Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation

Omar Saeed, Shuaiqi Zhang, Snehal R. Patel, Ulrich P. Jorde, Mario J. Garcia, Nurilign Bulcha, Tanush Gupta, Ying Xian, Roland Matsouaka, Shreyansh Shah, Eric E. Smith, Lee H. Schwamm, Gregg C. Fonarow

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain. Methods: Utilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC. Results: A total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC. Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p<0.01). After adjustment for clinical covariates, the likelihood of 1 year mortality was higher in those on OAC (aHR: 1.22, 95% CI 1.05-1.41, p<0.01), while no significant differences were noted for ICH (aHR: 1.34, 95% CI 0.69-2.59, p=0.38) and recurrent ischemic stroke (aHR: 0.78, 95% CI 0.54-1.15, p = 0.21). The likelihood of all-cause bleeding (aHR: 1.59, 95% CI 1.29-1.96, p<0.01) and all-cause re-hospitalization (aHR: 1.14, 95% CI 1.02-1.27, p = 0.02) was higher for those on OAC. Conclusion: Initiation of OAC after an ischemic stroke in older patients with HF in the absence of atrial fibrillation is associated with death, bleeding and re-hospitalization without an associated reduction in recurrent ischemic stroke. If validated, these findings raise caution for prescribing OAC to such patients.

Original languageEnglish (US)
Pages (from-to)857-864
Number of pages8
JournalJournal of Cardiac Failure
Volume27
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • Heart Failure
  • Hemorrhage
  • Mortality
  • Oral Anticoagulation
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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