PMID- 36972921
OWN - NLM
STAT- MEDLINE
DCOM- 20231027
LR  - 20231117
IS  - 2059-8696 (Electronic)
IS  - 2059-8688 (Print)
IS  - 2059-8688 (Linking)
VI  - 8
IP  - 5
DP  - 2023 Oct
TI  - Efficacy and safety of early anticoagulation after endovascular treatment in 
      patients with atrial fibrillation.
PG  - 405-412
LID - 10.1136/svn-2022-002082 [doi]
AB  - BACKGROUND: The timing for initiating anticoagulant therapy in acute ischaemic 
      stroke (AIS) patients with atrial fibrillation who recanalised after endovascular 
      treatment (EVT) is unclear. The objective of this study was to evaluate the 
      effect of early anticoagulation after successful recanalisation in AIS patients 
      with atrial fibrillation. METHODS: Patients with anterior circulation large 
      vessel occlusion and atrial fibrillation who were successfully recanalised by EVT 
      within 24 hours after stroke in the Registration Study for Critical Care of Acute 
      Ischemic Stroke after Recanalization registry were analysed. Early 
      anticoagulation was defined as the initiation of unfractionated heparin (UFH) or 
      low-molecular-weight heparin (LMWH) within 72 hours after EVT. Ultra-early 
      anticoagulation was defined if it was initiated within 24 hours. The primary 
      efficacy outcome was the score on the modified Rankin Scale (mRS) at day 90, and 
      the primary safety outcome was symptomatic intracranial haemorrhage within 90 
      days. RESULTS: Overall, 257 patients were enrolled, of whom 141 (54.9%) initiated 
      anticoagulation within 72 hours after EVT, including 111 within 24 hours. A 
      significant shift towards better mRS scores at day 90 was associated with early 
      anticoagulation (adjusted common OR 2.08 (95% CI 1.27 to 3.41)). Symptomatic 
      intracranial haemorrhage was comparable between patients treated with early and 
      routine anticoagulation (adjusted OR 0.20 (95% CI 0.02 to 2.18)). Comparison of 
      different early anticoagulation regimens showed that ultra-early anticoagulation 
      was more significantly associated with favourable functional outcomes (adjusted 
      common OR 2.03 (95% CI 1.20 to 3.44)) and reduced the incidence of asymptomatic 
      intracranial haemorrhage (OR 0.37 (95% CI 0.14 to 0.94)). CONCLUSIONS: In AIS 
      patients with atrial fibrillation, early anticoagulation with UFH or LMWH after 
      successful recanalisation is associated with favourable functional outcomes 
      without increasing the risk of symptomatic intracranial haemorrhages. TRIAL 
      REGISTRATION NUMBER: ChiCTR1900022154.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Xu, Yaning
AU  - Xu Y
AUID- ORCID: 0000-0003-4351-5453
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Liu, Chengchun
AU  - Liu C
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Li, Wei
AU  - Li W
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Nie, Ximing
AU  - Nie X
AUID- ORCID: 0000-0002-8380-4076
AD  - Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 
      Beijing, China.
AD  - China National Clinical Research Center for Neurological Diseases, Beijing, 
      China.
FAU - Huang, Shuhan
AU  - Huang S
AUID- ORCID: 0000-0003-4158-5407
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Li, Xiaoshu
AU  - Li X
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Wu, Ya
AU  - Wu Y
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Jin, Wang-Sheng
AU  - Jin WS
AUID- ORCID: 0000-0001-5263-6965
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Jiang, Jiaojin
AU  - Jiang J
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Dong, Jun
AU  - Dong J
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Yang, Yi
AU  - Yang Y
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Sun, Zhiqiang
AU  - Sun Z
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Han, Wenjun
AU  - Han W
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Wang, Yanjiang
AU  - Wang Y
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China.
FAU - Liu, Liping
AU  - Liu L
AD  - Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 
      Beijing, China.
AD  - China National Clinical Research Center for Neurological Diseases, Beijing, 
      China.
FAU - Zhang, Meng
AU  - Zhang M
AD  - Department of Neurology, Army Medical Center of PLA, Army Medical University, 
      Chongqing, China zhangmeng@tmmu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230327
PL  - England
TA  - Stroke Vasc Neurol
JT  - Stroke and vascular neurology
JID - 101689996
RN  - 9005-49-6 (Heparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Stroke/diagnosis/drug therapy/prevention & control
MH  - *Brain Ischemia/therapy
MH  - Heparin
MH  - *Atrial Fibrillation/diagnosis/drug therapy
MH  - Heparin, Low-Molecular-Weight
MH  - *Ischemic Stroke/diagnosis/drug therapy
MH  - Anticoagulants/adverse effects
MH  - Intracranial Hemorrhages/complications
PMC - PMC10647876
OTO - NOTNLM
OT  - Anticoagulants
OT  - Atrial Fibrillation
OT  - Stroke
OT  - Thrombectomy
COIS- Competing interests: None declared.
EDAT- 2023/03/28 06:00
MHDA- 2023/10/27 06:43
PMCR- 2023/03/27
CRDT- 2023/03/27 20:43
PHST- 2022/10/12 00:00 [received]
PHST- 2023/01/27 00:00 [accepted]
PHST- 2023/10/27 06:43 [medline]
PHST- 2023/03/28 06:00 [pubmed]
PHST- 2023/03/27 20:43 [entrez]
PHST- 2023/03/27 00:00 [pmc-release]
AID - svn-2022-002082 [pii]
AID - 10.1136/svn-2022-002082 [doi]
PST - ppublish
SO  - Stroke Vasc Neurol. 2023 Oct;8(5):405-412. doi: 10.1136/svn-2022-002082. Epub 
      2023 Mar 27.