We sought to identify the proportion of avoidable mechanical thrombectomy (MT) procedures in elderly patients (age ≥70 years) with stroke due to atrial fibrillation (AF). 

This study included 348 consecutive MT cases at a high-volume stroke center from Feb 2015 to Sept 2018. A retrospective chart review was conducted to identify patient sociodemographics, presence of AF, use of anticoagulation, stroke severity, CHA₂DS₂-VASc scores, and functional outcome.

A total of 191 (55%) patients were ≥70 years (mean age 81±7, 61% female), of which 116 (61%) had AF (median age 82±6, 67% female). Elderly patients with AF were more likely to have hypertension and heart failure and be on antiplatelets and OACs. Pre-existing AF was present in 75 (39%) patients, of which 38 (49%) were not on OACs prior to stroke. Of the 39 (51%) patients with known AF on OACs, 10 (68%) had subtherapeutic INR levels and 5 (21%) were not adherent to direct OACs. Overall, 53/191 (28%) patients with known AF were not adequately anticoagulated prior to the index stroke. There was no significant difference in modified Rankin Scale score at discharge or rate of symptomatic intracerebral hemorrhage between the two groups. 

In our study, about 1 in 4 elderly patients with known AF were not adequately anticoagulated prior to stroke and underwent potentially avoidable thrombectomy. Better practice strategies are needed to increase OAC utilization and adherence to reduce the burden of stroke in patients with AF, especially in elderly women.