Efficacy And Safety Of Early Anticoagulant Therapy For Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation

Objective:nonvalvular atrial fibrillation(NVAF)is an important independent risk factor of cerebral stroke,and high risk factor for early recurrence of stroke.Some studies have suggested that early anticoagulant therapy can help to prevent the early recurrence of stroke,but currently there is a lack of high-quality practice guidelines,and its efficacy and safety are still controversial.There is currently a lack of high-quality randomized controlled trials to demonstrate the efficacy and safety of new oral anticoagulatant in the treatment of patients with recent(previous)ischemic stroke.The purpose of this study is to evaluate the efficacy and safety of early use of new oral anticoagulants in patients with recent(first few weeks)acute ischemic stroke and NVAF.Methods:patients admitted to the department of neurology of liaoning provincial people's hospital from September 2018 to August 2019 and diagnosed with acute ischemic stroke complicated with atrial fibrillation were selected as the study subjects.The NOAC group(dabigatran,rivaroxaban)and the control group(aspirin,clopidogrel or both)were divided according to whether or not the new oral anticoagulants were used.Clinical data of patients were collected,including demographic information,vascular risk factors,previous disease history and clinical data(NIHSS score,etc.),imaging data(head MRI,cardiac ultrasound,etc.),and laboratory examination.SPSS22.0 software was used for data statistics and analysis.Results:a total of 105 patients with acute stroke with atrial fibrillation were enrolled,including 51 patients(48.6%)in the NOAC group and 54 patients in the control group.In the entire cohort,30 patients(28.6%)in the NOAC group applied rivaroxaban and 21 patients(20%)applied dabigatran.The median delay time of oral anticoagulant therapy at onset after stroke was 4 days(2-7 days in the quartile range),with an average median delay time of 3 days(1-5 days in the quartile range)for early anticoagulant therapy and 12.5 days(8.75-15.75 days in the quartile range)for latetreatment.During the 90-day follow-up,no patients were lost to follow-up.Among the subjects,7(6.7%)had a composite endpoint event: 5(4.8%)were recurrent ischemic stroke events,including 3(5.9%)in the NOAC group and 2(3.7%)in the control group.Two cases(1.9%)were intracranial bleeding events,and one case(2%)was in each NOAC group and control group respectively,all of which were asymptomatic intracranial bleeding events.In the NOAC group,75%(3/4)of the composite endpoint events were recurrent stroke and 25%(1/4)were bleeding transformation.With the exception of 1 patient,all recurrent ischemic stroke events were treated with anticoagulants within 7 days of onset.Two patients(50%)received dabigatran and two(50%)received rivaroxaban.The age of the 4 patients was >55 years old.Among the 3 patients with recurrent stroke,2(50%)were female and 1 was male.All 4 patients had at least one risk factor for cardiovascular and cerebrovascular disease,and all had left atrial enlargement and significantly elevated BNP levels.In the control group,there were 3patients with endpoint events,including 2 patients(66.7%)with recurrent stroke and 1patient(33.3%)with hemorrhage transformation.All the 3 patients were female,of whom 2(66.7%)were >90 years old.All 3 patients had at least one cardiovascular risk factor,all of which were persistent atrial fibrillation,left atrial enlargement,and BNP abnormalities.Conclusion:For acute ischemic stroke patients with atrial fibrillation,including patients with NIHSS score ?8,early application of novel oral anticoagulant drugs to prevent stroke recurrence is effective and safe.