Anticoagulation After Ischemic Stroke or Transient Ischemic Attack (TIA) in the Time of Direct Oral Anticoagulation (DOAC) and Thrombectomy

Abstract

Objective To assess anticoagulation (AC) timing and appropriateness in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) due to atrial fibrillation (AF) in a predominantly Hispanic community hospital in the era of direct oral AC (DOAC) and endovascular thrombectomy (EVT). Methods Adult patients presenting with known or new-onset AF and primary diagnosis of AIS/TIA admitted to Baptist Hospital of Miami between January 2018 and January 2019 were included. AC appropriateness was determined on medical history and concordance with American Heart AssociationAHA/AmericanStrokeAssociation (ASA) AC guidelines. Median time from AIS/TIA diagnosis to AC initiation was the primary endpoint. AC guideline concordance on admission and at discharge, discordant justification, and AC selection were secondary endpoints. Results The sample included 120 patients. AC initiation was five days (interquartile range (IQR) 2-9) following AIS/TIA. Patients' receiving intravenous (IV) alteplase experienced a 1.4-day delay in AC initiation (x=5.44, SE=1.05, p