Background: Anticoagulation is intended to treat and prevent thrombotic events in patients with atrial fibrillation (AF). For acute ischemic stroke (AIS) patients without AF, antiplatelets are recommended to prevent recurrence, although recurrence by certain demographic groups is not well described.

Aims: Assess incidence of ischemic stroke recurrence in patients without AF in the US by demographic groups and evaluate the trend across calendar years.

Methods: Hospitalized patients with first AIS (index date) without prior AF were identified from 4 US administrative claims databases, IBM MarketScan® Commercial Claims and Encounters (CCAE), Multi‐state Medicaid (MDCD), Medicare Supplemental Beneficiaries (MDCR), and OptumInsight´s Clinformatics® Datamart (Optum) from January-1-2008 to December-31-2018. Crude incidence rate (IR, /100 person-years) and incidence proportion (IP, /100 persons) of recurrent event during 1-year post-index was calculated overall and stratified by sex and age groups. Age-sex adjusted IR of recurrent event during 1-year was calculated by calendar years.

Results: CCAE, MDCD, MDCR, and Optum databases included 122,317, 77,979, 127,046, 172,415 AIS patients without AF with mean age of 54.0, 61.6, 78.9, 70.0 years, respectively. AIS recurrence IR ranged from 11.7 to 14.9 /100 person-years and IP ranged from 10.2-11.8 /100 persons. In three databases, recurrence IR did not differ by sex while increased with age (Table 1). In MDCD, recurrence IR was higher for men vs. women (difference: 1.7/100 person-years) and for patients aged 45-64y vs ≥65y (4.6) and vs 18-44y (1.8) (all P< 0.05). Age-sex adjusted IR of recurrence were generally stable over the study period (Figure 1).

Conclusions: AIS recurrence rate in patients without AF in this real-world study is higher than some previous reports. Recurrence rate increased with age, did not differ by sex in three databases. Age-sex adjusted incidence did not appreciably change during 2008-2018. Future studies may assess risk factors and treatment pattern in association with recurrence.

[Table 1. Unadjusted 1-year incidence of recurrent AIS among patients with no prior AF, stratified by sex, age, and calendar year]

[Figure 1. Sex and age standardized 1-year incidence of recurrent AIS across calendar years 2008-2018 among patients with no prior AF.]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/incidence-of-recurrent-ischemic-stroke-in-patients-without-atrial-fibrillation-a-real-world-study/