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Updated: Jun 25, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation
Moises A Vasquez1, Litsa K Lambrakos2, Alex Velasquez2
1Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave, C-600D, Miami, FL 33136, USA.
Insights
Long-term anticoagulation (AC) therapy for atrial fibrillation (AF) patients significantly reduces in-hospital mortality and stroke severity. AC use also led to fewer complications and better outcomes for AF patients experiencing ischemic stroke.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Long-term anticoagulation (AC) therapy is crucial for reducing stroke risk in patients with Atrial Fibrillation (AF).
- Limited data exists on the specific impact of AC on in-hospital stroke outcomes for AF patients.
Purpose of the Study:
- To investigate the association between pre-stroke long-term AC use and in-hospital outcomes in patients with Atrial Fibrillation (AF) and ischemic stroke.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2020.
- Identified adult inpatients with AF and primary ischemic stroke diagnosis.
- Employed multivariate regression to analyze in-hospital outcomes, adjusting for comorbidities, comparing AC users and non-users.
Main Results:
- Included 655,540 hospitalizations; 29.7% were on long-term AC.
- AC use was linked to significantly decreased in-hospital mortality (aOR 0.62).
- AC patients showed reduced stroke severity (NIHSS 8 vs. 10) and fewer complications, including intracranial hemorrhage and GI bleeding.
Conclusions:
- Pre-stroke AC use in AF patients with ischemic stroke is associated with improved in-hospital outcomes.
- AC therapy correlates with lower mortality, reduced stroke severity, and fewer complications.
- Findings suggest the benefit of maintaining AC in AF patients at risk for stroke.
Background:
Long-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). However, 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 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 hospitalizations with AF and a primary hospitalization 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]), intracranial hemorrhage (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 for 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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