Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation

Yaning Xu; Chengchun Liu; Wei Li; Ximing Nie; Shuhan Huang; Xiaoshu Li; Ya Wu; Wang-Sheng Jin; Jiaojin Jiang; Jun Dong; Yi Yang; Zhiqiang Sun; Wenjun Han; Yanjiang Wang; Liping Liu; Meng Zhang

doi:10.1136/svn-2022-002082

Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation

Stroke Vasc Neurol. 2023 Oct;8(5):405-412. doi: 10.1136/svn-2022-002082. Epub 2023 Mar 27.

Authors

Yaning Xu¹, Chengchun Liu¹, Wei Li¹, Ximing Nie^{2

3}, Shuhan Huang¹, Xiaoshu Li¹, Ya Wu¹, Wang-Sheng Jin¹, Jiaojin Jiang¹, Jun Dong¹, Yi Yang¹, Zhiqiang Sun¹, Wenjun Han¹, Yanjiang Wang¹, Liping Liu^{2

3}, Meng Zhang⁴

Affiliations

¹ Department of Neurology, Army Medical Center of PLA, Army Medical University, Chongqing, China.
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ China National Clinical Research Center for Neurological Diseases, Beijing, China.
⁴ Department of Neurology, Army Medical Center of PLA, Army Medical University, Chongqing, China zhangmeng@tmmu.edu.cn.

Abstract

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.

Keywords: Anticoagulants; Atrial Fibrillation; Stroke; Thrombectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants / adverse effects
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / drug therapy
Brain Ischemia* / therapy
Heparin
Heparin, Low-Molecular-Weight
Humans
Intracranial Hemorrhages / complications
Ischemic Stroke* / diagnosis
Ischemic Stroke* / drug therapy
Stroke* / diagnosis
Stroke* / drug therapy
Stroke* / prevention & control

Substances

Heparin
Heparin, Low-Molecular-Weight
Anticoagulants