Anticoagulant therapy in patients with ischemic stroke and atrial fibrillation (data from the registry of internal medicine departments of multidisciplinary hospitals of the North Caucasus Federal District)

Aim. To analyze anticoagulant therapy (ACT) in patients hospitalized with ischemic stroke (IS) and nonvalvular atrial fibrillation (AF) in neurological departments, based on a subanalysis of the ACT registry of patients with AF treated in multidisciplinary hospitals of the North Caucasus Federal District.

Material and methods. Patients were recruited from January to December 2018. A total of 2667 clinical records were analyzed; 118 patients with IS and AF were included in the study. In all patients, the risks of thromboembolic and bleeding events were calculated using the CHA2DS2-VASc and HAS-BLED scores. In addition, examination data and prescribed therapy, including ACT, were studied.

Results. Of the 118 patients with IS included in the study, 106 (89,8%) had a recurrent event. In 30,8% of patients with recurrent ischemic stroke, AF was registered for the first time. The included patients were characterized by a high risk of ischemic (CHA2DS2-VASc 4,0 [4,0; 5,0] points) and moderate risk of bleeding (HAS-BLED 2,0 [1,0; 2,0] points) events. Also, 21,2% of patients received triple antiplatelet therapy for percutaneous coronary intervention preceding the index event. Hemorrhagic transformation of ischemic stroke occurred in 18 (15,3%) patients. ACT was prescribed to 80% (n=80) of patients with ischemic stroke without hemorrhagic transformation and 66,7% (n=12) of patients with hemorrhagic transformation of ischemic stroke. Direct oral anticoagulants (DOAC) were prescribed to 92,5% (n=74) of patients with ischemic stroke without hemorrhagic transformation and 91,7% (n=8) of patients with hemorrhagic transformation of ischemic stroke. Most often, factor Xa inhibitors were prescribed. In 51,2% (n=41) of cases, patients with ischemic stroke without hemorrhagic transformation were prescribed reduced anticoagulant doses, while the dose reduction was justified in half of the cases. Thus, among patients with ischemic stroke without hemorrhagic transformation and AF, ACT was prescribed in accordance with guidelines to 57% of patients.

Conclusion. According to the study, anticoagulants are under prescribed to patients with IS and AF. In real-world practice, physicians prefer DOAC in reduced doses. Despite the lack of guidelines on the timing of ACT initiation in patients with hemorrhagic transformation of IS, anticoagulants are prescribed to two thirds of such patients.

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