Discussion
ICH, stroke, acute ischemic stroke, ischemia, vessel occlusion, hemorrhagic, ICA occlusion, hemorrhage, reperfusion injury, endovascular damage, NVAF, nonvalvular atrial fibrillation, strokes, sICH, intracranial hemorrhage, ischemic stroke, AF-associated, systemic hemorrhage, atrial fibrillation, LVO stroke
ISCHEMIC CEREBROVASCULAR DISEASE, INTRACRANIAL HEMORRHAGE, ISCHEMIA, EVENT, STROKE, ISCHEMIC STROKE, HEMORRHAGE, SECONDARY, ATRIAL FIBRILLATION, EVENTS, CORONARY HEART DISEASE, COMPLICATIONS, STROKES
The population in this study included AF-related patients with large vessel occlusion who underwent EVT. The incidence of sICH and any ICH events after EVT of patients in this cohort study were 10.3% and 44.9%, which was slightly higher than the average incidences of the five RCTs. The average NIHSS on admission was 15 (IQR12-18). Furthermore, a part of the patients received bridge therapy, which might be sicker patients with large strokes, and with a high risk of hemorrhagic complications. It is possible that more factors such as IVT, drug administration during thrombectomy, antithrombotic therapy, endovascular damage after thrombectomy, ischemia–reperfusion injury, etc. would affect ICH and other complications exist. Therefore, it undoubtedly increased the complexity and difficulty of anticoagulation therapy for AF-associated AIS followed by EVT. In this case, this observational study firstly identified that for AF-related AIS patients who received EVT, a history of coronary heart disease, higher NIHSS on admission, higher serum glucose level on admission, ICA occlusion, a larger number of passes, and a longer onset to reperfusion time were associated with the unfavorable outcome. These results were consistent with the previous research. Moreover, a shred of new-found evidence in this study was that a longer EVT to anticoagulation time was the independent risk factor that was associated with the efficacy and safety outcomes at 90-day follow-up after AIS onset (Fig. 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 daysBased on the guidelines and the clinical practice in large clinical studies [However, there wasn’t a piece of potent evidence to demonstrate that a late anticoagulation strategy benefited the decrease in recurrent ischemic cerebrovascular disease, mortality, and sICH event in our study (Furthermore, according to the result of our studied longitudinal cohort, we found that the optimum initiation time of anticoagulants after EVT for prediction of the favorable outcome (mRS 0–1) was 4.5 days, and 3.5 days for the hemorrhage events (sICH, any ICH, systemic hemorrhage). These two cut-off times also demonstrated that firstly, initiation of anticoagulant within four days after EVT does not improve the functional outcome of patients. This was consistent with the conclusions of previous studies that among patients with AF and LVO stroke necessitating EVT, adequacy of anticoagulation does not significantly affect the chances for a favorable outcome [Indeed, the debates on the optimal timing of anticoagulants after stroke existed for a long time and a series of studies focused on this issue. For example, multicenter data of Maurizio et.al [In this study, there were 86.8% of patients suffered from NVAF. The DOACs or VKAs can both be used as the first-line therapy for the secondary prevention of ischemic stroke in nonvalvular atrial fibrillation (NVAF) patients [