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.

中文翻译：

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紧急再灌注治疗与房颤相关的缺血性卒中患者的抗凝安全性。

背景与目的：与房颤相关的缺血性中风后开始口服抗凝剂的最佳时机仍然是一个挑战，主要是在接受全身溶栓或机械血栓切除术治疗的患者中。我们旨在评估溶栓治疗和/或血栓切除术治疗并随后接受口服抗凝剂二级预防的急性缺血性中风和房颤患者的早期复发和大出血发生率。方法：我们将RAF和RAF-NOACs（非维生素K口服抗凝剂治疗的急性缺血性卒中和房颤患者的早期复发和大出血）研究分别为2012年1月至2014年3月和2014年4月至2016年6月进行的前瞻性观察性研究。我们纳入了连续的急性缺血性中风和房颤患者，均接受维生素K拮抗剂或非维生素K口服抗凝剂治疗。主要结果是卒中，短暂性脑缺血发作，有症状的全身性栓塞，有症状的脑出血和入选后90天内的主要脑外出血的综合结果。根据基线临床特征，分层后治疗患者与未治疗患者的比例匹配为1：1。结果：共纳入2159例患者，其中564例（26％）患者接受了急性再灌注治疗。指数事件后，有505例（90％）的患者接受了急性再灌注疗法，而1595例中的1287例（81％）患者未经治疗开始口服抗凝治疗。在再灌注治疗和未治疗的患者中开始口服抗凝药的时间是相似的（分别为中位数7.5天和7.0天）。在第90天，接受再灌注治疗的患者（37％（7％））和未经治疗的患者（146％（9％））发生的主要研究结局（比值为0.74 [95％CI，0.50–1.07]）。倾向评分匹配后，两组的主要结局风险相当（优势比为1.06 [95％CI，0.53–2.02]）。结论：急性再灌注治疗不影响早期复发和大出血的风险。与房颤有关的急性缺血性中风，开始口服抗凝药。