Timing of Anticoagulation After Stroke in Patients with Non-Valvular Atrial Fibrillation (4696)

Objective: To determine practice trends in prescribing anticoagulation for patients with atrial fibrillation in post stroke patients. Background: Optimal timing of oral anticoagulation (OAC) in acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) is unknown. The risk of recurrent ischemic events is often weighted against that of hemorrhagic transformation, especially in patients with large infarctions and when early treatment is initiated. Despite substantial evidence for the benefit of OAC in reducing stroke recurrence, current nationally recognized practice guidelines do not provide clear recommendations on the timing of OAC (TOAC) after acute AF-related AIS. Design/Methods: We surveyed neurologists on therapeutic approaches to timing of anticoagulation after stroke in patients with non-valvular atrial fibrillation (NVAF) using an online questionnaire. Various ischemic and hemorrhagic stroke scenarios,with various locations, size, and high risk thrombotic complications were presented and survey respondents were asked to provide post stroke timeframe for TOAC. Practice background, specialty and years of experience of respondents were also recorded. Results: Majority of participants favored early initiation of OAC in small infarcts. In larger infarcts, or when ischemia was complicated by hemorrhagic transformation, there was an overall trend to delay any initiation of OAC , irrespective of specialty or years of experience. The overt presence of an additional cardiac embolic source such as cardiac thrombus led to earlier timing decisions regarding initiation of OAC. Conclusions: General practice trends were captured, optimal timing of anticoagulation following acute ischemic stroke in NVAF remains unknown. Further research is warranted to determine optimal timing and anticoagulant selection. Disclosure: Marina Sagalovich has nothing to disclose. Dr. Osteraas has nothing to disclose. Jon J. Glover has nothing to disclose. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.