We assessed the clinical outcomes of patients with acute ischemic stroke (AIS) in association with atrial fibrillation (AF) admitted at Ochsner-LSU Health Shreveport (OLSU-S) as a reflection of anticoagulant use.

AF is a risk factor of AIS associated with 15% of strokes for all ages. Based upon clinical trial information, most AF patients are on long term oral anti-coagulation (OAC) therapy. We wanted to assess the relationship between use and compliance of OACs with outcome in consecutive patients admitted with AIS and AF. 

We conducted a retrospective, observational study of patients (age > 18 years) who presented to OLSU-S for the management of AIS with AF with and without long term anticoagulation use from June 2020 to May 2021. Data collection included: history of AF, OAC use and clinical course for 103 patients. Patients with AIS were divided into three subgroups: OAC_naive: patients who never took OACs, OAC_discontinue: patients who were on OACs but with discontinuation for > 24 hours before AIS, and OAC_compliant: patients who were compliant with OACs. 

Of the 103 patients admitted for AIS with AF, 65 (63.1%) patients were on long term OAC use with 31 out of 65 (47%) patients reported discontinuation of the OAC for > 24 hours prior to presentation. The mean modified Rankin Scale (mRS) and the mean NIH Stroke Scale (NIHSS) were in the following order: OAC_naive patients (mRS: 2.92, NIHSS: 12),  OAC_discontinue (mRS: 2.50, NIHSS: 10) and OAC_compliant (mRS: 2.15, NIHSS: 9). 

Our observations further confirm that patients compliant with OACs tend to have a better outcome than those either not on OACs or those who had recently discontinued their OACs. Further data collection and analysis may help in determining how best to optimize compliance and avoid discontinuation of OACs in an effort to prevent stroke in highly susceptible patients.