Annals of Neurology: Atrial fibrillation is pre-oral anticoagulant, which helps reduce the severity of stroke and improves thrombosis prognosis

Oral anticoagulants, such as direct oral anticoagulants or vitamin K antagonists VKAs, are very effective in preventing atrial fibrillation in patients with acute ischemic stroke.
, however, the incidence of ischemic stroke using anticoagulant drugs is 2% per year, and 10% of all ischemic stroke patients have received anticoagulant therapy at the time of stroke.
previous therapeutic VKA and DOAC therapies were associated with a decrease in the severity of stroke.
acute retransmosis therapy (venous thrombosis (IVT) and mechanical hydrant (MT) is the cornerstone of acute stroke therapy, which improves functional outcomes and prevents severe disability after stroke.
According to the Guidelines of the American Heart Association/American Stroke Association (AHA/ASA), early anticoagulant therapy is a relative drug taboo for IVT, and the use of MT requires risk-benefit judgment.
observational results show that IVT and MT are safe in patients who choose to take VKAs (INR ≤1.7) and DOACs.
, however, early anticoagulant therapy brings a major challenge in hyperacute scenarios - increasing the risk of symptomatic intracranial bleeding.
, advance DOAC treatment may be a major obstacle to the use of acute rectration therapy, as uncertainty of drug ability monitoring cannot be accurately assessed.
, the benefits of previous DOAC therapies for acute stroke characteristics may in turn be offset by poor long-term functional outcomes due to reluctance to use acute rectation therapy.
Based on the above questions, Thomas R. Meinel of the University of Bern and others explored the relationship between early anticoagulant (VKA) or direct oral anticoagulant (DOACs) and stroke severity, venous thrombosis (IVT) use, IVT safety, and 3-month prognosis in patients with atrial fibrillation and acute ischemic stroke.
They included patients who received continuous anticoagulant therapy in 2014-2019 and patients who did not receive anticoagulant therapy, conducting a cohort study to explore the relationship between early anticoagulant and the following outcomes: severity of stroke, IVT/mechanical thrombosis rate, symptomatic intracranial hemorrhage (sICH), and a good prognosis at 3 months (modified Rankin score 0-2).
total of 8,179 patients (average age 79.8 years, average age 9.6 years, 49% female), 1486 (18%) were treated with VKA, 1634 (20%) were treated with DOAC, and 5,059 were compared.
patients with lower stroke severity than VKA and control groups.
the VKA and DOAC groups were significantly lower in IVT than in the control group (aOR=0.67 and aOR=0.06).
IVT, the ICH rates were 3.6% in the control group, 4.6% in the VKA group, and 3.1% in the DOAC group.
, DOAC's early anticoagulant was associated with good results for 3 months (aOR=1.24) after adjusting for prognostic-related conferring factors.
importance of this study: early access to DOAC treatment in patients with atrial fibrillation was associated with a decrease in the severity of stroke admitted to hospital at the onset of the disease and a significant decrease in the incidence of IVT.
, patients taking DOAC may have better functional outcomes after 3 months.
of course, further research is needed to overcome the limitations of DOACs for IVT treatment.
origins: Meinel, TR, Branca, M., De Marchis, GM, Nedeltchev, K., Kahles, T., Bonati, L., ... & Investigators of the Swiss Stroke Registry. (2021). Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation. Annals of neurology , 89 (1), 42-53.<!--5f39ae17-8c62-4a45-bc43-b32064c9388a: W3siYmxvY2tJZCI6IjY1NzctMTYxMDIxOTc5MzgwNCIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOlt7ImNoYXIiOiJBIn0seyJjaGFyIjoibiJ9LHsiY2hhciI6Im4ifSx7ImNoYXIiOiJhIn0seyJjaGFyIjoibCJ9LHsiY2hhciI6InMifSx7ImNoYXIiOiIgIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImYif Sx7ImNoYXIiOiIgIn0seyJjaGFyIjoiTiJ9LHsiY2hhciI6ImUifSx7ImNoYXIiOiJ1In0seyJjaGFyIjoiciJ9LHsiY2hhciI6Im8ifSx7ImNoYXIiOiJsIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImcifSx7ImNoYXIiOiJ5In0seyJjaGFyIjoiICJ9LHsiY2hhciI6IuaIvyJ9LHsiY2hhciI6IumipCJ9LHsiY2hhciI6IuaPkCJ9LHsiY2hhciI6IuWJjSJ9LHsiY2hhciI6IuWPoyJ9LHsiY2hhciI6IuacjSJ9LHsiY2hhciI6IuaKlyJ9LHsiY2hhciI6IuWHnSJ9LHsiY2hhciI6Iu +8jCJ9LHsiY2hhciI6IuaciSJ9LHsiY2hhciI6IuWKqSJ9LHsiY2hhciI6IuS6jiJ9LHsiY2hhciI6IumZjSJ9LHsiY2hhciI6IuS9jiJ9LHsiY2hhciI6IuiEkSJ9LHsiY2hhciI6IuS4rSJ9LHsiY2hhciI6IumjjiJ9LHsiY2hhciI6IuS4pSJ9LHsiY2hhciI6IumHjSJ9LHsiY2hhciI6IuaApyJ9LHsiY2hhciI6Iu+ 8jCJ9LHsiY2hhciI6IuaUuSJ9LHsiY2hhciI6IuWWhCJ9LHsiY2hhciI6Iua6tiJ9LHsiY2hhciI6IuagkyJ9LHsiY2hhciI6IumihCJ9LHsiY2hhciI6IuWQjiJ9XSwiaXNSaWNoVGV4dCI6dHJ1ZSwia2VlcExpbmVCcmVhayI6dHJ1ZX19LHsiYmxvY2tJZCI6IjkyMzAtMTYxMDIyMTc5Njc2OCIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIs InJpY2hUZXh0Ijp7ImRhdGEiOltdLCJpc1JpY2hUZXh0Ijp0cnVlLCJrZWVwTGluZUJyZWFrIjp0cnVlfX0seyJibG9ja0lkIjoiMjI3MC0xNjEwMjIxNTg4NDI1IiwiYmxvY2tUeXBlIjoicGFyYWdyYXBoIiwic3R5bGVzIjp7ImFsaWduIjoibGVmdCIsImluZGVudCI6MCwidGV4dC1pbmRlbnQiOjAsImxpbmUtaGVpZ2h0IjoxLjc1LCJiYWNrLWNvbG9yIjoiIiwicGFkZGluZyI6IiJ9LCJ0eXBlIjoicGFyYWdyYXBoIiwicmljaFRleHQiOnsiZGF0YSI6W3siY2hhciI6IuWPoyJ9LHsiY2hhciI6IuacjSJ9LHsiY2hhciI6IuaKlyJ9LHsiY2hhciI6I uWHnSJ9LHsiY2hhciI6Iu+ 8jCJ9LHsiY2hhciI6IuavlCJ9LHsiY2hhciI6IuWmgiJ9LHsiY2hhciI6IuebtCJ9LHsiY2hhciI6IuaOpSJ9LHsiY2hhciI6IuWPoyJ9LHsiY2hhciI6IuacjSJ9LHsiY2hhciI6IuaKlyJ9LHsiY2hhciI6IuWHnSJ9LHsiY2hhciI6IuWJgiJ9LHsiY2hhciI6IuaIliJ9LHsiY2hhciI6Iue7tCJ9LHsiY2hhciI6IueUnyJ9LHsiY2hhciI6Iue0oCJ9LHsiY2hhciI6IiAifSx7ImNoYXIiOiJLIn0seyJjaGFyIjoi5ouuIn0seyJjaGFyIjoi5oqXIn0seyJjaGFyIjoi5YmCIn0seyJjaGFyIjoiViJ9LHsiY2hhciI6IksifSx7ImNoYXIiOiJBIn0seyJj aGFyIjoicyJ9LHsiY2hhciI6IuWcqCJ9LHsiY2hhciI6IumihCJ9LHsiY2hhciI6IumYsiJ9LHsiY2hhciI6IuaApSJ9LHsiY2hhciI6IuaApyJ9LHsiY2hhciI6Iue8uiJ9LHsiY2hhciI6IuihgCJ9LHsiY2hhciI6IuaApyJ9LHsiY2hhciI6IuiEkSJ9LHsiY2hhciI6IuWNkiJ9LHsiY2hhciI6IuS4rSJ9LHsiY2hhciI6IuaCoyJ9LHsiY2hhciI6IuiAhSJ9LHsiY2hhciI6IueahCJ9LHsiY2hhciI6IuaIvyJ9LHsiY2hhciI6IumipCJ9LHsiY2hhciI6IuS4rSJ9LHsiY2hhciI6IumdniJ9LHsiY2hhciI6IuW4uCJ9LHsiY2hhciI6IuaciSJ9LHsiY 2hhciI6IuaViCJ9LHsiY2hhciI6IuOAgiJ9LHsiY2hhciI6IueEtiJ9LHsiY2hhciI6IuiAjCJ9LHsiY2hhciI6Iu+ 8jCJ9LHsiY2hhciI6IuavjyJ9LHsiY2hhciI6IuW5tCJ9LHsiY2hhciI6IuS9vyJ9LHsiY2hhciI6IueUqCJ9LHsiY2hhciI6IuaKlyJ9LHsiY2hhciI6IuWHnSJ9LHsiY2hhciI6IuiNryJ9LHsiY2hhciI6IueJqSJ9LHsiY2hhciI6IueahCJ9LHsiY2hhciI6Iue8uiJ9LHsiY2hhciI6IuihgCJ9LHsiY2hhciI6IuaApyJ9LHsiY2hhciI6IuWNkiJ9LHsiY2hhciI6IuS4rSJ9LHsiY2hhciI6IuWPkSJ9LHsiY2hhciI6IueUnyJ9LHsiY2hhciI6IueOhyJ9LHsiY2hhciI6IuS4uiJ9LHsiY2hhciI6IjIifSx7ImNoYXIiOiIlIn0seyJjaGFyIjoiICJ9 LHsiY2hhciI6Iu+8jCJ9LHsiY2hhciI6IuWcqCJ9LHsiY2hhciI6IuaJgCJ9LHsiY2hhciI6IuaciSJ9LHsiY2hhciI6Iue8uiJ9LHsiY2hhciI6IuihgCJ9LHsiY2hhci