Objectives

To evaluate the effects of early anticoagulation on functional outcome, recurrent ischaemic events and haemorrhagic complications in Atrial Fibrillation (AF)-related acute ischaemic strokes (AIS).

Materials and methods

We retrospectively evaluated patients hospitalised in a Stroke Unit due to AF-related AIS. Patients were divided according to anticoagulation initiation timing (0–4 days, 5–14 days, no anticoagulation by the 14th day). We assessed the following outcomes at 3 months: favourable functional outcome [modified Rankin Scale (mRS) score 0–2 or equal to pre-stroke], recurrent ischaemic events and haemorrhagic complications after anticoagulation initiation.

Results

We included 395 patients. Anticoagulation was initiated at days 0–4 in 33.9% of patients, days 5–14 in 25.3% and not initiated by the day 14 in 40.8%. Factors associated with earlier anticoagulation included lower previous mRS, valvular AF and lower stroke severity. Favourable functional outcome occurred in 40.2% of patients, with lower odds in those anticoagulated at 5–14 versus 0–4 days (OR: 0.47, 95% CI: 0.23–0.94), independently of age, previous mRS and stroke severity. Recurrent ischaemic events occurred in 8.3% of patients, with higher odds in non-anticoagulated patients by the 14th day, compared to the remainder groups (OR: 3.26, 95% CI: 1.29–8.22 vs. 0–4 days and OR: 8.16, 95% CI: 1.76–37.9 vs. 5–14 days). In patients who started anticoagulation (n = 288), haemorrhagic complications occurred in 10.8%, being more frequent in those who started at 0–4 days vs. > 14 days. However, it did not abolish the 0–4-day initiation’s benefit on functional outcome.

Conclusions

Early anticoagulation was associated with lower ischaemic recurrence and better functional outcome at 3 months. Additional studies are needed to better clarify its haemorrhagic risk.

中文翻译：

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房颤相关急性缺血性卒中的早期抗凝：疗效和安全性

目标

评估早期抗凝对心房颤动 (AF) 相关急性缺血性卒中 (AIS) 功能结果、复发性缺血事件和出血性并发症的影响。

材料和方法

我们回顾性评估了因 AF 相关 AIS 而在卒中单元住院的患者。根据抗凝开始时间（0-4 天、5-14 天、第 14 天不抗凝）对患者进行分组。我们在 3 个月时评估了以下结果：良好的功能结果 [改良 Rankin 量表 (mRS) 评分 0-2 或等于卒中前]、抗凝开始后复发性缺血事件和出血并发症。

结果

我们纳入了 395 名患者。33.9% 的患者在第 0-4 天开始抗凝，25.3% 在第 5-14 天开始抗凝，40.8% 在第 14 天未开始抗凝。与早期抗凝相关的因素包括较低的先前 mRS、瓣膜性 AF 和较低的卒中严重程度。40.2% 的患者出现良好的功能结果，与年龄、既往 mRS 和卒中严重程度无关，在 5-14 天与 0-4 天抗凝治疗的几率较低（OR：0.47，95% CI：0.23-0.94）。与其余组相比，8.3% 的患者发生复发性缺血事件，到第 14 天未接受抗凝治疗的患者发生率更高（OR：3.26，95% CI：1.29-8.22 与 0-4 天和 OR：8.16 , 95% CI：1.76–37.9 与 5–14 天）。在开始抗凝的患者中（n = 288)，出血性并发症发生率为 10.8%，在 0-4 天开始的患者比 > 14 天的患者更常见。然而，它并没有消除 0-4 天启动对功能结果的益处。

结论

早期抗凝治疗与 3 个月时较低的缺血性复发和较好的功能结果相关。需要更多的研究来更好地阐明其出血风险。