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Abstract Details

Therapeutic Anticoagulation in Patients with Large Hemispheric Infarctions
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (8:00 AM-9:00 AM)
4-003
We hypothesize that timing of anticoagulation post-large hemispheric infarction (LHI) is not correlated to poor clinical outcomes.
LHI are associated with significant morbidity and mortality. Limited data exists regarding timing of anticoagulation initiation in patients with LHI and whether this correlates to poor outcomes.
We performed retrospective review of acute ischemic stroke patients admitted to the neurosciences intensive care unit at a tertiary care center from 1/12-12/18. Inclusion criteria included admission imaging (MRI or CT) with stroke size > ? of middle cerebral artery territory, +/- other vascular territory. Logistic regression was used for association measures and model creation.
In total, 2,318 patients were screened; 381 met inclusion criteria, and 107 (28%) had indication for anticoagulation initiation. Mean age was 64 years; 51% (n= 55) were female. Mean admission NIHSS was 20. Indications for anticoagulation initiation: atrial fibrillation, left ventricular or atrial thrombus, deep vein thrombosis, pulmonary embolism, or other. Mean post-stroke timing to initiation of anticoagulation were 15.2 days (median 14). No bolus given and goal partial prothromblastin time 50-70. Of the limited follow-up data, there were 3 documented cases of clinical deterioration after initiation of anticoagulation, and there were 3 cases that required reversal of anticoagulation. At discharge 6.5% (n=7) had good outcome (modified Rankin scale [mRS] 0-2) and remaining patients (93.5%, n= 100) had poor outcome (mRS 3-5). Therapeutic anticoagulation was not associated with worse mRS on discharge. Receiving anticoagulation was associated with a better discharge disposition (OR 0.3, p<0.0001, CI 0.19 to 0.48).
Patients with LHI tolerate and perhaps benefit from therapeutic anticoagulation. Though limited, our study suggests therapeutic anticoagulation in this timeframe is not correlated to poor clinical outcomes. Further research regarding anticoagulation timing and safety is necessary.
Authors/Disclosures
Hannah Breit, MD (University of Southern California)
PRESENTER 		Dr. Breit has nothing to disclose.
Andrea Sterenstein, MD (Rush University Medical Center) Dr. Sterenstein has nothing to disclose.
Nandini Abburi, MD (Duke University Department of Neurology) Dr. Abburi has nothing to disclose.
Sarah Song, MD, MPH, FÂ鶹´«Ã½Ó³»­ (Rush University Medical Center) Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Â鶹´«Ã½Ó³»­.
Sayona John, MD, FÂ鶹´«Ã½Ó³»­ (Cook County Health) Dr. John has nothing to disclose.
Ivan Da Silva, MD Dr. Da Silva has nothing to disclose.
Lauren Koffman, DO, MS (Temple University Hospital) Dr. Koffman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Law Firm. Dr. Koffman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Walters Kluwer.