A RETROSPECTIVE OBSERVATIONAL RESEARCH TO ASSESS THE INCIDENCE OF ACUTE ISCHEMIC STROKE IN HOSPITALIZED ATRIAL FIBRILLATION PATIENTS WITH ANTICOAGULATION INTERRUPTIONS

Abstract

Aim: To determine the Incidence of Acute Ischemic Stroke in Hospitalized Patients with Atrial
Fibrillation Who Had Anticoagulation Interruption.
Methods: A retrospective study was conducted in the Department of Cardiology This study included
patients 18 years or older who were admitted to the hospital with a primary or secondary diagnosis of AF
who had anticoagulation interruption without heparin bridge vs. non-interrupted group.
Results: A total of 450 patients were included in the study. In this cohort, mean age was 71.1 ± 10.21
years and 50.89% were female. A total of 50 patients out of 450 (11.11%) had anticoagulation
interruption in more than 48 h (median interruption of 67 h). Compared to non-interruption group,
patients with anticoagulation interruption were older (mean age 75.45 ± 10.52 vs. 71.06 ± 10.88 years, P
= 0.001), had slightly higher CHADS2VASc score (3.88 vs. 3.52, P = 0.01), more likely to have heart
failure and less likely to have HTN. Only 10 patients out of 450 (2.22%) had acute ischemic stroke
during their hospital stay: 2 patient (4%) in the anticoagulation interruption group, and 8 patients (2%) in
the non-interruption group. There was no statistically significant difference in incidence of ischemic
stroke between the two groups (1.31% vs. 0.27%, P = 0.21). Short-term interruption of anticoagulation
was not associated with a significant increased risk of in-hospital ischemic stroke. CHA2DS2VASc score
was an independent strong predictor of in-hospital stroke (odds ratio (OR): 7.67, 95% confidence interval
(CI): 2.89 - 18.03) In terms of secondary outcomes in anticoagulation interruption versus noninterruption groups, results were as follows: mortality (0 vs. 0.68%, P = 1), bleeding (4% vs. 1%, P =
0.03), number of readmissions within 90 days (48% vs. 37%, P = 0.03) and average LOS (7.74 vs. 2.75
days, P < 0.0001).
Conclusion: Patients suffering with AF the incidence of ischemic stroke during hospitalisation is
minimal and does not rise considerably when anticoagulation is stopped for a short period of time. The
CHA2DS2VASc score has a significant correlation with the occurrence of ischemic stroke in
hospitalised patients with AF.