By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
Dr. Fink reports no financial relationships relevant to this field of study.
SOURCE: Giustozzi M, Acciarresi M, Agnelli G, et al. Safety of anticoagulation in patients treated with urgent reperfusion for ischemic stroke related to atrial fibrillation. Stroke 2020; July 10. doi:10.1161/STROKEAHA.120.030143. [Online ahead of print].
Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy. Guidelines state that no anticoagulation should be given within the first 24 hours following thrombolysis or mechanical thrombectomy, but there are no further recommendations that have reached a level of consensus. These investigators attempted to assess the incidence of early recurrence of stroke or major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with reperfusion therapy who then received oral anticoagulants for secondary prevention.
The investigators analyzed data from two large studies of patients with ischemic stroke and atrial fibrillation, and compared the composite rates of recurrent stroke, transient ischemic attack, systemic embolism, intracerebral hemorrhage, and major extracerebral bleeding within 90 days from inclusion into the study. The study included 2,159 patients, with 26% receiving acute reperfusion therapy. Ninety percent of patients treated with acute reperfusion therapy were started on oral anticoagulation, compared to 81% of those who were untreated. The timing of starting oral anticoagulants was similar in both groups (median 7.5 days vs. 7.0 days, respectively).
At 90 days, the primary study outcome occurred in 7% of patients treated with acute reperfusion therapy, compared to 9% of patients who were treated conservatively without reperfusion. There was no statistically significant difference between the two groups. After matching the groups and further analysis, the risk of primary outcome was comparable between the two groups. The investigators concluded that acute reperfusion therapy did not influence the risk of early stroke recurrence or major bleeding in patients with ischemic stroke related to atrial fibrillation.