Upon IRB approval, data was retrospectively reviewed for patients >60 years, seen from 1/31/11-12/31/16, who had a history of stroke and seizure(s). Individuals with history of epilepsy prior to stroke were excluded. Data included patient demographics, stroke characteristics, seizure onset, history of SE, and information about anti-epileptics and anticoagulants. 

Out of 70 patients, the proportion developing SE was similar regardless of use of anticoagulation (including Coumadin and NOACs), 43.75% vs 53.85% respectively. The majority of patients on anticoagulation who developed SE were taking Coumadin, (14.3% vs. 66.7%, p<0.03). Time from seizure onset to SE was shorter in the anticoagulation group (3.17 months +/- 1.69 vs 6.92 +/- 2.66, p=0.04). There was no difference in the number of anti-epileptics between those on anticoagulation or not (1.44 +/- 0.22, and 2.00 +/- 0.25, p=0.12). No difference in number of lifetime strokes between the coumadin, NOAC vs no anticoagulation group was seen (2.00 +/- 0.30, 1.43 +/- 0.34 vs 1.65 +/- 0.12).  

Patients on anticoagulation (specifically Coumadin) developed SE much sooner than patients not on anticoagulation, despite no differences between lifetime strokes, number of antiepileptics, age at seizure onset. While no known adverse events were reported for this cohort regarding outcomes, our data suggests clinicians should be cautious when managing post-stroke epilepsy in older patients on anticoagulants.