Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation
Authors: Giustozzi Michela , Acciarresi Monica , Agnelli Giancarlo , Caso Valeria , Bandini Fabio , Tsivgoulis Georgios , Yaghi Shadi , Furie Karen L. , Tadi Prasanna , Becattini Cecilia , Zedde Marialuisa , Abdul-Rahim Azmil H. , Lees Kennedy R. , Alberti Andrea , Venti Michele , D’Amore Cataldo , Giulia Mosconi Maria , Anna Cimini Ludovica , Bovi Paolo , Carletti Monica , Rigatelli Alberto , Cappellari Manuel , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Marcheselli Simona , Pezzini Alessandro , Poli Loris , Padovani Alessandro , Vannucchi Vieri , Sohn Sung-Il , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Ntaios George , Athanasakis George , Makaritsis Konstantinos , Karagkiozi Efstathia , Vadikolias Konstantinos , Liantinioti Chrissoula , Theodorou Aikaterini , Halvatsiotis Panagiotis , Mumoli Nicola , Galati Franco , Sacco Simona , Tiseo Cindy , Corea Francesco , Ageno Walter , Bellesini Marta , Silvestrelli Giorgio , Ciccone Alfonso , Lanari Alessia , Scoditti Umberto , Denti Licia , Mancuso Michelangelo , Ferrari Elena , Ulivi Leonardo , Orlandi Giovanni , Giannini Nicola , Tassinari Tiziana , Luisa De Lodovici Maria , Rueckert Christina , Baldi Antonio , Toni Danilo , Letteri Federica , Giuntini Martina , Maria Lotti Enrico , Flomin Yuriy , Pieroni Alessio , Kargiotis Odysseas , Karapanayiotides Theodore , Monaco Serena , Maimone Baronello Mario , Csiba Laszló , Szabó Lilla , Chiti Alberto , Giorli Elisa , Del Sette Massimo , Imberti Davide , Zabzuni Dorjan , Doronin Boris , Volodina Vera , Michel Patrik , Vanacker Peter , Barlinn Kristian , Barlinn Jessica , Deleu Dirk , Gourbali Vanessa , Paciaroni Maurizio , Masotti Luca 
Published: July 2020

Background and Purpose:
The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention.

Methods:
We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features.

Results:
A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50–1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53–2.02]).

Conclusions:
Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation–related acute ischemic stroke, who started on oral anticoagulant.