J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Original Article

Volume 15, Number 1, January 2025, pages 39-46

Anticoagulation in Elderly Ischemic Stroke Patients With Atrial Fibrillation: Perspective From a Tertiary Neuroscience Center

↓ **Table 1.** Anticoagulation Adequate/Therapeutic for Patients
Drug	Usual dosage	Considerations
INR: international normalized ratio.
Warfarin	Varies; INR target 2 - 3	-
Apixaban	5 mg twice per day	2.5 mg twice per day if two of following: age ≥ 80 years old; body weight ≤ 60 kg; serum creatinine ≥ 114 µmol/L. Not recommended in Child-Pugh class B and C patients
Dabigatran	150 mg twice per day	110 mg twice per day for patients ≥ 80 years old 75 mg twice per day if CrCl 15 to 30 mL/min/1.73 m² No specific dose adjustments recommended for hepatic impairment
Rivaroxaban	20 mg per day with evening meal	15 mg per day if CrCl 15 to 50 mL/min/1.73 m² Note: CrCl < 30 mL generally was not studied in trials Not recommended in Child-Pugh class B and C patients

↓ Table 1. Anticoagulation Adequate/Therapeutic for Patients

Drug

Usual dosage

Considerations

INR: international normalized ratio.

Warfarin

Varies; INR target 2 - 3

Apixaban

5 mg twice per day

2.5 mg twice per day if two of following: age ≥ 80 years old; body weight ≤ 60 kg; serum creatinine ≥ 114 µmol/L.
Not recommended in Child-Pugh class B and C patients

Dabigatran

150 mg twice per day

110 mg twice per day for patients ≥ 80 years old
75 mg twice per day if CrCl 15 to 30 mL/min/1.73 m²
No specific dose adjustments recommended for hepatic impairment

Rivaroxaban

20 mg per day with evening meal

15 mg per day if CrCl 15 to 50 mL/min/1.73 m²
Note: CrCl < 30 mL generally was not studied in trials
Not recommended in Child-Pugh class B and C patients

↓ **Table 2.** Demographics and Clinical Profiles of Elderly CE Stroke Patients With NVAF
Characteristics	Overall patients, n	With anticoagulation	No anticoagulation, n (%)	P value
^aIndependent t-test. ^bChi-square test. ^cFisher’s exact test. CE: cardioembolic; DOACs: direct oral anticoagulants; NVAF: non-valvular atrial fibrillation; TIA: transient ischemic attack.
	74	6 (8.1)	50 (67.6)	18 (24.3)
Median age (25th, 75th)	77.0 (70.0, 83.0)	73.0 (69.0, 81.3)	82.0 (78.0, 84.8)	0.004^a
		71.0 (67.5, 79.0)	73.5 (70.0, 81.8)
Female	34	28 (82.4)	6 (17.6)	0.217^b
		3 (8.8)	25 (73.5)
Male	40	28 (70.0)	12 (30.0)	0.217^b
		3 (7.5)	25 (62.5)
Congestive heart failure	16	13 (81.3)	3 (18.8)	0.746^c
		4 (25.0)	9 (56.3)
Hypertension	59	45 (76.3)	14 (23.7)	1.000^c
		4 (6.8)	41 (69.5)
Diabetes	26	22 (84.6)	4 (15.4)	0.187^b
		2 (7.7)	20 (76.9)
Peripheral vascular disease	18	14 (77.8)	4 (22.2)	1.000^c
		3 (16.7)	11 (61.1)
Previous stroke/TIA	22	17 (77.3)	5 (22.7)	0.835^b
		4 (18.2)	13 (59.1)
Median CHA₂DS₂-VASc score (25th, 75th)	4.0 (3.0, 5.0)	4.0 (3.0, 5.3)	4.0 (3.0, 5.0)	0.729^a
		6.5 (3.8, 7.0)	4.0 (3.0, 5.0)

↓ Table 2. Demographics and Clinical Profiles of Elderly CE Stroke Patients With NVAF

Characteristics

Overall patients, n

With anticoagulation

No anticoagulation, n (%)

P value

Warfarin, n (%)

DOACs, n (%)

^aIndependent t-test. ^bChi-square test. ^cFisher’s exact test. CE: cardioembolic; DOACs: direct oral anticoagulants; NVAF: non-valvular atrial fibrillation; TIA: transient ischemic attack.

6 (8.1)

50 (67.6)

18 (24.3)

Median age (25th, 75th)

77.0 (70.0, 83.0)

73.0 (69.0, 81.3)

82.0 (78.0, 84.8)

0.004^a

71.0 (67.5, 79.0)

73.5 (70.0, 81.8)

Female

28 (82.4)

6 (17.6)

0.217^b

3 (8.8)

25 (73.5)

Male

28 (70.0)

12 (30.0)

0.217^b

3 (7.5)

25 (62.5)

Congestive heart failure

13 (81.3)

3 (18.8)

0.746^c

4 (25.0)

9 (56.3)

Hypertension

45 (76.3)

14 (23.7)

1.000^c

4 (6.8)

41 (69.5)

Diabetes

22 (84.6)

4 (15.4)

0.187^b

2 (7.7)

20 (76.9)

Peripheral vascular disease

14 (77.8)

4 (22.2)

1.000^c

3 (16.7)

11 (61.1)

Previous stroke/TIA

17 (77.3)

5 (22.7)

0.835^b

4 (18.2)

13 (59.1)

Median CHA₂DS₂-VASc score (25th, 75th)

4.0 (3.0, 5.0)

4.0 (3.0, 5.3)

4.0 (3.0, 5.0)

0.729^a

6.5 (3.8, 7.0)

4.0 (3.0, 5.0)

↓ **Table 3.** Anticoagulation Used in CE Stroke Patients (n = 56)
Anticoagulation	n (%)
CE: cardioembolic; BD: twice daily; OD: once daily.
Dabigatran
110 mg OD	1 (1.8)
110 mg BD	21 (47.5)
150 mg BD	13 (23.2)
Rivaroxaban
15 mg OD	2 (3.6)
20 mg OD	1 (1.8)
Apixaban
2.5 mg BD	7 (12.5)
5 mg BD	5 (8.9)
Warfarin	6 (10.7)

↓ Table 3. Anticoagulation Used in CE Stroke Patients (n = 56)

Anticoagulation

n (%)

CE: cardioembolic; BD: twice daily; OD: once daily.

Dabigatran

110 mg OD

1 (1.8)

110 mg BD

21 (47.5)

150 mg BD

13 (23.2)

Rivaroxaban

15 mg OD

2 (3.6)

20 mg OD

1 (1.8)

Apixaban

2.5 mg BD

7 (12.5)

5 mg BD

5 (8.9)

Warfarin

6 (10.7)

↓ **Table 4.** Stroke Recurrence, Bleeding Risk, and Mortality Within 2 Years for Anticoagulation and Non-Anticoagulated Patients
	Anticoagulated (n = 56), n (%)	No anticoagulation (n = 18), n (%)	P value
^aFisher’s exact test.
No stroke within 2 years	51 (91.1)	18 (100.0)	0.000^a
Stroke within 2 years	5 (8.9)	0 (0.0)
No bleeding	49 (87.5)	11 (61.1)	0.032^a
Bleeding	7 (12.5)	7 (38.9)
No mortality within 2 years	41 (73.2)	5 (27.8)	0.001
Mortality within 2 years	15 (26.8)	13 (72.2)

↓ Table 4. Stroke Recurrence, Bleeding Risk, and Mortality Within 2 Years for Anticoagulation and Non-Anticoagulated Patients

Anticoagulated (n = 56), n (%)

No anticoagulation (n = 18), n (%)

P value

^aFisher’s exact test.

No stroke within 2 years

51 (91.1)

18 (100.0)

0.000^a

Stroke within 2 years

5 (8.9)

0 (0.0)

No bleeding

49 (87.5)

11 (61.1)

0.032^a

Bleeding

7 (12.5)

7 (38.9)

No mortality within 2 years

41 (73.2)

5 (27.8)

0.001

Mortality within 2 years

15 (26.8)

13 (72.2)

↓ **Table 5.** Comparisons of Outcomes Between DOACs, Warfarin, and Non-Anticoagulated Groups
	DOACs (n = 50), n (%)	Warfarin (n = 6), n (%)	No anticoagulation (n = 18), n (%)	P value
^aFisher’s exact test. DOACs: direct oral anticoagulants.
No stroke within 2 years	45 (90.0)	6 (100.0)	18 (100.0)	0.557^a
Stroke within 2 years	5 (10.0)	0 (0.0)	0 (0.0)
No bleeding	44 (88.0)	5 (83.3)	11 (61.1)	0.043^a
Bleeding	6 (12.0)	1 (16.7)	7 (38.9)
No mortality within 2 years	36 (72.0)	5 (83.3)	5 (27.8)	0.002^a
Mortality within 2 years	14 (28.0)	1 (16.7)	13 (72.2)

↓ Table 5. Comparisons of Outcomes Between DOACs, Warfarin, and Non-Anticoagulated Groups

DOACs (n = 50), n (%)

Warfarin (n = 6), n (%)

No anticoagulation (n = 18), n (%)

P value

^aFisher’s exact test. DOACs: direct oral anticoagulants.

No stroke within 2 years

45 (90.0)

6 (100.0)

18 (100.0)

0.557^a

Stroke within 2 years

5 (10.0)

0 (0.0)

No bleeding

44 (88.0)

5 (83.3)

11 (61.1)

0.043^a

Bleeding

6 (12.0)

1 (16.7)

7 (38.9)

No mortality within 2 years

36 (72.0)

5 (83.3)

5 (27.8)

0.002^a

Mortality within 2 years

14 (28.0)

1 (16.7)

13 (72.2)

↓ **Table 6.** Comparisons of Outcomes in Therapeutic and Subtherapeutic Dosage Groups
	Therapeutic dose of anticoagulation (n = 42), n (%)	Subtherapeutic anticoagulation dose (n = 14), n (%)	P value
^aFisher’s exact test.
No stroke within 2 years	39 (92.9)	12 (85.7)	0.590^a
Stroke within 2 years	3 (7.1)	2 (14.3)
No bleeding	38 (90.5)	11 (78.6)	0.350^a
Bleeding	4 (9.5)	3 (21.4)
No mortality within 2 years	33 (78.6)	8 (57.1)	0.165^a
Mortality within 2 years	9 (21.4)	6 (42.9)

↓ Table 6. Comparisons of Outcomes in Therapeutic and Subtherapeutic Dosage Groups

Therapeutic dose of anticoagulation (n = 42), n (%)

Subtherapeutic anticoagulation dose (n = 14), n (%)

P value

^aFisher’s exact test.

No stroke within 2 years

39 (92.9)

12 (85.7)

0.590^a

Stroke within 2 years

3 (7.1)

2 (14.3)

No bleeding

38 (90.5)

11 (78.6)

0.350^a

Bleeding

4 (9.5)

3 (21.4)

No mortality within 2 years

33 (78.6)

8 (57.1)

0.165^a

Mortality within 2 years

9 (21.4)

6 (42.9)

↓ **Table 7.** Comparison Between Patients < 80 Years Old and ≥ 80 Years Old
	Anticoagulation	P value	No anticoagulation	P value
^aFisher’s exact test.
Stroke within 2 years	3 (7.9)	2 (11.1)	0.652^a	0 (0.0)	0 (0.0)	-
Bleeding	5 (13.2)	2 (11.1)	1.000^a	3 (42.9)	4 (36.4)	1.000^a
Mortality within 2 years	10 (26.3)	5 (27.8)	1.000^a	5 (71.4)	8 (72.7)	1.000^a

↓ Table 7. Comparison Between Patients < 80 Years Old and ≥ 80 Years Old

Anticoagulation

P value

No anticoagulation

P value

< 80 years (n = 38), n (%)

≥ 80 years (n = 18), n (%)

< 80 years (n = 7), n (%)

≥ 80 years (n = 11), n (%)

^aFisher’s exact test.

Stroke within 2 years

3 (7.9)

2 (11.1)

0.652^a

0 (0.0)

Bleeding

5 (13.2)

2 (11.1)

1.000^a

3 (42.9)

4 (36.4)

1.000^a

Mortality within 2 years

10 (26.3)

5 (27.8)

1.000^a

5 (71.4)

8 (72.7)

1.000^a