ArticleScientific reports2025
Practice patterns of vascular neurologists in timing anticoagulation for high risk stroke mechanisms versus atrial fibrillation.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The optimal timing for initiating anticoagulation following an ischemic stroke remains a debated issue. While several professional societies offer guidelines derived from observational studies and randomized clinical trials in patients with atrial fibrillation, these studies often exclude patients with high-risk embolic sources and hemorrhagic transformation. To address this gap, we conducted a nationwide survey to determine current practice patterns among vascular neurologists. We used the REDCap platform at the University of Chicago to distribute a survey to board-certified vascular neurologists identified through the American Board of Psychiatry and Neurology and the American Academy of Neurology databases. Statistical analyses, including t-tests, chi-squared tests, Mann-Whitney-Wilcoxon tests, and Kruskal-Wallis tests, were performed to evaluate continuous and categorical variables as applicable. Out of 1,556 invited participants, 201 (approximately 13%) responded, with 62% identifying as academic neurologists. Early anticoagulation is defined as within 24 h for ischemic stroke < 1.5 cm, 5 days for one third of MCA territory with hemorrhagic transformation type 1, and 7 days with parenchymal hemorrhage type 2. When compared to atrial fibrillation, vascular neurologists are more likely to initiate early anticoagulation in ischemic stroke with hemorrhagic transformation type 1 when it is caused by LV thrombus (69% vs. 21%, p < 0.001), antiphospholipid syndrome (87% v 21%, p < 0.001), and non-occlusive thrombus (83% vs. 21%, p < 0.001). A similar trend of early anticoagulation was noted in cases of ischemic stroke with parenchymal hemorrhage type 2 caused by LV thrombus (63% vs. 13%, p < 0.001), antiphospholipid syndrome (73% vs. 13%, p < 0.001), and non-occlusive thrombus (71% vs. 13%, p < 0.001) when compared to atrial fibrillation as the underlying cause. This study suggests that vascular neurologists prefer early anticoagulation in high-risk stroke mechanisms as compared to atrial fibrillation.
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