University , Durham , North Carolina , United States )
  • Smith, Eric  ( , Calgary , Alberta , Canada )
  • Bhatt, Deepak  ( Mount Sinai Fuster Heart Hospital , Scarsdale , New York , United States )
  • Ayodele, Iyanuoluwa  ( Duke University , Durham , North Carolina , United States )
  • Matsouaka, Roland  ( Duke University , Durham , North Carolina , United States )
  • Obrien, Emily  ( Duke University , Durham , North Carolina , United States )
  • Xian, Ying  ( UTSW , Dallas , Texas , United States )
  • Sherrod, Charles  ( MID AMERICA HEART INSTITUTE , Kansas City , Missouri , United States )
  • Chan, Paul  ( MID AMERICA HEART INSTITUTE , Kansas City , Missouri , United States )
  • Laskowitz, Daniel  ( Duke University , Durham , North Carolina , United States )
  • Peterson, Eric  ( , Dallas , Texas , United States )
  • Fonarow, Gregg  ( UCLA MEDICAL CENTER , Los Angeles , California , United States )
  • Schwamm, Lee  ( Yale School of Medicine , New Haven , Connecticut , United States )
    • Author Disclosures:
    Duanduan Wang: DO NOT have relevant financial relationships | Eric Smith: DO NOT have relevant financial relationships | Deepak Bhatt: DO have relevant financial relationships ; Advisor:Angiowave, Bayer, Boehringer Ingelheim, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Stasys:Active (exists now) ; Other (please indicate in the box next to the company name):Honoraria cont: Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), WebMD (CME steering committees), Wiley (steering committee);:Active (exists now) ; Other (please indicate in the box next to the company name):Trustee: American College of Cardiology; Unfunded Research: FlowCo.:Active (exists now) ; Other (please indicate in the box next to the company name):Site Co-Investigator: Abbott, Biotronik, Boston Scientific, CSI, Endotronix, St. Jude Medical (now Abbott), Philips, SpectraWAVE, Svelte, Vascular Solutions;:Active (exists now) ; Royalties/Patent Beneficiary:Royalties: Elsevier (Editor, Braunwald’s Heart Disease);:Active (exists now) ; Research Funding (PI or named investigator):Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Alnylam, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CinCor, Cleerly, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Otsuka, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, Youngene, 89Bio;:Active (exists now) ; Royalties/Patent Beneficiary:Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent);:Active (exists now) ; Other (please indicate in the box next to the company name):Other: Clinical Cardiology (Deputy Editor);:Active (exists now) ; Other (please indicate in the box next to the company name):American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology),:Active (exists now) ; Other (please indicate in the box next to the company name):Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (Chair, PEITHO trial), Cleveland Clinic, Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical; for ALLAY-HF, funded by Alleviant Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial);:Active (exists now) ; Consultant:Broadview Ventures, GlaxoSmithKline, Hims, SFJ, Youngene:Active (exists now) ; Individual Stocks/Stock Options:Board of Directors: Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now) ; Other (please indicate in the box next to the company name):Board of Directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now) | Iyanuoluwa Ayodele: DO NOT have relevant financial relationships | Roland Matsouaka: DO NOT have relevant financial relationships | Emily Obrien: DO NOT have relevant financial relationships | Ying Xian: DO NOT have relevant financial relationships | Charles Sherrod: DO NOT have relevant financial relationships | Paul Chan: DO have relevant financial relationships ; Consultant:Optum Rx:Active (exists now) | Daniel Laskowitz: No Answer | Eric Peterson: DO have relevant financial relationships ; Researcher:amgen:Active (exists now) ; Consultant:Novo Nordisk:Active (exists now) ; Consultant:Jansen:Active (exists now) | Gregg Fonarow: DO NOT have relevant financial relationships | Lee Schwamm: DO have relevant financial relationships ; Consultant:genentech:Active (exists now) ; Advisor:Penumbra:Past (completed) ; Consultant:medtronic:Active (exists now)
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Risk Factors and Prevention Posters I

Wednesday, 02/05/2025 , 07:00PM - 07:30PM

Poster Abstract Session

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