Antithrombotic Choice and Timing in Patients Presenting with Symptomatic Hemorrhagic Conversion of Ischemic Stroke

The primary aim of this research project is to determine the optimal time for antithrombotic agent initiation post ischemic stroke without resulting hemorrhagic conversion. We hypothesize that not only is hemorrhagic conversion risk often inaccurately estimated, but also that antiplatelet agents and anticoagulants may pose similar risk of hemorrhagic conversion, particularly when initiated seven days post ischemic stroke. This risk potentially outweighs their protective effects against recurrent stroke. We are in the process of identifying patients with hemorrhagic conversion of ischemic stroke at Thomas Jefferson University Hospital and will analyze the type and timing of antithrombotic agents. Additional risk factors studied include mechanism and location of stroke, infarct volume, atrial fibrillation, LDL levels, statin therapy, chronic diseases, and substance abuse. We will perform a multivariate analysis to evaluate for associations among the risk factors. Due to unexpectedly lower rates of patients with hemorrhagic conversion and difficulties obtaining data due to coding variability, we do not currently have sufficient data for a full analysis (N=50). Interesting trends seen in the data include that 22 out of our 50 patients bled on aspirin monotherapy. However, there is a need for more patient data to begin drawing statistically significant conclusions. Once data collection is completed, we anticipate identifying specific antithrombotic therapies and timing of therapies that have strong associations with hemorrhagic conversion. This will help to develop evidence-based guidelines for management of acute ischemic stroke treatment at a large comprehensive stroke center with diverse patient population

Early Follow-Up Phone Calls to Reduce 30-Day Readmissions For Stroke Patients Discharged to Home

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to medication management, organizing follow-up appointments, monitoring blood pressure, and coordinating home services. In addition to recovering mentally and physically from stroke, these tasks can lead to additional burden particularly on weekends when access to care may be limited. We hypothesize that those who are discharged home on a Thursday or Friday are at higher risk for readmission and predict that scripted phone calls to these patients over the weekend could result in reduction in readmissions