111Therapeutic Anticoagulation: A Determinant of Outcome after Atrial Fibrillation-Associated Stroke

Abstract

Background: The prevalence of atrial fibrillation (AF)-associated stroke is expected to rise substantially in the coming decades. The literature has established the benefit in longterm outcome for vitamin K-antagonist anticoagulation in atrial fibrillation-associated stroke. This study's aim was to incorporate the use of newer anticoagulants and determine their association with functional outcomes and mortality. Methods: Quantitative: retrospective cohort study, at a 600 bed university teaching hospital. Patients were recruited from November 2014-December 2015. 256 patients with ischaemic and haemorrhagic stroke were included. Patient characteristics at index presentation and outcomes were recorded through review of electronic patient records. Results: 220 patients with ischaemic stroke, 116 anticoagulated for atrial fibrillation. 32 patients with intracranial haemorrhage, 6 with subarachnoid haemorrhage, none of whom were anticoagulated. Types of therapy included Warfarin (21.5%), Apixaban (30.2%), Rivaroxaban (13.8%), Dabigatran (10.6%), Aspirin (16.4%) and Clopidogrel (6.03%). Mean length of stay for those anticoagulated for AF-associated ischaemic stroke was 34.5 days, and 34.9 days for those not. For those anticoagulated, 0.07% had MRS 6 score on discharge, 0.03% MRS 5, 22% MRS 4, 16% MRS 3, 26% MRS 2, 20% MRS 1, 17% MRS 0. For those not anticoagulated, 43% had MRS 6, 21% MRS 5, 14% MRS 3, 21% MRS 0 scores at time of discharge. Improved functional status as defined by MRS was associated with anticoagulation at stroke onset. There was no difference in length of stay between those anticoagulated and those not. Conclusions: Anticoagulant therapy for atrial fibrillation-associated stroke is correlated with improved functional outcomes and mortality as defined by the MRS. There was no difference in length of stay, however prolonged waiting times for placement in a rehabilitation facility may be contributory. This study demonstrates the beneficial influence associated with newer oral anticoagulants, in addition to their established use in stroke prevention.