Abstract W P306: Novel Oral Anticoagulant Initiation Within 14 days of Stroke Is Not Associated with Excess Hemorrhagic Transformation Rates
Introduction: The risk of early recurrent stroke after a cerebrovascular event is elevated. Despite a lack of safety data related to oral anticoagulation (OAC) after TIA/stroke in patients with atrial fibrillation (AF), particularly with respect to novel OACs (NOACs), many physicians do initiate therapy within 14 days of symptom onset. We aimed to assess current practice patterns and hemorrhagic transformation rates associated with early OAC use in AF patients. Methods: We conducted a retrospective chart review of AF patients admitted to a single stroke unit over a 24-month period. OAC agents and time from onset to initiation were recorded. Hemorrhagic transformation (HT) was assessed on CT scans and graded using the ECASS classification system (Hemorrhagic Infarction; HI and Parenchymal Hemorrhage; PH). Results: A total of 402 AF patients, with a mean age of 78.0±11.4 years (196 female), were included. OACs were initiated in 233 (58.0%) patients within 14 days of symptom onset. Of these 233 patients, warfarin was started in 136 (58.4%), dabigatran in 52 (22.3%), rivaroxaban in 40 (17.2%), and apixaban in 5 (2.1%). The median(IQR) number of days from onset to OAC initiation was similar between patients treated with warfarin (2.0(6.0)), dabigatran (2.0(3.8)), rivaroxaban (3.0(6.8)), and apixaban (3.0(5.5), P=0.44). HT was found in 10 patients, 7 (5.1%) of whom were initiated on warfarin and 3 (5.8%) on dabigatran (λ2= 2.9, P=0.14). Of the 7 warfarin related HT cases, 6 were asymptomatic HI and 1 was a symptomatic PH. All 3 dabigatran related HT cases were asymptomatic HI. HT was detected at a median of 3(4) days following OAC initiation. Systemic bleeding was seen in 7 patients, all of whom were taking warfarin (4 gastrointestinal bleeds, 2 retroperitoneal, and 1 ureteral hematoma). Conclusion: Off-label use of NOACs in acute stroke is common. Although hemorrhagic transformation rates appear to be no higher than those associated with warfarin, early NOAC initiation after stroke should be studied in a prospective fashion.
Author Disclosures: K. Phoa: None. M. Kate: None. L. Gioia: None. B. Buck: None. K. Butcher: None.
- © 2015 by American Heart Association, Inc.