Factors affecting ischemia recurrence in patients presenting to the emergency department with recurrent ischemic stroke under antiembolicor antithrombotic treatment

Introduction The department where stroke patients are admitted for the first time, is recognized and treated is the emergency department.Despite progress and declining trends, recurrent ischemic stroke is still frequent.Recurrent ischemic stroke has been associated with increased mortality and functional dependence. The primary goal of secondary prevention strategies after ischemic strokeis to reduce the risk of recurrent stroke. However, recurrence may develop despite adequate antiaggregant and amticoagulant therapy for secondary prevention.The aim of this study was to evaluate the risk factors associated with stroke in patients who had recurrent ischemic stroke under antiaggregant or anticoagulant therapy. Two hundred seventy-three patients, applied to the emergency department with the diagnosis of recurrent ischemic stroke between 01.01.2017 and 31.01.2021, were included in our study retrospectively. The Patient's demographic characteristics, usage of antiaggregant and anticoagulant drugs, comorbid diseases, electrocardiography, echocardiography and imaging findings, emergency department and hospital outcomes were evaluated. The mean age of the patients was 70.9 ± 12.6 years (20-101 years).46.2% were female, 53.8% were male. Atrial fibrillation (AF) was present in 20.9%of the patients. The most common comorbidities were hypertension (HT) (72.5%), coronary artery disease (CAD) (37.7%) and diabetes mellitus (DM) (35.2%). 5.3% of the patients were taking antiaggregant monotherapy, 7% antiaggregant dual therapy, 26.3% antiaggregant and anticoagulant, 54.4% anticoagulant monotherapy. However,7% were not taking neither antiaggregant nor anticoagulant.The emergency outcomes of the patients were respectively in theinpatientwards (45.4%), intensive care unit (ICU) (38.8%), voluntary discharge (7.3%), discharge (5.1%), referral (1.8%), and exitus (1.5%). Hospital outcomes were discharge (57.9%), referral (28.2%), and exitus (13.9%), respectively. The mean age of the patients who died was higher (p=0.011).The frequency of AF (p=0.009) and malignancy (p=0.002) was higher, and the frequency of HT was lower (p=0.035) in patients with hospital outcome wasexitus.The frequency of use of antiaggregant dual therapy was higher in patients who were discharged from the hospital than in patients who died (p=0.047).The frequency of septic infarcts was higher in MR imaging in patients who died (p=0.037). Recurrent ischemic stroke has characteristics similar to the first stroke. Recurrence of ischemic stroke may occur in patients receiving antiaggregant or anticoagulant therapy. However, patients receiving dual antiaggregant therapy have a better prognosis.