The optimum anticoagulation time after endovascular thrombectomy for atrial fibrillation-related large vessel occlusion stroke: a real-world study

Figures

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  Fig. 1. Flow diagram. The study enrolled 300 individuals with anterior circulation territories AF-related AIS who underwent EVT within 24 h. A total of 66 patients without anticoagulants after EVT were excluded. The final study cohort included 234 eligible patients, and there were 63 patients divided into the favorable outcome group and 171 patients into the unfavorable outcome group according to the mRS at ninety-day after EVT. AF atrial fibrillation, AIS acute ischemic stroke, EVT endovascular thrombectomy, MODS multiple organ dysfunction syndromes, AMI acute myocardial infarction. *Continuous active bleeding due to severe stress ulcer of the digestive tract; Favorable outcome: mRS 0–1; Unfavorable outcome: mRS 3–6

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  Fig. 2. Incidence of efficacy and safety outcomes at different times. There was no significant statistical difference in recurrent AIS/TIA, mortality, and sICH events at ninety-day follow-up among the three groups. The incidences of any ICH and systemic hemorrhage of patients who received early anticoagulation (EVT to anticoagulation ≤ 4 days) were higher than those who received late anticoagulation (EVT to anticoagulation ≥ 15 days). EVT endovascular thrombectomy, AIS acute ischemic stroke, TIA transient ischemic attack, sICH symptomatic intracranial hemorrhage, ICH intracranial hemorrhage. **p < 0.01; *p < 0.05

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  Fig. 3. The ROC curves for the efficacy and safety outcomes. The AUC values of EVT to anticoagulation time to predict favorable outcome (a), sICH (b), ICH (c), and systemic hemorrhage (d) were 0.595, 0.802, 0.707, and 0.653, respectively. AUC area under the curve, sICH symptomatic intracranial hemorrhage, ICH intracranial hemorrhage. Central Illustration Anticoagulation time after endovascular thrombectomy for atrial fibrillation-related acute ischemic stroke

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  Fig. 4. Central Illustration. For acute ischemic stroke patients associated with atrial fibrillation who received endovascular thrombectomy (EVT), the initiation time of anticoagulants after EVT is an independent factor that affects the incidence of the favorable outcome (mRS 0–1) and hemorrhage events at ninety-day follow-up. Early anticoagulation (EVT to anticoagulation ≤ 4 days) increases the risk of intracranial hemorrhage and systemic hemorrhage events more than late anticoagulation (EVT to anticoagulation ≥ 15 days). The optimum time for initiating anticoagulants after EVT to achieve a favorable outcome is 4.5 days