Abstract TP061: Evaluating Anticoagulation for Atrial Fibrillation at Discharge Practices within a State-wide Stroke Clinical Network

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Introduction: Atrial fibrillation (Afib) is a well-known and significant risk factor for acute ischemic stroke (AIS). Various factors are considered when determining if AIS patient with Afib should be discharged on anticoagulation (AC). Not all are appropriate for AC due to various potential contraindications. At a large geographically diverse Stroke Clinical Network (SCN), composed of one large academic certified comprehensive stroke center (CSC), and seven primary stroke centers (PSCs), a retrospective analysis was conducted to evaluate if there were differences in prescribing AC amongst varying demographics. Methods: The Get With the Guidelines® database was queried for stroke patients discharged from the SCN between 2023-2024 to evaluate AC prescription practices for patients with known Afib. Patients were excluded if they had a hemorrhagic stroke, died during hospitalization, discharged to hospice, left against medical advice, or did not have a documented history or new finding of Afib. Additional data elements collected included age, sex, race, mRS at discharge, NIHSS at presentation, disposition, and if discharging facility was a PSC or a CSC. Categorical variables were compared using chi-squared tests to examine relationships between demographic and medical variables and AC prescribing at discharge. Results: A total of 671 AIS patients met the inclusion criteria. Mean age was 75.1 (SD ± 12.2), 53% were male (353/671), and 64.1% were white (430/671). Of the 671, a total of 83.7% (562/671) were discharged on AC, 13.6% (91/671) were discharged without AC but with a documented contraindication, and overall only 2.7% (18/671) were discharged without AC and no documented contraindication. There was a relationship between being discharged without AC and no documented reason from the PSC compared to those discharged from the CSC (3.8% vs. 0.4%; p < 0.01). There were no other statistically significant differences in patient demographics between the two groups. Conclusions: In conclusion, this large SCN demonstrated high rates of appropriate anticoagulation prescribing, with 83.7% of stroke patients with Afib discharged on AC for secondary stroke prevention. Areas of opportunity remain for patients being discharged from the primary stroke centers. Future studies should focus on identifying barriers to appropriate AC prescribing and those patients’ candidacy for left atrial appendage closure

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