PB0039 - Predictive Value of Infarction Volume on Hemorrhagic Transformation in Ischemic Stroke/Transient ischemic stroke With Non-valve Atrial Fibrillation (NVAF) Patients Using Rivaroxaban

Background: Early anticoagulation after cardioembolic stroke remains controversial because of the potential for hemorrhagic transformation (HT). Identification of patients with high risk of hemorrhage transformation has not been well studied.

Aims: We aimed to measure the volume of infarction and matrix metalloproteinase-9 (MMP-9) activity to predict HT among patients with newly diagnosed acute ischemic stroke/transient ischemic attack (TIA) combined with nonvalvular atrial fibrillation.

Methods: A prospective, open-label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of ischemic stroke or TIA. All patients underwent magnetic resonance imaging between < 24 hours of rivaroxaban initiation and day 14. The primary end point was HT at day 14. The predictive power of the volume of infarction and MMP-9 activity, individually and in combination, was compared using the area under a ROC curve (AUC).

Results: A total of 400 patients (mean±SD, age 74±10 years) were enrolled from 16 hospitals in Zhejiang province between 1 January 2019 and 1 June 2022. Median National Institute of Health Stroke Scale was 3 (1, 5), and median diffusion-weighted imaging volume was 3.4 (0.7, 15.2) mL. 266 patients finished follow-up imaging and HT developed in 30 patients. 131 patients had MMP-9 measurement and median serum MMP-9 level was 8.7 ng/ml. Multivariate logistic regression analysis showed that age and the volume of infarction were independent influencing factors in patients with HT. An ROC curve was constructed using age, sex, the volume of infarction and/or MMP-9. The AUC of combined age, sex, the volume of infarction and MMP-9 was larger than the AUC of combined age, sex, and the volume of infarction (AUC 0.909 vs 0.845).

Conclusion(s): Early anticoagulation without symptomatic hemorrhagic transformation indicates the safety of rivaroxaban. Stroke volume is valuable in predicting HT among patients with acute ischemic stroke/TIA with NVAF which indicate early anticoagulation in patients with small infarct volume.