ABSTRACT NUMBER: ESOC2026A1360 ANTICOAGULATION MANAGEMENT IN PATIENTS WITH PERIOPERATIVE ISCHEMIC STROKE

Abstract Background and aims Although guidelines exist for perioperative anticoagulation management, real-world implementation remains poorly characterized. This study aimed to evaluate adherence to these recommendations in patients with ischemic stroke following recent procedures and to analyze stroke severity, complications, and factors associated with management. Methods We conducted a single-center observational study including patients using anticoagulation (DOAC, VKA or enoxaparin) with stroke/TIA within 30 days post-procedure (April 2023–October 2024), extracted from the Stroke Unit registry. Patients whose anticoagulation was discontinued due to hemorrhage requiring intervention were excluded. Inadequate management was defined as anticoagulation discontinuation for a period different from that indicated according to the procedure's bleeding risk. Non-parametric tests and multivariate analysis using Firth’s penalized regression were applied. Results Of 886 patients, 40 met inclusion criteria. DOACs were used by 65%, VKAs by 27.5%, and enoxaparin by 7.5%. Low bleeding-risk procedures comprised 47.5%. Adequate anticoagulation management occurred in 35%, while 65% received inadequate management. In the latter group, median anticoagulation discontinuation exceeded recommendations by 2.5 days. No factors were significantly associated to inadequate anticoagulation management in univariate and multivariate analyses, although peripheral artery disease (OR 2.02, 95% CI 0.32-21.86, p=0.46) and higher bleeding risk procedures (OR 1.67 per level, 95% CI 0.75-4.28, p=0,21) showed a trend toward increased risk. No significant differences were observed in stroke severity or complications rates. Conclusions Adherence to anticoagulation management recommendations is limited in perioperative stroke patients. Larger studies are needed to identify determinants of suboptimal management and to develop strategies to minimize both ischemic and hemorrhagic risk. Conflict of interest Jaime Romero Ferro: nothing to disclose, Laura Gil Martínez: nothing to disclose, Ana Sánchez Asensio: nothing to disclose, Jose Cortina García: nothing to disclose, Sebastián García Madrona: nothing to disclose, Rocío Vera: nothing to disclose, Alicia De Felipe: nothing to disclose, Consuelo Matute Lozano: nothing to disclose, Jaime Masjuan: nothing to disclose, Antonio Cruz: nothing to disclose.