@article{2987479,
    title = "Safety of Anticoagulation in Patients Treated with Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation",
    author = "Giustozzi, M. and Acciarresi, M. and Agnelli, G. and Caso, V. and Bandini, F. and Tsivgoulis, G. and Yaghi, S. and Furie, K.L. and Tadi, P. and Becattini, C. and Zedde, M. and Abdul-Rahim, A.H. and Lees, K.R. and Alberti, A. and Venti, M. and D'Amore, C. and Giulia Mosconi, M. and Anna Cimini, L. and Bovi, P. and Carletti, M. and Rigatelli, A. and Cappellari, M. and Putaala, J. and Tomppo, L. and Tatlisumak, T. and Marcheselli, S. and Pezzini, A. and Poli, L. and Padovani, A. and Vannucchi, V. and Sohn, S.-I. and Lorenzini, G. and Tassi, R. and Guideri, F. and Acampa, M. and Martini, G. and Ntaios, G. and Athanasakis, G. and Makaritsis, K. and Karagkiozi, E. and Vadikolias, K. and Liantinioti, C. and Theodorou, A. and Halvatsiotis, P. and Mumoli, N. and Galati, F. and Sacco, S. and Tiseo, C. and Corea, F. and Ageno, W. and Bellesini, M. and Silvestrelli, G. and Ciccone, A. and Lanari, A. and Scoditti, U. and Denti, L. and Mancuso, M. and Ferrari, E. and Ulivi, L. and Orlandi, G. and Giannini, N. and Tassinari, T. and Luisa De Lodovici, M. and Rueckert, C. and Baldi, A. and Toni, D. and Letteri, F. and Giuntini, M. and Maria Lotti, E. and Flomin, Y. and Pieroni, A. and Kargiotis, O. and Karapanayiotides, T. and Monaco, S. and Maimone Baronello, M. and Csiba, L. and Szabó, L. and Chiti, A. and Giorli, E. and Del Sette, M. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Michel, P. and Vanacker, P. and Barlinn, K. and Barlinn, J. and Deleu, D. and Gourbali, V. and Paciaroni, M. and Masotti, L.",
    journal = "ISRN Stroke",
    year = "2020",
    volume = "51",
    number = "8",
    pages = "2347-2354",
    publisher = "Lippincott Williams and Wilkins",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.120.030143",
    keywords = "alteplase;  anticoagulant agent;  antivitamin K;  enoxaparin;  low molecular weight heparin;  anticoagulant agent, aged;  anticoagulant therapy;  Article;  atrial fibrillation;  bleeding;  brain ischemia;  clinical outcome;  controlled study;  female;  fibrinolytic therapy;  human;  major clinical study;  male;  mechanical thrombectomy;  priority journal;  recurrent disease;  secondary prevention;  adverse event;  atrial fibrillation;  bleeding;  blood clotting;  brain ischemia;  cerebrovascular accident;  drug effect;  fibrinolytic therapy;  middle aged;  physiology;  procedures;  prospective study;  reperfusion;  thrombectomy;  treatment outcome;  very elderly, Aged;  Aged, 80 and over;  Anticoagulants;  Atrial Fibrillation;  Blood Coagulation;  Brain Ischemia;  Female;  Hemorrhage;  Humans;  Male;  Middle Aged;  Prospective Studies;  Reperfusion;  Stroke;  Thrombectomy;  Thrombolytic Therapy;  Treatment Outcome",
    abstract = "Background and Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either Vitamin K antagonists or nonVitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. Results: A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]). Conclusions: Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant. © 2020 The Authors."
}