Impact of anticoagulation management following endovascular therapy on prognosis of patients with atrial fibrillation and acute ischemic stroke

TL;DR

Starting anticoagulation therapy at hospital discharge improves recovery and reduces mortality in atrial fibrillation patients who had a stroke and underwent endovascular therapy.

Contribution

Demonstrates that early oral anticoagulant use after stroke treatment significantly improves patient outcomes, even after adjusting for baseline differences.

Findings

Anticoagulated patients had better functional outcomes at 90 days and 1 year post-discharge.

Lower all-cause mortality was observed in the anticoagulation group within both 90 days and 1 year.

OAC therapy was identified as an independent predictor of improved functional recovery.

Abstract

This study evaluates the impact of early oral anticoagulant (OAC) initiation at hospital discharge on functional and safety outcomes in atrial fibrillation (AF)-related acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT).

AF patients undergoing EVT of symptom onset in AIS were included in this study. Patients were grouped by postoperative anticoagulation status. The patients were regularly followed up 90 days and 1 year after discharge. The primary outcome measure for assessing prognosis is the modified Rankin Scale (mRS) score. The secondary evaluation indicators were the occurrence of recurrent ischemic stroke/systemic embolism (IS/SE) outcomes, safety outcomes, and all-cause mortality outcomes within 1 year. The differences in prognostic indicators between the two groups were compared by combining PSM.

Among the 296 eligible patients, 113 (38.18%) received anticoagulation at discharge, while 183 (61.82%) did not. Before PSM, the anticoagulation cohort exhibited markedly elevated rates of favorable functional outcomes at 90 days post-discharge (mRS 0–2: 60.18% vs. 25.14%, P < 0.001) and at 1 year (mRS 0–2: 64.60% vs. 30.05%, P < 0.001), along with a lower all-cause mortality rate within 1 year (16.81% vs. 44.26%, P < 0.001). After PSM, the results demonstrated that the anticoagulation group had elevated rates of favorable functional outcomes at 90 days (55.81% vs. 27.91%, P < 0.001) and at 1 year (60.47% vs. 30.23%, P < 0.001). The anticoagulation group had a lower all-cause mortality rate at both 90-day (11.63% vs. 40.70%, P < 0.001) and 1-year follow-up (17.44% vs. 50%, P < 0.001). Statistical analysis revealed no significant intergroup differences in terms of IS/SE recurrence rates, safety outcomes. Multivariate logistic regression modeling identified OAC therapy upon discharge as an independent predictor of improved 90-days (OR = 4.478, 95% CI: 1.122–17.874, P = 0.034) and 1 year (OR = 4.168, 95% CI: 1.118–5.542, P = 0.033) functional recovery among patients.

In patients with AF complicated by stroke who underwent EVT and were at no high risk for severe bleeding, OAC therapy is associated with improved functional and mortality outcomes compared with those not receiving OAC. The benefit remained statistically significant following PSM to adjust for intergroup disparities.

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