Abstract
Objectives
Atrial fibrillation (AF) is responsible for 30-50% of large strokes requiring endovascular
thrombectomy (EVT). Anticoagulation (AC) underutilization is a common source of AF-related
stroke. We compared antithrombotic medications among stroke patients with AF that
did or did not undergo EVT to determine if AC underutilization disproportionately
results in strokes requiring EVT, while quantifying the proportion of likely preventable
thrombectomies.
Methods
This retrospective single-center cohort included consecutive patients admitted with
acute ischemic stroke between 2016 and 2021. Patients were categorized based on the
presence of AF, and pre-admission antithrombotic medications were compared between
those who underwent EVT and those who didn't. The reason for not being on AC was abstracted
from the medical record, and patients were categorized as either AC eligible or AC
contraindicated.
Results
Of 3092 acute ischemic stroke patients, 644 had a history of AF, 213 of whom underwent
EVT. Patients who required EVT were more likely to not be taking any antithrombotics
prior to admission (34% vs 24%, p=0.007) or have subtherapeutic INR on admission if
taking warfarin (83% vs 63%; p = 0.046). Among the AF-EVT patients, 44% were taking
AC, and only 31% were adequately anticoagulated. Only 8% of AF-EVT patients who were
not on pre-admission AC had a clear contraindication, and 94% were ultimately discharged
on AC.
Conclusions
Lack of antithrombotic therapy in AF patients disproportionately contributes to strokes
requiring EVT. A small minority of AF patients have contraindications to AC, so adequate
anticoagulation can prevent a remarkable number of strokes requiring EVT.
Keywords
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Article info
Publication history
Published online: January 10, 2023
Accepted:
January 5,
2023
Received in revised form:
December 8,
2022
Received:
October 14,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106980
Copyright
© 2023 Elsevier Inc. All rights reserved.
