Risk factors associated with ischemic stroke during temporary oral anticoagulant interruption in patients with non-valvular atrial fibrillation.

BACKGROUND

Ischemic stroke may occur during temporary interruption of oral anticoagulant (OAC) therapy; however, clinical factors associated with stroke during short-term discontinuation remain incompletely defined. This study aimed to identify factors associated with ischemic stroke during temporary OAC interruption in hospitalized patients receiving anticoagulation at admission.

METHODS

We conducted a retrospective, single-center observational study of consecutive hospitalized patients receiving OAC therapy for non-valvular atrial fibrillation who underwent temporary OAC interruption for invasive procedures without heparin bridging between January 2023 and May 2025. Ischemic stroke was defined as newly developed neurological deficits with corresponding ischemic lesions on neuroimaging during the discontinuation period. Multivariable analysis was performed using Firth's penalized logistic regression to account for rare event bias.

RESULTS

Among 9,059 patients receiving OAC at admission, 3,402 underwent temporary interruption. After applying exclusion criteria, 1,008 patients were included in the final analysis. Thirteen patients (1.3%) developed ischemic stroke during the interruption period. Multivariable Firth logistic regression demonstrated that CHADS2 score (per 1-point increase; adjusted odds ratio [aOR], 4.21; 95% confidence interval [CI], 1.18-15.02; p = 0.026) and OAC discontinuation ≥ 5 days (aOR, 13.82; 95% CI, 3.02-63.21; p < 0.001) were independently associated with ischemic stroke, whereas age, OAC type, secondary prevention status, presence of postoperative hemorrhagic complication, and concomitant antiplatelet therapy were not independently associated with stroke occurrence.

CONCLUSIONS

Prolonged OAC interruption and higher baseline embolic risk were independently associated with ischemic stroke in hospitalized patients. Careful attention should be paid to avoid unnecessary prolongation of anticoagulation discontinuation, particularly in high-risk individuals.