Abstract TP383: Use of Oral Anticoagulants in FAST-MAG Patients
Background: Many patients being evaluated acutely in the field for acute ischemic stroke will be on anticoagulation, usually for atrial fibrillation. Ischemic stroke related to atrial fibrillation is more severe than that of other etiologies and there is the added risk of intracranial hemorrhage in these patients. We describe rates anticoagulant and clinical characteristics use among stroke patients being evaluated by paramedics <2 hours from symptom onset.
Methods: The Field Administration Stroke Therapy-Magnesium (FAST-MAG) is a phase 3 NIH-funded, randomized, placebo-control study of prehospital initiated magnesium sulfate within 2 hours of stroke onset. Data on demographics and examination was obtained from paramedic run sheets and medical records.
Results: Of the 1116 consecutive, mean age was 70 (SD 13) years, 40% were women, 23% Hispanic Ethnicity, 77% white race, and 23% had ICH on initial imaging. A total of 114 (10%) were on anticoagulation at EMS evaluation, most often for known atrial fibrillation (n= 83) and/or valvular heart disease (n=44). Those on anticoagulation were less likely to present with ICH (16% vs 25%). Those on anticoagulation were often found to have an INR less than 2 (n=77 66%), 26 were therapeutic with an INR between 2 and 3, and 11 had an INR > 3. NIH scores were higher at the time of ED arrival (11.16 vs 9.87) and at the 24hour mark (8.70 vs 7.97). Additionally, patients with a sub- therapeutic INR (0-2) had the highest observed NIHSS (mean 12.03). No association between high INR (over 3.0) and intracerebral hemorrhage was seen (p=0.752).
Conclusion: Patients on anticoagulation therapy most often present with ischemic stroke. A sub therapeutic INR led to greater severity of stroke.
- © 2012 by American Heart Association, Inc.