Anticoagulation Therapy After Reperfusion Treatment for Non-Valvular Atrial Fibrillation-Related Acute Ischemic Stroke—A Multicenter Retrospective Study

Anticoagulation Therapy After Reperfusion Treatment for Non-Valvular Atrial Fibrillation-Related Acute Ischemic Stroke—A Multicenter Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anticoagulation Therapy After Reperfusion Treatment for Non-Valvular Atrial Fibrillation-Related Acute Ischemic Stroke—A Multicenter Retrospective Study Fang Li, Jingjing Liu, Fan Zhang, Xiangbin Wu, Tingmin Dai, Jie Kuang, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4117392/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To understand anticoagulation therapy in acute ischemic stroke (AIS) patients with related atrial fibrillation (AF) after receiving reperfusion treatments in the real world. Methods This retrospective study collected basic clinical data, the initiation time of anticoagulation therapy, treatment plans, and prognosis of acute ischemic stroke patients with atrial fibrillation who underwent intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or a combination of IVT and EVT from January 2019 to January 2022 in four tertiary hospitals in Jiangxi Province. A multivariate logistic regression analysis was used to analyze the factors influencing anticoagulation therapy in these patients. Results A total of 410 patients met the selection criteria, including 168 (41.0%) in the IVT group, 144 (35.1%) in the EVT group, and 98 (23.9%) in the IVT + EVT group. Initiation of anticoagulation therapy within 14 days post-AIS was found in 175 patients in total (42.7%), which is significantly different in three groups (49.7% in IVT group, 30.3% in EVT group, and 20.0% in IVT + EVT groups, P < 0.01). Multivariate logistic regression analysis revealed that prior use of antiplatelet drugs was more common in patients receiving early anticoagulation therapy (OR = 0.122, 95% CI: 0.065–0.228, P < 0.01). Patients receiving no anticoagulation had higher-3- days post-reperfusion NIHSS score (OR = 1.109, 95% CI: 1.073–1.147, P < 0.01) and more in-hospital hemorrhagic transformation (OR = 2.572, 95% CI: 1.423–4.648, P < 0.01). Of all patients, 281 had a favorable 90-day prognosis [mRS score 0–2], including 152 (86.9%) in the early anticoagulation group and 129 (54.9%) in the late anticoagulation group (P < 0.01). Postoperative 90-day outcomes included 25 (6.1%) cases of recurrent ischemic stroke (P = 0.55) and 27 (6.6%) bleeding events (p = 0.32). Conclusions Early initiation of anticoagulation therapy improves 90-day outcomes in nonvalvular AF post-related AIS patients with related AF after receiving reperfusion treatments; however, the initiation of anticoagulation in most patients might be much later than the currently recommended timing in real world. Ischemic Stroke Atrial Fibrillation Intravenous Thrombolysis Endovascular Intervention Anticoagulation Therapy ICH Figures Figure 1 Introduction Cardioembolic strokes account for about 1/4 of all stroke types ( 1 , 2 ), with approximately 70% caused by atrial fibrillation. Compared to other causes, cardioembolic strokes are often more severe, have a poorer prognosis, and have a higher recurrence rate ( 3 , 4 ). Reperfusion therapy using intravenous thrombolysis (IVT) or endovascular treatment (EVT) is recommended as a standard of treatment for AIS by stroke guidelines ( 5 ). Current research confirms that atrial fibrillation can be prevented by oral anticoagulants to avoid embolic events, with a reduction in the recurrence risk of ischemic stroke to 3.0%, it also increases the risk of intracranial hemorrhage by 1.8% ( 6 – 10 ). Based on studies related to the optimal timing of oral anticoagulation in patients with acute ischemic stroke (AIS) with atrial fibrillation ( 11 ), the recommended timing of anticoagulation is the "1-3-6-12" rule based on expert consensus by the European Heart Rhythm Association and the European Society of Cardiology, and the "4–14”( 12 ) day standard based on the RAF trial ( 13 ) recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines. However, AIS patients with related AF who receive reperfusion therapy often have a higher severity of stroke,a larger lesion, higher NIHSS scores, and more severe conditions. Until now, there have been no specific recommendations for the optimal timing of anticoagulation treatment for those patients ( 14 – 18 ). The main objective of this study is to observe the current status and the factors influencing the initiation of anticoagulation in acute ischemic stroke patients with related AF who have undergone reperfusion therapy in the real world. Methods Patients This study involved patients discharged from January 2019 to January 2022, diagnosed with acute cerebral infarction and atrial fibrillation, and who underwent intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or a combination of IVT and EVT. The investigation was conducted through electronic medical records systems at the Second Affiliated Hospital of Nanchang University, Ganzhou People's Hospital, Yingtian People's Hospital, and the Affiliated Hospital of Jiujiang College. This study was registered with the ethics committee of the institution. Inclusion criteria were: ( 1 ) discharge diagnoses including "cerebral infarction" and "atrial fibrillation" or "paroxysmal atrial fibrillation" or "atrial flutter" or "paroxysmal atrial flutter" or "flutter"; ( 2 ) cases treated with "IVT" or/and "EVT". Exclusion criteria were: ( 1 ) cases with diagnoses of "cardiac valvular disease" or "rheumatic heart disease"; ( 2 ) cases of self-discharge due to severe illness, transfer to another hospital, or death; ( 3 ) cases with missing data, making research completion impossible. Data Collection A retrospective study design was employed. Patients' data, including age, sex, history of hypertension/diabetes, history of stroke, history of previous atrial fibrillation, antithrombotic drugs(antiplatelet drugs/anticoagulants) used previously, ASPECT score, NIHSS score before vascular reperfusion, mRS score before reperfusion, CHA2DS2-VASc score, HAS-BLED score, method of vascular reperfusion, time of reperfusion, NIHSS score 3 days after reperfusion, timing of anticoagulation initiation after reperfusion, anticoagulation regimen, pre-anticoagulation antiplatelet drug use, hemorrhagic transformation, hemorrhage type (ECASS classification), concurrent complications, NIHSS score at discharge, mRS score at discharge, 90-day mRS score, any bleeding events at 90 days, and recurrent cerebral infarction, were recorded. Outcome The primary outcome measure was the timing and regimen of anticoagulation initiation/re-initiation in patients. Secondary outcome measures included any ischemic stroke recurrence or new bleeding events within three months. Statistical Analysis Quantitative data with normal distribution were expressed as mean ± standard deviation (SD) and compared by ANOVA. Non-normally distributed quantitative data were expressed as median with interquartile range [M(P25, P75)] and compared using the Kruskal-Wallis H test. Categorical data were expressed as percentages (%) and analyzed using the chi-squared test or Fisher's exact test. Multivariate logistic regression analysis was used to determine the independent factors influencing anticoagulation therapy in patients with AF-related stroke. A p-value < 0.05 was considered statistically significant, and the Bonferroni method was used for multiple comparisons to adjust for the level of significance. All analyses were performed using SPSS 25.0 software (IBM SPSS Statistics for Windows, Version 25.0; Armonk, NY: IBM Corp). Results Patients characteristics A total of 410 patients underwent vascular reperfusion treatment (Fig. 1 ), including 168 (41.0%) in the IVT group, 144 (35.1%) in the EVT group, and 98 (23.9%) in the IVT + EVT group, as detailed in Table 1 . The average age of all patients was 72.66 (± 9.622) years, with 208 (50.7%) female patients. 40 (9.8%) patients had previously been treated with antithrombotic drugs, and 29 had received anticoagulant therapy. Among the 224 (54.6%) patients previously diagnosed with atrial fibrillation, only 28 were on anticoagulant medication at admission. Of the 72 patients with a history of ischemic stroke, 42 were diagnosed with atrial fibrillation, but only 14 were on anticoagulants. Age (P < 0.01), history of stroke (P = 0.02), history of atrial fibrillation (P = 0.01), NIHSS score before vascular reperfusion (P < 0.01), ASPECT score (P < 0.01), mRS score before reperfusion (P = 0.02), use of antiplatelet drugs before reperfusion (P = 0.05), NIHSS score 3 days after reperfusion (P < 0.01), hemorrhagic transformation conversion post-reperfusion (P < 0.01), and start of oral anticoagulation therapy (P < 0.01) were all statistically different between groups. After more comparisons, it was found that the IVT group had lower NIHSS scores before and after reperfusion, lower rates of hemorrhagic transformation conversion, and lower rates of starting anticoagulation more than 14 days later than the other groups. The EVT group had lower ages and ASPECT scores than the other groups, a higher proportion of previous atrial fibrillation, and a lower proportion of pre-anticoagulation antiplatelet drug use compared to the IVT group. The IVT + EVT group had a lower proportion of patients with a history of stroke compared to the other groups. Antithrombotic drug use Of the patients, 287 (70%) received anticoagulation therapy during their hospitalization. This included 110 patients on single oral anticoagulants, of whom 68 were previously on antiplatelet therapy (single or dual); 103 patients received subcutaneous heparin bridging to oral anticoagulants, 29 received subcutaneous heparin bridging to antiplatelet therapy, and 39 on subcutaneous heparin alone. Six patients received apixaban, four of whom were bridged to oral anticoagulants and one to antiplatelet therapy. Of the patients who did not receive anticoagulation therapy, 72 were on antiplatelet therapy (single or dual), and 51 received no antithrombotic drugs. Factors associated with anticoagulation therapy Of the 410 patients, 235 received oral anticoagulant therapy beyond the acute hospitalization (> 14 days). Univariate analysis of clinical data comparing in-hospital oral anticoagulant therapy to delayed (or non-) oral anticoagulant therapy (Table 2 ) revealed statistically significant differences in pre-reperfusion NIHSS score, ASPECT score, pre-reperfusion mRS score, method of vascular reperfusion, NIHSS score 3 days after reperfusion, pre-anticoagulation antiplatelet drug use, and hemorrhagic transformation conversion post-reperfusion (P < 0.05). Multivariate logistic regression analysis (Table 3 ) showed that pre-anticoagulation antiplatelet drug use (OR = 0.122, 95%CI: 0.065–0.228, P < 0.01) was favorable for early initiation of anticoagulant therapy. Higher NIHSS score 3 days post-reperfusion (OR = 1.109, 95%CI: 1.073–1.147, P < 0.01) and hemorrhagic transformation during hospitalization (OR = 2.572, 95%CI: 1.423–4.648, P < 0.01) were unfavorable for anticoagulation therapy. For patients whose initiation of oral anticoagulation therapy was delayed beyond the acute hospitalization period, 120 questionnaires from chief physicians at the Second Affiliated Hospital of Nanchang University were collected. The analysis indicated that large infarct size (23%), infarct location (20%), and post-stroke hemorrhagic transformation (23%) were the most common reasons inflencing physicians' decisions to initiate anticoagulation therapy (Table 4 ). 90-day Prognosis Of the 410 patients, a total of 281 cases achieved a good prognosis [mRS score 0–2] within 90 days. This included 152 (86.9%) in the early anticoagulation group and 129 (54.9%) in the late anticoagulation group, with a statistically significant difference in 90-day good prognosis rates between the two groups (Table 5). Within 90 days post-treatment, there were 25 (6.1%) cases of ischemic stroke recurrence, with 7 patients having received early anticoagulation treatment, including 2 in the IVT group, 4 in the EVT group, and 1 in the IVT + EVT group. There were a total of 27 bleeding events at 90 days, including 16 cases of intracranial hemorrhage, 6 cases of gum bleeding, 2 cases of skin ecchymosis, 2 cases of urinary bleeding, and 1 case of gastrointestinal bleeding. The difference in the rates of ischemic stroke recurrence and bleeding events at 90 days between the different treatment groups and the timing of anticoagulation therapy was not statistically significant (Table 5). Discussion Based on the "Chinese Guidelines for the Prevention of Cardiogenic Stroke (2019)," the CHA2DS2-VASc scoring system is recommended for atrial fibrillation patients, suggesting oral anticoagulant therapy for males with a score ≥ 2 and females with a score ≥ 3 ( 19 ). This study included 410 patients, with 42.7% receiving oral anticoagulants during acute hospitalization, slightly higher than the global registry study—GARFIELD ( 20 )—which reported a 28% anticoagulation rate among Chinese patients with a CHA2DS2-VASc score ≥ 2. However, our study focused on acute cerebral infarction patients with a higher average age, indicating a higher risk population than the aforementioned studies, and suggesting an issue of insufficient anticoagulation. Oral anticoagulant therapy is the cornerstone for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation. Novel oral anticoagulants (NOACs) have been shown in previous research to be just as good as warfarin at preventing stroke. They have the same or a lower risk of major bleeding events and a much lower risk of intracranial hemorrhage ( 21 – 25 ). The RAF study demonstrated a better prognosis for patients with nonvalvular atrial fibrillation (NVAF) and AIS treated solely with oral anticoagulants compared to those treated with low molecular weight heparins (LMWH) alone or LMWH followed by oral anticoagulants. However, the optimal timing for initiating anticoagulation after acute ischemic stroke remains uncertain ( 26 ), as key large-scale studies comparing NOACs with warfarin excluded patients who had recently (within 7–30 days) experienced a stroke ( 21 , 23 – 24 ). Due to a lack of evidence, current international guidelines do not provide specific recommendations on the optimal timing for initiating anticoagulation therapy after an acute cerebral stroke. The latest research (TIMING, ELAN) suggests that early anticoagulation is more effective than delayed anticoagulation ( 27 , 28 ). The risk of ischemic stroke recurrence or post-stroke hemorrhagic transformation is highest within the first few days after an ischemic stroke ( 12 ). Such events may offset the advantages of acute secondary prevention. Previous studies indicate that patients receiving IVT, EVT, or IVT + EVT treatments might have higher symptomatic hemorrhagic transformation rates than control groups, but better 90-day outcomes [mRS score 0–2] ( 29 , 30 ). In this study, the early anticoagulation group (< 14 days) had a 90-day good prognosis rate of 86.9%, compared to 54.9% in the late anticoagulation group, with 90-day ischemic stroke recurrence and bleeding event rates of 4.0% and 6.9%, respectively. Referring to the TIMING trial for anticoagulation timing groups, the early anticoagulation initiation group (≤ 4 days) included 60 people, with a 90-day good prognosis rate of 93.3%, while the delayed or non-initiation group (> 4 days) with 350 people had a 90-day good prognosis rate of 64.3%. There were no new ischemic strokes in the early anticoagulation group within 90 days, but there were 5 new bleeding events, compared to 25 new ischemic strokes and 22 new bleeding events in the delayed group. The early (< 4 days) anticoagulation group had a higher proportion of a good prognosis at 90 days and fewer new ischemic strokes and bleeding events than the delayed group, aligning with the latest findings from the TIMING and ELAN studies. However, it should be noted that only 60 patients in our study initiated anticoagulation treatment early (≤ 4 days). The average age of the people in our study was 72.66 years, and their NIHSS score was 13. This is higher than the range of 2–10 in previous observational studies. Also, 17.3% of the people in our study had severe strokes (NIHSS > 25), which is much higher than in previous studies ( 5 , 18 , 31 , 32 ). Patients with early severe symptomatic bleeding or a high risk of bleeding did not meet the criteria for initiating anticoagulation therapy. The median time to initiate oral anticoagulant therapy during hospitalization in our study population was 7 days, higher than the currently recommended early initiation time ( 28 , 33 ). Only 42.7% of patients underwent anticoagulation therapy within 14 days of AIS occurrence, with 41.0% in the IVT group. However, the Irene ( 18 ) trial reported an 82% anticoagulation rate within 14 days, with 85.1% receiving IVT treatment and a median NIHSS score of 10 ( 6 – 16 ) at admission, compared to a median NIHSS score of 13 ( 8 – 20 ) in our study, with 10 in the IVT group and 15 in the EVT and IVT + EVT groups. For patients with atrial fibrillation undergoing EVT treatment, initiating anticoagulation between 5–14 days resulted in the lowest recurrence rate of ischemic cerebrovascular events ( 34 ). Thus, a higher NIHSS score, more severe stroke, and endovascular intervention may significantly impact the timing of anticoagulation initiation and outcome events ( 32 , 35 , 36 ), including increasing the risk of bleeding. Previous studies have shown that the ICH (intracranial hemorrhage) incidence rate in IVT patients is 2.7–5.1% and even lower in EVT patients ( 37 – 39 ). In our study, there were 116 cases of ICH, with a 7.6% incidence rate of large parenchymal hematoma (PH2). Moreover, our findings suggest that pre-anticoagulation antiplatelet drug use is a protective factor for early initiation of anticoagulation treatment (OR = 0.122, 95% CI: 0.065–0.228, P < 0.001), which is inconsistent with previous experimental results ( 40 ). This suggests that physicians' use of antiplatelet drugs before anticoagulation typically indicates no bleeding events in these patients. However, in the GARFIELD-AF study, the use of NOACs in conjunction with antiplatelet drugs, regardless of the sequence, increased the risk of stroke or bleeding in patients with atrial fibrillation ( 40 ). Currently, there are few studies on the status of anticoagulation therapy in patients with NVAF and AIS undergoing vascular recanalization therapy. In the RAF and TIMING studies, only 22.4% and 35.2% of patients, respectively, underwent vascular recanalization therapy. Compared to patients who did not receive such therapy, these patients likely had more severe strokes, with higher mRS and NIHSS scores at admission. Pathologically, early in a stroke, particularly during ischemic reperfusion, the risk of hemorrhagic transformation increases due to impaired autoregulation and blood-brain barrier disruption; thus, early anticoagulation might elevate the risk of ICH ( 41 ). Additionally, for patients receiving EVT, initiating anticoagulation within 4 days did not significantly improve functional outcomes ( 34 ), potentially due to the small sample size of 60 patients initiating anticoagulation within this period in our study. The high proportion of good outcomes at 90 days in this group compared to the delayed anticoagulation group may indicate selection bias. Therefore, it's essential to further explore a balanced timing or period for anticoagulation therapy in such patients. The strength of this study is that it is a multicenter, real-world study that provides new evidence regarding the anticoagulation strategy after reperfusion therapy for patients with AF-related AIS. However, the study also has certain limitations. First, patient outcomes were assessed by telephone follow-ups, and due to the limited-literacy, some patients may not have been able to accurately report discontinued antiplatelet drugs or switch to anticoagulants. This could introduce some information bias into the study. Second, this is a retrospective study, with a larger proportion of patients receiving EVT, who are at a higher risk of bleeding. There is a selection bias in anticoagulation therapy, which limits the generalizability of the study results to other populations. Conclusion In summary, this study, along with previous observational studies, indicates that early initiation of anticoagulation therapy after AIS in patients treated with IVT, EVT, or both improves 90-day outcome and does not affect treatment safety. However, in most patients, anticoagulation therapy is initiated much later than the currently recommended timing. Declarations Declaration of conflicting interests: All authors declare no conflicts of interest. Author Contributions Statement: FL and JJ were responsible for experimental design, paper writing, statistical data analysis, and graphing; FZ, XB,TM,WP,CJ, MY, KW, and TH were responsible for data organization. JK: guidance on data analysis; JL and GY: research direction, article review, and financial assistance. All authors reviewed the manuscript. Funding: This work is supported by the National Natural Science Foundation of China (82260278, 82360667) and the Jiangxi Provincial Science and Technology Department Key R&D Program (20212BBG71012，20223BBG71010). Research ethics and patient consent: All enrolled patients had been approved by the Ethics Committee (O-Medical Research Ethics [2023] No. 35) of The Second Affiliated Hospital of Nanchang University, Nanchang, China. The study was conducted according to the principles of the Declaration of Helsinki.All persons gave their informed consent prior to their inclusion in the study. Acknowledgments: We express our gratitude to our mentors and department colleagues for their guidance and strong support in the research and manuscript preparation process. Data availability statement :The data that supports the findings of this study are available on request from the corresponding author, [J.L.T.], upon reasonable request. References Kamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017;120(3):514–26. .https://doi.org/10.1161/CIRCRESAHA.116.308407 . MacDougall NJ, Amarasinghe S, Muir KW. Secondary prevention of stroke. Expert Rev Cardiovasc Ther. 2009;7(9):1103–15. https://doi.org/10.1586/erc.09.77 . Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760–4. https://doi.org/10.1161/01.str.27.10.1760 . Bjerkreim AT, Khanevski AN, Thomassen L, et al. Five-year readmission and mortality differ by ischemic stroke subtype. J Neurol Sci. 2019;403:31–7. https://doi.org/10.1016/j.jns.2019.06.007 . Chinese Socity of Neurology, Chinese Stroke Neurology. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018. Chin J Neurol. 2018;51(9):666–82. https://doi.org/10.3760/cma.j.issn.1006-7876.2018.09.004 . Cairns JA. Stroke prevention in atrial fibrillation trial. Circulation. 1991;84(2):933–5. https://doi.org/10.1161/01.cir.84.2.933 . Saxena R, Koudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack. Cochrane Database Syst Rev. 2004;2CD000185. https://doi.org/10.1002/14651858.CD000185.pub2 . Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857–67. https://doi.org/10.7326/0003-4819-146-12-200706190-00007 . Seiffge DJ, Paciaroni M, Wilson D, et al. Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019;85(6):823–34. https://doi.org/10.1002/ana.25489 . Paciaroni M, Agnelli G, Micheli S, et al. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38(2):423–30. https://doi.org/10.1161/01.STR.0000254600.92975.1f . Gorenek B, Pelliccia A, Benjamin EJ et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace.2017;19(2),190–25. https://doi.org/10.1093/europace/euw242 . Powers WJ, Rabinstein AA, Ackerson T, et al. Association Stroke. 2019;50(12):e344–418. https://doi.org/10.1161/STR.0000000000000211 . Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke. Paciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study. Stroke. 2015;46(8):2175–82. https://doi.org/10.1161/STROKEAHA.115.008891 . Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. https://doi.org/10.1056/NEJMoa1411587 . Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. https://doi.org/10.1056/NEJMoa1414792 . Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306. https://doi.org/10.1056/NEJMoa1503780 . Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. https://doi.org/10.1056/NEJMoa1415061 . Escudero-Martinez I, Mazya M, Teutsch C, et al. Dabigatran initiation in patients with non-valvular AF and first acute ischaemic stroke: a retrospective observational study from the SITS registry. BMJ Open. 2020;10(5):e037234. https://doi.org/10.1136/bmjopen-2020-037234 . Atrial Fibrillation Stroke Prevention and Control Specialized Committee, Stroke Prevention and Control Expert Committee of the National Health and Wellness Commission.Cardiac Electrophysiology and Pacing Branch, Chinese Medical Association, ChinaCardiac Rhythmology Committee, Chinese Medical Doctor Association. Guidline on prevention and treatment of cardiogenic stroke(2019). Chin J Cardiac Arrhyth. 2019; 23(6):463–484. https//doi.org10.3760/cma.j.issn.1007-6638.2019.06.002. Camm AJ, Steffel J, Virdone S, et al. Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF. Eur Heart J Open. 2023;3(3):oead051. https://doi.org/10.1093/ehjopen/oead051 . Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92. https://doi.org/10.1056/NEJMoa1107039 . Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62. https://doi.org/10.1016/S0140-6736(13)62343-0 . Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51. https://doi.org/10.1056/NEJMoa0905561 . Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. https://doi.org/10.1056/NEJMoa1009638 . Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093–104. https://doi.org/10.1056/NEJMoa1310907 . Hankey GJ. Unanswered questions and research priorities to optimise stroke prevention in atrial fibrillation with the new oral anticoagulants. Thromb Haemost. 2014;111(5):808–16. https://doi.org/10.1160/TH13-09-0741 . Oldgren J, Åsberg S, Hijazi Z et al. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation.2022;146(14)1056–66 https://doi.org/10.1161/CIRCULATIONAHA.122.060666 . Fischer U, Koga M, Strbian D, et al. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023;388:2411–21. 10.1056/NEJMoa2303048 . National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. https://doi.org/10.1056/NEJM199512143332401 . Geng C, Li SD, Zhang DD, et al. Endovascular Thrombectomy Versus Bridging Thrombolysis: Real-World Efficacy and Safety Analysis Based on a Nationwide Registry Study. J Am Heart Assoc. 2021;10(3):e018003. https://doi.org/10.1161/JAHA.120.018003 . Paciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study. J Am Heart Assoc. 2017;6(12):e007034. https://doi.org/10.1161/JAHA.117.007034 . Seiffge DJ, Traenka C, Polymeris A, et al. Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events. Neurology. 2016;87(18):1856–62. https://doi.org/10.1212/WNL.0000000000003283 . Geriatric Neurology Group of the Chinese Medical Association Geriatrics Branch, Vascular Neurology Committee of the Beijing Neuroscience Society, Chinese Expert Consensus Group on Cardiac Stroke Treatment. Chinese Expert Consensus on Cardiac Stroke Treatment (2022). Natl Med J China. 2022;102(11):760–73. https//doi.org/10.3760/cma.j.cn112137-20210712-01555 . Ma H, Che R, Zhang Q, et al. The optimum anticoagulation time after endovascular thrombectomy for atrial fibrillation-related large vessel occlusion stroke: a real-world study. J Neurol. 2023;270(4):2084–95. https://doi.org/10.1007/s00415-022-11515-y . Arihiro S, Todo K, Koga M, et al. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: The SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016;11(5):565–74. https://doi.org/10.1177/1747493016632239 . Gioia LC, Kate M, Sivakumar L, et al. Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation: A Prospective Magnetic Resonance Imaging Study. Stroke. 2016;47(7):1917–9. https://doi.org/10.1161/STROKEAHA.116.013491 . Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929–35. https://doi.org/10.1016/S0140-6736(14)60584-5 . Mazya MV, Lees KR, Collas D, et al. IV thrombolysis in very severe and severe ischemic stroke: Results from the SITS-ISTR Registry. Neurology. 2015;85(24):2098–106. https://doi.org/10.1212/WNL.0000000000002199 . Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. https://doi.org/10.1016/S0140-6736(16)00163-X . Fox KAA, Velentgas P, Camm AJ, et al. Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation. JAMA Netw Open. 2020;3(2):e200107. https://doi.org/10.1001/jamanetworkopen.2020.0107 . Mac Grory B, Flood S, Schrag M, et al. Anticoagulation Resumption After Stroke from Atrial Fibrillation. Curr Atheroscler Rep. 2019;21(8):29. https://doi.org/10.1007/s11883-019-0790-x . Tables Table 1 Patients characteristics for IVT group, EVT group, and IVT + EVT group All patients (n = 410) IVT (n = 168) EVT (n = 144) IVT + EVT (n = 98) P value Age, mean (SD), y 72.66 ± 9.622 73.92 ± 9.408a 70.42 ± 9.939b 73.80 ± 8.995a 0.002* Female,No,(%) 208/(50.7) 82/(48.8) 83/(57.6) 43/(43.9) 0.089 Hypertension,No,(%) 251/(61.2) 106/(63.1) 84/(58.3) 61/(62.2) 0.671 Diabetes,No,(%) 71/(17.3) 28/(16.7) 23/(16.0) 20/(20.4) 0.642 hyperlipidemia,No,(%) 26/(6.3) 14/(8.3) 6/(4.2) 6/(6.1) 0.320 Smoking/drinking history,No(%) 54/(13.2) 16/(9.5) 23/(16.0) 15/(15.3) 0.189 Stroke,No(%) 72/(17.6) 33/(19.6)a 31/(21.5)a 8/(8.2)b 0.018 * History of previous atrial fibrillation ,No,(%) 224/(54.6) 78/(46.4)a 93/(64.4)b 53/(54.1)ab 0.006 * antithrombotic drugs used previously,No,(%) 40/(9.8) 16/(9.5) 17/(11.8) 7/(7.1) 0.483 NIHSS score before vascular reperfusion, median (IQR) 13( 8 , 20 ) 10( 5 , 16 )a 15( 10 , 25 )b 15(10.75,22)b 0.000 * ASPECT score, median (IQR) 8( 6 , 9 ) 8( 7 , 9 )a 7( 6 , 8 )b 8( 6 , 9 )a 0.000 * mRS score before vascular reperfusion, median (IQR) 4( 2 , 5 ) 3( 2 , 4 )a 4( 2 , 5 )ab 4( 1 , 5 )b 0.017 * CHA2DS2-VASc score, median (IQR) 5( 3 , 5 ) 5(3.25,6) 4( 3 , 5 ) 5( 4 , 6 ) 0.167 HAS-BLED score, median (IQR) 3( 2 , 3 ) 3( 2 , 3 ) 3( 2 , 3 ) 3( 2 , 3 ) 0.888 NHISS score 3 days after reperfusion, median (IQR) 8( 2 , 16 ) 3( 1 , 10 )a 12(5.25,18)b 8( 5 , 15 )b 0.000 * pre-anticoagulation antiplatelet drug use, No(%) 96/(23.4) 49/(29.2)a 25/(17.4)b 22/(22.4)ab 0.048 * Time to initiate oral anticoagulation after reperfusion ,No,(%) 0ཞ3d 34/(8.3) 18/(10.7) 9/(6.3) 7/(7.1) 0.324 4ཞ14d 141/(34.4) 69/(41.1) 44/(30.6) 28/(28.6) 0.057 > 14d 235/(57.3) 81/(48.2)a 91/(63.2)b 63/(64.3)b 0.008 * Hemorrhagic transformation,No,(%) 116/(28.2) 28/(16.7)a 55/(38.2)b 33/(33.7)b 0.000 * Note: mRS is modified Rankin score; NIHSS is National Institutes of Health Stroke Scale;* P <0. 05 ;“ཁ”、“ ག”: Post hoc two-by-two comparisons of results with Bonferroni-corrected significance levels were taken. Table 2 Patients characteristics for early start and delayed start All patients (n = 410) Early start (n = 175) Delayed start (n = 235) P value Age, mean (SD), y 72.66 ± 9.622 71.82 ± 10.114 73.29 ± 9.211 0.125 Female,No,(%) 208/(50.7) 82/(46.9) 126/(53.6) 0.176 Hypertension,No,(%) 251/(61.2) 105/(60) 146/(62.1) 0.662 Diabetes,No,(%) 71/(17.3) 33/(18.9) 38/(16.2) 0.477 hyperlipidemia,No,(%) 26/(6.3) 8/(4.6) 18/(7.7) 0.204 Smoking/drinking history,No(%) 54/(13.2) 28/(16.0) 26/(11.1) 0.144 Stroke,No(%) 72/(17.6) 34/(19.4) 38/(16.2) 0.391 History of previous atrial fibrillation ,No,(%) 224/(54.6) 97/(55.4) 127/(54.0) 0.780 antithrombotic drugs used previously,No,(%) 40/(9.8) 20/(11.4) 20/(8.5) 0.325 NIHSS score before vascular reperfusion, median (IQR) 13( 8 , 20 ) 10( 6 , 19 ) 10( 14 , 24 ) 0.000* ASPECT score, median (IQR) 8( 6 , 9 ) 8( 7 , 9 ) 7( 6 , 9 ) 0.001* mRS score before vascular reperfusion, median (IQR) 4( 2 , 5 ) 3( 1 , 5 ) 4( 2 , 5 ) 0.025* CHA2DS2-VASc score, median (IQR) 5( 3 , 5 ) 4( 3 , 5 ) 5( 4 , 5 ) 0.238 HAS-BLED score, median (IQR) 3( 2 , 3 ) 3( 2 , 3 ) 3( 2 , 3 ) 0.597 NHISS score 3 days after reperfusion, median (IQR) 8( 2 , 16 ) 3( 1 , 8 ) 11( 5 , 20 ) 0.000* pre-anticoagulation antiplatelet drug use, No(%) 96/(23.4) 76/(43.4) 20/(8.5) 0.000* Reperfusion treatment,No,(%) 0.008* IVT(a) 168/(41.0) 87/(49.7) 81/(34.5) EVT(b) 144/(35.1) 53/(30.3) 91/(38.7) IVT + EVT(b) 98/(23.9) 35/(20.0) 63/(26.8) Hemorrhagic transformation,No,(%) 116/(28.3) 26/(14.9) 90/(38.3) 0.000* Table 3 Multivariate logistic regression analysis of factors associated with anticoagulation therapy B SE Wald X² P value OR value 95%CI NHISS score 3 days after reperfusion 0.104 0.017 36.780 0.000 1.109 1.073–1.147 pre-anticoagulation antiplatelet drug use -2.106 0.321 43.147 0.000 0.122 0.065–0.228 Hemorrhagic transformation 0.945 0.302 9.782 0.002 2.572 1.423–4.648 Table 4 Reasons for delaying the start of oral anticoagulant beyond the attending physician's acute length of stay Reasons for delay % Severity of stroke 11% Large size of infarct 23% site of infarction 20% Haemorrhagic transformation 23% Other bleeding during hospitalisation (intracranial haemorrhage, gastrointestinal haemorrhage, urinary tract haemorrhage, etc.) 9% Patient bleeding risk factors 4% Other reasons 10% Total 100% Table 5.90 day prognosis after anticoagulation All patients (n = 410) Early start (n = 175) Delayed start (n = 235) P value 90-day favorable prognosis [mRS score 0–2],No,(%) 281/(68.5) 152/(86.9) 129/(54.9) 0.000* Recurrence of AIS ,No,(%) 25/(6.1) 7/(4.0) 18/(7.7) 0.553 IVT 2/(25.0) 6/(75.0) EVT 4/(40.0) 6/(60.0) IVT + EVT 1/(14.3) 6/(85.7) Incidence of bleeding events ,No,(%) 27/(6.6) 12/(6.9) 15/(6.4) 0.316 IVT 4/(36.4) 7/(63.6) EVT 4/(36.4) 7/(63.6) IVT + EVT 4/(80.0) 1/(20.0) Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jingjing","middleName":"","lastName":"Liu","suffix":""},{"id":282001570,"identity":"5179b993-9916-480f-ba3a-eef7865e2768","order_by":2,"name":"Fan Zhang","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"Zhang","suffix":""},{"id":282001571,"identity":"c0dd6ad3-bcee-4a21-9063-624ca88f812c","order_by":3,"name":"Xiangbin Wu","email":"","orcid":"","institution":"The Affiliated Hospital of Jiujiang University","correspondingAuthor":false,"prefix":"","firstName":"Xiangbin","middleName":"","lastName":"Wu","suffix":""},{"id":282001572,"identity":"042e9543-521c-4b28-87f7-3870be620f21","order_by":4,"name":"Tingmin Dai","email":"","orcid":"","institution":"The Affiliated Hospital of Jiujiang University","correspondingAuthor":false,"prefix":"","firstName":"Tingmin","middleName":"","lastName":"Dai","suffix":""},{"id":282001573,"identity":"70a20fc5-6bd9-4539-b4dc-2cef3a7ba365","order_by":5,"name":"Jie Kuang","email":"","orcid":"","institution":"Nanchang University School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Kuang","suffix":""},{"id":282001574,"identity":"68912848-994f-4966-bcde-b4ca443719be","order_by":6,"name":"Zhijuan Cheng","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Zhijuan","middleName":"","lastName":"Cheng","suffix":""},{"id":282001575,"identity":"688c62ce-40d4-4088-88f2-2b0fc781d473","order_by":7,"name":"Weiping Chen","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Weiping","middleName":"","lastName":"Chen","suffix":""},{"id":282001576,"identity":"f117f547-894a-4302-891e-f4c7e7ad6815","order_by":8,"name":"Min Yin","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Yin","suffix":""},{"id":282001577,"identity":"26d20c38-89b5-445d-b5b9-20fafb23dc8f","order_by":9,"name":"Kai Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Wang","suffix":""},{"id":282001578,"identity":"7c10a72a-dc63-4596-9dcc-2febfcde4a2e","order_by":10,"name":"Tinghao Guo","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Tinghao","middleName":"","lastName":"Guo","suffix":""},{"id":282001579,"identity":"128cb932-e731-4fa4-a1f3-995d25b6fa08","order_by":11,"name":"Guoyong Zeng","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guoyong","middleName":"","lastName":"Zeng","suffix":""},{"id":282001580,"identity":"e85cce82-216a-4db5-a0d5-d177b6f4f0c9","order_by":12,"name":"Jianglong Tu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYHCChANAQgaIGR//qJCQ4yekngeqBUgzMBsznLEwlmwgrAVOs0kztlUkbiCkxV4i4eGBnztqefil2y8bF86TYNzAwPzw0Q18tkgkJBzsPXOcR3LOmcLHM7dJMJszsBkb5xDQcoC37RiPwY2cZAPebRJslg08bNKEtBz8C9GSJsE7R4LH4AARWg7zttUAtaQfk+ZtkJAgrOXMg4TDsm0HeCRn5DAbzjgmYSDZTMAv7O05yR/fttXJ8UukP3zwoaauvp+9+eFjfFqA9iQAicMghgFEgBmvcrA9B4BEHYjxgKDaUTAKRsEoGJkAAFH1TUUnNvEXAAAAAElFTkSuQmCC","orcid":"","institution":"The Second Affiliated Hospital of Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Jianglong","middleName":"","lastName":"Tu","suffix":""}],"badges":[],"createdAt":"2024-03-17 14:14:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4117392/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4117392/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53254994,"identity":"378a85e8-5d13-421f-83df-1c2f453298da","added_by":"auto","created_at":"2024-03-22 13:25:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":302784,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Flowchart\u0026nbsp;\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4117392/v1/c4c7532aaf73ac61408a3ce0.jpeg"},{"id":59593040,"identity":"87ff6199-f529-4525-931e-6ca56189c0a5","added_by":"auto","created_at":"2024-07-03 15:12:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1010704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4117392/v1/bbe2014d-0041-4b8f-9eae-c64bc35ea193.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anticoagulation Therapy After Reperfusion Treatment for Non-Valvular Atrial Fibrillation-Related Acute Ischemic Stroke—A Multicenter Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardioembolic strokes account for about 1/4 of all stroke types (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with approximately 70% caused by atrial fibrillation. Compared to other causes, cardioembolic strokes are often more severe, have a poorer prognosis, and have a higher recurrence rate (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Reperfusion therapy using intravenous thrombolysis (IVT) or endovascular treatment (EVT) is recommended as a standard of treatment for AIS by stroke guidelines (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Current research confirms that atrial fibrillation can be prevented by oral anticoagulants to avoid embolic events, with a reduction in the recurrence risk of ischemic stroke to 3.0%, it also increases the risk of intracranial hemorrhage by 1.8% (\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Based on studies related to the optimal timing of oral anticoagulation in patients with acute ischemic stroke (AIS) with atrial fibrillation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), the recommended timing of anticoagulation is the \"1-3-6-12\" rule based on expert consensus by the European Heart Rhythm Association and the European Society of Cardiology, and the \"4\u0026ndash;14\u0026rdquo;(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) day standard based on the RAF trial (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines. However, AIS patients with related AF who receive reperfusion therapy often have a higher severity of stroke,a larger lesion, higher NIHSS scores, and more severe conditions. Until now, there have been no specific recommendations for the optimal timing of anticoagulation treatment for those patients (\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The main objective of this study is to observe the current status and the factors influencing the initiation of anticoagulation in acute ischemic stroke patients with related AF who have undergone reperfusion therapy in the real world.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis study involved patients discharged from January 2019 to January 2022, diagnosed with acute cerebral infarction and atrial fibrillation, and who underwent intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or a combination of IVT and EVT. The investigation was conducted through electronic medical records systems at the Second Affiliated Hospital of Nanchang University, Ganzhou People's Hospital, Yingtian People's Hospital, and the Affiliated Hospital of Jiujiang College. This study was registered with the ethics committee of the institution.\u003c/p\u003e \u003cp\u003eInclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) discharge diagnoses including \"cerebral infarction\" and \"atrial fibrillation\" or \"paroxysmal atrial fibrillation\" or \"atrial flutter\" or \"paroxysmal atrial flutter\" or \"flutter\"; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) cases treated with \"IVT\" or/and \"EVT\".\u003c/p\u003e \u003cp\u003eExclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) cases with diagnoses of \"cardiac valvular disease\" or \"rheumatic heart disease\"; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) cases of self-discharge due to severe illness, transfer to another hospital, or death; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) cases with missing data, making research completion impossible.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA retrospective study design was employed. Patients' data, including age, sex, history of hypertension/diabetes, history of stroke, history of previous atrial fibrillation, antithrombotic drugs(antiplatelet drugs/anticoagulants) used previously, ASPECT score, NIHSS score before vascular reperfusion, mRS score before reperfusion, CHA2DS2-VASc score, HAS-BLED score, method of vascular reperfusion, time of reperfusion, NIHSS score 3 days after reperfusion, timing of anticoagulation initiation after reperfusion, anticoagulation regimen, pre-anticoagulation antiplatelet drug use, hemorrhagic transformation, hemorrhage type (ECASS classification), concurrent complications, NIHSS score at discharge, mRS score at discharge, 90-day mRS score, any bleeding events at 90 days, and recurrent cerebral infarction, were recorded.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOutcome\u003c/h2\u003e \u003cp\u003eThe primary outcome measure was the timing and regimen of anticoagulation initiation/re-initiation in patients. Secondary outcome measures included any ischemic stroke recurrence or new bleeding events within three months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data with normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared by ANOVA. Non-normally distributed quantitative data were expressed as median with interquartile range [M(P25, P75)] and compared using the Kruskal-Wallis H test. Categorical data were expressed as percentages (%) and analyzed using the chi-squared test or Fisher's exact test. Multivariate logistic regression analysis was used to determine the independent factors influencing anticoagulation therapy in patients with AF-related stroke. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, and the Bonferroni method was used for multiple comparisons to adjust for the level of significance. All analyses were performed using SPSS 25.0 software (IBM SPSS Statistics for Windows, Version 25.0; Armonk, NY: IBM Corp).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatients characteristics\u003c/h2\u003e \u003cp\u003eA total of 410 patients underwent vascular reperfusion treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), including 168 (41.0%) in the IVT group, 144 (35.1%) in the EVT group, and 98 (23.9%) in the IVT\u0026thinsp;+\u0026thinsp;EVT group, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of all patients was 72.66 (\u0026plusmn;\u0026thinsp;9.622) years, with 208 (50.7%) female patients. 40 (9.8%) patients had previously been treated with antithrombotic drugs, and 29 had received anticoagulant therapy. Among the 224 (54.6%) patients previously diagnosed with atrial fibrillation, only 28 were on anticoagulant medication at admission. Of the 72 patients with a history of ischemic stroke, 42 were diagnosed with atrial fibrillation, but only 14 were on anticoagulants. Age (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), history of stroke (P\u0026thinsp;=\u0026thinsp;0.02), history of atrial fibrillation (P\u0026thinsp;=\u0026thinsp;0.01), NIHSS score before vascular reperfusion (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), ASPECT score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), mRS score before reperfusion (P\u0026thinsp;=\u0026thinsp;0.02), use of antiplatelet drugs before reperfusion (P\u0026thinsp;=\u0026thinsp;0.05), NIHSS score 3 days after reperfusion (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), hemorrhagic transformation conversion post-reperfusion (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and start of oral anticoagulation therapy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were all statistically different between groups. After more comparisons, it was found that the IVT group had lower NIHSS scores before and after reperfusion, lower rates of hemorrhagic transformation conversion, and lower rates of starting anticoagulation more than 14 days later than the other groups. The EVT group had lower ages and ASPECT scores than the other groups, a higher proportion of previous atrial fibrillation, and a lower proportion of pre-anticoagulation antiplatelet drug use compared to the IVT group. The IVT\u0026thinsp;+\u0026thinsp;EVT group had a lower proportion of patients with a history of stroke compared to the other groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAntithrombotic drug use\u003c/h2\u003e \u003cp\u003eOf the patients, 287 (70%) received anticoagulation therapy during their hospitalization. This included 110 patients on single oral anticoagulants, of whom 68 were previously on antiplatelet therapy (single or dual); 103 patients received subcutaneous heparin bridging to oral anticoagulants, 29 received subcutaneous heparin bridging to antiplatelet therapy, and 39 on subcutaneous heparin alone. Six patients received apixaban, four of whom were bridged to oral anticoagulants and one to antiplatelet therapy. Of the patients who did not receive anticoagulation therapy, 72 were on antiplatelet therapy (single or dual), and 51 received no antithrombotic drugs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with anticoagulation therapy\u003c/h2\u003e \u003cp\u003eOf the 410 patients, 235 received oral anticoagulant therapy beyond the acute hospitalization (\u0026gt;\u0026thinsp;14 days). Univariate analysis of clinical data comparing in-hospital oral anticoagulant therapy to delayed (or non-) oral anticoagulant therapy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) revealed statistically significant differences in pre-reperfusion NIHSS score, ASPECT score, pre-reperfusion mRS score, method of vascular reperfusion, NIHSS score 3 days after reperfusion, pre-anticoagulation antiplatelet drug use, and hemorrhagic transformation conversion post-reperfusion (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eMultivariate logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed that pre-anticoagulation antiplatelet drug use (OR\u0026thinsp;=\u0026thinsp;0.122, 95%CI: 0.065\u0026ndash;0.228, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) was favorable for early initiation of anticoagulant therapy. Higher NIHSS score 3 days post-reperfusion (OR\u0026thinsp;=\u0026thinsp;1.109, 95%CI: 1.073\u0026ndash;1.147, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and hemorrhagic transformation during hospitalization (OR\u0026thinsp;=\u0026thinsp;2.572, 95%CI: 1.423\u0026ndash;4.648, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were unfavorable for anticoagulation therapy.\u003c/p\u003e \u003cp\u003eFor patients whose initiation of oral anticoagulation therapy was delayed beyond the acute hospitalization period, 120 questionnaires from chief physicians at the Second Affiliated Hospital of Nanchang University were collected. The analysis indicated that large infarct size (23%), infarct location (20%), and post-stroke hemorrhagic transformation (23%) were the most common reasons inflencing physicians' decisions to initiate anticoagulation therapy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e90-day Prognosis\u003c/h2\u003e \u003cp\u003eOf the 410 patients, a total of 281 cases achieved a good prognosis [mRS score 0\u0026ndash;2] within 90 days. This included 152 (86.9%) in the early anticoagulation group and 129 (54.9%) in the late anticoagulation group, with a statistically significant difference in 90-day good prognosis rates between the two groups (Table\u0026nbsp;5). Within 90 days post-treatment, there were 25 (6.1%) cases of ischemic stroke recurrence, with 7 patients having received early anticoagulation treatment, including 2 in the IVT group, 4 in the EVT group, and 1 in the IVT\u0026thinsp;+\u0026thinsp;EVT group. There were a total of 27 bleeding events at 90 days, including 16 cases of intracranial hemorrhage, 6 cases of gum bleeding, 2 cases of skin ecchymosis, 2 cases of urinary bleeding, and 1 case of gastrointestinal bleeding. The difference in the rates of ischemic stroke recurrence and bleeding events at 90 days between the different treatment groups and the timing of anticoagulation therapy was not statistically significant (Table\u0026nbsp;5).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on the \"Chinese Guidelines for the Prevention of Cardiogenic Stroke (2019),\" the CHA2DS2-VASc scoring system is recommended for atrial fibrillation patients, suggesting oral anticoagulant therapy for males with a score\u0026thinsp;\u0026ge;\u0026thinsp;2 and females with a score\u0026thinsp;\u0026ge;\u0026thinsp;3 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This study included 410 patients, with 42.7% receiving oral anticoagulants during acute hospitalization, slightly higher than the global registry study\u0026mdash;GARFIELD (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u0026mdash;which reported a 28% anticoagulation rate among Chinese patients with a CHA2DS2-VASc score\u0026thinsp;\u0026ge;\u0026thinsp;2. However, our study focused on acute cerebral infarction patients with a higher average age, indicating a higher risk population than the aforementioned studies, and suggesting an issue of insufficient anticoagulation. Oral anticoagulant therapy is the cornerstone for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation. Novel oral anticoagulants (NOACs) have been shown in previous research to be just as good as warfarin at preventing stroke. They have the same or a lower risk of major bleeding events and a much lower risk of intracranial hemorrhage (\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The RAF study demonstrated a better prognosis for patients with nonvalvular atrial fibrillation (NVAF) and AIS treated solely with oral anticoagulants compared to those treated with low molecular weight heparins (LMWH) alone or LMWH followed by oral anticoagulants. However, the optimal timing for initiating anticoagulation after acute ischemic stroke remains uncertain (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), as key large-scale studies comparing NOACs with warfarin excluded patients who had recently (within 7\u0026ndash;30 days) experienced a stroke (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Due to a lack of evidence, current international guidelines do not provide specific recommendations on the optimal timing for initiating anticoagulation therapy after an acute cerebral stroke. The latest research (TIMING, ELAN) suggests that early anticoagulation is more effective than delayed anticoagulation (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe risk of ischemic stroke recurrence or post-stroke hemorrhagic transformation is highest within the first few days after an ischemic stroke (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Such events may offset the advantages of acute secondary prevention. Previous studies indicate that patients receiving IVT, EVT, or IVT\u0026thinsp;+\u0026thinsp;EVT treatments might have higher symptomatic hemorrhagic transformation rates than control groups, but better 90-day outcomes [mRS score 0\u0026ndash;2] (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In this study, the early anticoagulation group (\u0026lt;\u0026thinsp;14 days) had a 90-day good prognosis rate of 86.9%, compared to 54.9% in the late anticoagulation group, with 90-day ischemic stroke recurrence and bleeding event rates of 4.0% and 6.9%, respectively. Referring to the TIMING trial for anticoagulation timing groups, the early anticoagulation initiation group (\u0026le;\u0026thinsp;4 days) included 60 people, with a 90-day good prognosis rate of 93.3%, while the delayed or non-initiation group (\u0026gt;\u0026thinsp;4 days) with 350 people had a 90-day good prognosis rate of 64.3%. There were no new ischemic strokes in the early anticoagulation group within 90 days, but there were 5 new bleeding events, compared to 25 new ischemic strokes and 22 new bleeding events in the delayed group. The early (\u0026lt;\u0026thinsp;4 days) anticoagulation group had a higher proportion of a good prognosis at 90 days and fewer new ischemic strokes and bleeding events than the delayed group, aligning with the latest findings from the TIMING and ELAN studies. However, it should be noted that only 60 patients in our study initiated anticoagulation treatment early (\u0026le;\u0026thinsp;4 days). The average age of the people in our study was 72.66 years, and their NIHSS score was 13. This is higher than the range of 2\u0026ndash;10 in previous observational studies. Also, 17.3% of the people in our study had severe strokes (NIHSS\u0026thinsp;\u0026gt;\u0026thinsp;25), which is much higher than in previous studies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Patients with early severe symptomatic bleeding or a high risk of bleeding did not meet the criteria for initiating anticoagulation therapy.\u003c/p\u003e \u003cp\u003eThe median time to initiate oral anticoagulant therapy during hospitalization in our study population was 7 days, higher than the currently recommended early initiation time (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Only 42.7% of patients underwent anticoagulation therapy within 14 days of AIS occurrence, with 41.0% in the IVT group. However, the Irene (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) trial reported an 82% anticoagulation rate within 14 days, with 85.1% receiving IVT treatment and a median NIHSS score of 10 (\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) at admission, compared to a median NIHSS score of 13 (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) in our study, with 10 in the IVT group and 15 in the EVT and IVT\u0026thinsp;+\u0026thinsp;EVT groups. For patients with atrial fibrillation undergoing EVT treatment, initiating anticoagulation between 5\u0026ndash;14 days resulted in the lowest recurrence rate of ischemic cerebrovascular events (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Thus, a higher NIHSS score, more severe stroke, and endovascular intervention may significantly impact the timing of anticoagulation initiation and outcome events (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), including increasing the risk of bleeding. Previous studies have shown that the ICH (intracranial hemorrhage) incidence rate in IVT patients is 2.7\u0026ndash;5.1% and even lower in EVT patients (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). In our study, there were 116 cases of ICH, with a 7.6% incidence rate of large parenchymal hematoma (PH2). Moreover, our findings suggest that pre-anticoagulation antiplatelet drug use is a protective factor for early initiation of anticoagulation treatment (OR\u0026thinsp;=\u0026thinsp;0.122, 95% CI: 0.065\u0026ndash;0.228, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which is inconsistent with previous experimental results (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). This suggests that physicians' use of antiplatelet drugs before anticoagulation typically indicates no bleeding events in these patients. However, in the GARFIELD-AF study, the use of NOACs in conjunction with antiplatelet drugs, regardless of the sequence, increased the risk of stroke or bleeding in patients with atrial fibrillation (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, there are few studies on the status of anticoagulation therapy in patients with NVAF and AIS undergoing vascular recanalization therapy. In the RAF and TIMING studies, only 22.4% and 35.2% of patients, respectively, underwent vascular recanalization therapy. Compared to patients who did not receive such therapy, these patients likely had more severe strokes, with higher mRS and NIHSS scores at admission. Pathologically, early in a stroke, particularly during ischemic reperfusion, the risk of hemorrhagic transformation increases due to impaired autoregulation and blood-brain barrier disruption; thus, early anticoagulation might elevate the risk of ICH (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Additionally, for patients receiving EVT, initiating anticoagulation within 4 days did not significantly improve functional outcomes (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), potentially due to the small sample size of 60 patients initiating anticoagulation within this period in our study. The high proportion of good outcomes at 90 days in this group compared to the delayed anticoagulation group may indicate selection bias. Therefore, it's essential to further explore a balanced timing or period for anticoagulation therapy in such patients.\u003c/p\u003e \u003cp\u003eThe strength of this study is that it is a multicenter, real-world study that provides new evidence regarding the anticoagulation strategy after reperfusion therapy for patients with AF-related AIS.\u003c/p\u003e \u003cp\u003eHowever, the study also has certain limitations. First, patient outcomes were assessed by telephone follow-ups, and due to the limited-literacy, some patients may not have been able to accurately report discontinued antiplatelet drugs or switch to anticoagulants. This could introduce some information bias into the study. Second, this is a retrospective study, with a larger proportion of patients receiving EVT, who are at a higher risk of bleeding. There is a selection bias in anticoagulation therapy, which limits the generalizability of the study results to other populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study, along with previous observational studies, indicates that early initiation of anticoagulation therapy after AIS in patients treated with IVT, EVT, or both improves 90-day outcome and does not affect treatment safety. However, in most patients, anticoagulation therapy is initiated much later than the currently recommended timing.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests:\u003c/strong\u003e All authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement:\u0026nbsp;\u003c/strong\u003eFL and JJ were responsible for experimental design, paper writing, statistical data analysis, and graphing; FZ, XB,TM,WP,CJ, MY, KW, and TH were responsible for data organization. JK: guidance on data analysis; JL and GY: research direction, article review, and financial assistance. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work is supported by the National Natural Science Foundation of China (82260278, 82360667) and the Jiangxi Provincial Science and Technology Department Key R\u0026amp;D Program (20212BBG71012，20223BBG71010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch ethics and patient consent:\u003c/strong\u003eAll enrolled patients had been approved by the Ethics Committee (O-Medical Research Ethics [2023] No. 35) of The Second Affiliated Hospital of Nanchang University, Nanchang, China. The study was conducted according to the principles of the Declaration of Helsinki.All persons gave their informed consent prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe express our gratitude to our mentors and department colleagues for their guidance and strong support in the research and manuscript preparation process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e :The data that supports the findings of this\u003c/p\u003e\n\u003cp\u003estudy are available on request from the corresponding author, [J.L.T.], upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017;120(3):514\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.https://doi.org/10.1161/CIRCRESAHA.116.308407\u003c/span\u003e\u003cspan address=\".10.1161/CIRCRESAHA.116.308407\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacDougall NJ, Amarasinghe S, Muir KW. Secondary prevention of stroke. Expert Rev Cardiovasc Ther. 2009;7(9):1103\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1586/erc.09.77\u003c/span\u003e\u003cspan address=\"10.1586/erc.09.77\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/01.str.27.10.1760\u003c/span\u003e\u003cspan address=\"10.1161/01.str.27.10.1760\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBjerkreim AT, Khanevski AN, Thomassen L, et al. Five-year readmission and mortality differ by ischemic stroke subtype. J Neurol Sci. 2019;403:31\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jns.2019.06.007\u003c/span\u003e\u003cspan address=\"10.1016/j.jns.2019.06.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese Socity of Neurology, Chinese Stroke Neurology. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018. Chin J Neurol. 2018;51(9):666\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.issn.1006-7876.2018.09.004\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.1006-7876.2018.09.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCairns JA. Stroke prevention in atrial fibrillation trial. Circulation. 1991;84(2):933\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/01.cir.84.2.933\u003c/span\u003e\u003cspan address=\"10.1161/01.cir.84.2.933\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaxena R, Koudstaal PJ. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack. Cochrane Database Syst Rev. 2004;2CD000185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD000185.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD000185.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7326/0003-4819-146-12-200706190-00007\u003c/span\u003e\u003cspan address=\"10.7326/0003-4819-146-12-200706190-00007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeiffge DJ, Paciaroni M, Wilson D, et al. Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019;85(6):823\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ana.25489\u003c/span\u003e\u003cspan address=\"10.1002/ana.25489\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaciaroni M, Agnelli G, Micheli S, et al. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38(2):423\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/01.STR.0000254600.92975.1f\u003c/span\u003e\u003cspan address=\"10.1161/01.STR.0000254600.92975.1f\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGorenek B, Pelliccia A, Benjamin EJ et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace.2017;19(2),190\u0026ndash;25.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/europace/euw242\u003c/span\u003e\u003cspan address=\"10.1093/europace/euw242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowers WJ, Rabinstein AA, Ackerson T, et al. Association Stroke. 2019;50(12):e344\u0026ndash;418. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/STR.0000000000000211\u003c/span\u003e\u003cspan address=\"10.1161/STR.0000000000000211\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study. Stroke. 2015;46(8):2175\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/STROKEAHA.115.008891\u003c/span\u003e\u003cspan address=\"10.1161/STROKEAHA.115.008891\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1411587\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1411587\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1414792\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1414792\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296\u0026ndash;306. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1503780\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1503780\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1415061\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1415061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEscudero-Martinez I, Mazya M, Teutsch C, et al. Dabigatran initiation in patients with non-valvular AF and first acute ischaemic stroke: a retrospective observational study from the SITS registry. BMJ Open. 2020;10(5):e037234. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2020-037234\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2020-037234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtrial Fibrillation Stroke Prevention and Control Specialized Committee, Stroke Prevention and Control Expert Committee of the National Health and Wellness Commission.Cardiac Electrophysiology and Pacing Branch, Chinese Medical Association, ChinaCardiac Rhythmology Committee, Chinese Medical Doctor Association. Guidline on prevention and treatment of cardiogenic stroke(2019). Chin J Cardiac Arrhyth. 2019; 23(6):463\u0026ndash;484. https//doi.org10.3760/cma.j.issn.1007-6638.2019.06.002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCamm AJ, Steffel J, Virdone S, et al. Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF. Eur Heart J Open. 2023;3(3):oead051. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ehjopen/oead051\u003c/span\u003e\u003cspan address=\"10.1093/ehjopen/oead051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGranger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1107039\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1107039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(13)62343-0\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(13)62343-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa0905561\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa0905561\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1009638\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1009638\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1310907\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1310907\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHankey GJ. Unanswered questions and research priorities to optimise stroke prevention in atrial fibrillation with the new oral anticoagulants. Thromb Haemost. 2014;111(5):808\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1160/TH13-09-0741\u003c/span\u003e\u003cspan address=\"10.1160/TH13-09-0741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOldgren J, \u0026Aring;sberg S, Hijazi Z et al. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation.2022;146(14)1056\u0026ndash;66\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIRCULATIONAHA.122.060666\u003c/span\u003e\u003cspan address=\"10.1161/CIRCULATIONAHA.122.060666\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFischer U, Koga M, Strbian D, et al. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023;388:2411\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa2303048\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa2303048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJM199512143332401\u003c/span\u003e\u003cspan address=\"10.1056/NEJM199512143332401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeng C, Li SD, Zhang DD, et al. Endovascular Thrombectomy Versus Bridging Thrombolysis: Real-World Efficacy and Safety Analysis Based on a Nationwide Registry Study. J Am Heart Assoc. 2021;10(3):e018003. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/JAHA.120.018003\u003c/span\u003e\u003cspan address=\"10.1161/JAHA.120.018003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaciaroni M, Agnelli G, Falocci N, et al. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study. J Am Heart Assoc. 2017;6(12):e007034. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/JAHA.117.007034\u003c/span\u003e\u003cspan address=\"10.1161/JAHA.117.007034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeiffge DJ, Traenka C, Polymeris A, et al. Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events. Neurology. 2016;87(18):1856\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1212/WNL.0000000000003283\u003c/span\u003e\u003cspan address=\"10.1212/WNL.0000000000003283\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeriatric Neurology Group of the Chinese Medical Association Geriatrics Branch, Vascular Neurology Committee of the Beijing Neuroscience Society, Chinese Expert Consensus Group on Cardiac Stroke Treatment. Chinese Expert Consensus on Cardiac Stroke Treatment (2022). Natl Med J China. 2022;102(11):760\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//doi.org/10.3760/cma.j.cn112137-20210712-01555\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.cn112137-20210712-01555\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa H, Che R, Zhang Q, et al. The optimum anticoagulation time after endovascular thrombectomy for atrial fibrillation-related large vessel occlusion stroke: a real-world study. J Neurol. 2023;270(4):2084\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00415-022-11515-y\u003c/span\u003e\u003cspan address=\"10.1007/s00415-022-11515-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArihiro S, Todo K, Koga M, et al. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: The SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016;11(5):565\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1747493016632239\u003c/span\u003e\u003cspan address=\"10.1177/1747493016632239\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGioia LC, Kate M, Sivakumar L, et al. Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation: A Prospective Magnetic Resonance Imaging Study. Stroke. 2016;47(7):1917\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/STROKEAHA.116.013491\u003c/span\u003e\u003cspan address=\"10.1161/STROKEAHA.116.013491\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(14)60584-5\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(14)60584-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazya MV, Lees KR, Collas D, et al. IV thrombolysis in very severe and severe ischemic stroke: Results from the SITS-ISTR Registry. Neurology. 2015;85(24):2098\u0026ndash;106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1212/WNL.0000000000002199\u003c/span\u003e\u003cspan address=\"10.1212/WNL.0000000000002199\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(16)00163-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(16)00163-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFox KAA, Velentgas P, Camm AJ, et al. Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation. JAMA Netw Open. 2020;3(2):e200107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamanetworkopen.2020.0107\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2020.0107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMac Grory B, Flood S, Schrag M, et al. Anticoagulation Resumption After Stroke from Atrial Fibrillation. Curr Atheroscler Rep. 2019;21(8):29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11883-019-0790-x\u003c/span\u003e\u003cspan address=\"10.1007/s11883-019-0790-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients characteristics for IVT group, EVT group, and IVT\u0026thinsp;+\u0026thinsp;EVT group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;410)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIVT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEVT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;144)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIVT\u0026thinsp;+\u0026thinsp;EVT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD), y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.92\u0026thinsp;\u0026plusmn;\u0026thinsp;9.408a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.939b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.80\u0026thinsp;\u0026plusmn;\u0026thinsp;8.995a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208/(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82/(48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83/(57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43/(43.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251/(61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106/(63.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84/(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61/(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71/(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23/(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20/(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehyperlipidemia,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26/(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14/(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6/(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking/drinking history,No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54/(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23/(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15/(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke,No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72/(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33/(19.6)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31/(21.5)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8/(8.2)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.018 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of previous atrial fibrillation ,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224/(54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78/(46.4)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93/(64.4)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53/(54.1)ab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eantithrombotic drugs used previously,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40/(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16/(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17/(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7/(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS score before vascular reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(10.75,22)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASPECT score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRS score before vascular reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)ab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.017 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHA2DS2-VASc score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(3.25,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAS-BLED score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNHISS score 3 days after reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(5.25,18)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre-anticoagulation antiplatelet drug use, No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96/(23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49/(29.2)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25/(17.4)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22/(22.4)ab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.048 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to initiate oral anticoagulation after reperfusion ,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0ཞ3d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34/(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9/(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7/(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4ཞ14d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141/(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69/(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44/(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28/(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;14d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235/(57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81/(48.2)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91/(63.2)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63/(64.3)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic transformation,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116/(28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/(16.7)a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55/(38.2)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33/(33.7)b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: mRS is modified Rankin score; NIHSS is National Institutes of Health Stroke Scale;* P \u0026lt;0. 05 ;\u0026ldquo;ཁ\u0026rdquo;、\u0026ldquo; ག\u0026rdquo;: Post hoc two-by-two comparisons of results with Bonferroni-corrected significance levels were taken.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients characteristics for early start and delayed start\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;410)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly start\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDelayed start\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD), y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208/(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82/(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126/(53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251/(61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105/(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146/(62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71/(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33/(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38/(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehyperlipidemia,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26/(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8/(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18/(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking/drinking history,No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54/(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26/(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke,No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72/(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34/(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38/(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of previous atrial fibrillation ,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224/(54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97/(55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127/(54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eantithrombotic drugs used previously,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40/(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20/(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS score before vascular reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASPECT score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emRS score before vascular reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHA2DS2-VASc score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAS-BLED score, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNHISS score 3 days after reperfusion, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre-anticoagulation antiplatelet drug use, No(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96/(23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76/(43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReperfusion treatment,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT(a)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168/(41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87/(49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81/(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEVT(b)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144/(35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53/(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91/(38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT\u0026thinsp;+\u0026thinsp;EVT(b)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98/(23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35/(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63/(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic transformation,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116/(28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90/(38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of factors associated with anticoagulation therapy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald X\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNHISS score 3 days after reperfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.073\u0026ndash;1.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre-anticoagulation antiplatelet drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.065\u0026ndash;0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic transformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.423\u0026ndash;4.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReasons for delaying the start of oral anticoagulant beyond the attending physician's acute length of stay\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReasons for delay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverity of stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge size of infarct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esite of infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemorrhagic transformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther bleeding during hospitalisation\u003c/p\u003e \u003cp\u003e(intracranial haemorrhage, gastrointestinal haemorrhage, urinary tract haemorrhage, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient bleeding risk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5.90\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eday prognosis after anticoagulation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;410)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly start\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDelayed start\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;235)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day favorable prognosis [mRS score 0\u0026ndash;2],No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e281/(68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152/(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e129/(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence of AIS ,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25/(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7/(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18/(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2/(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6/(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4/(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6/(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT\u0026thinsp;+\u0026thinsp;EVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1/(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6/(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of bleeding events ,No,(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27/(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12/(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15/(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4/(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7/(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4/(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7/(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVT\u0026thinsp;+\u0026thinsp;EVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4/(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1/(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ischemic Stroke, Atrial Fibrillation, Intravenous Thrombolysis, Endovascular Intervention, Anticoagulation Therapy, ICH","lastPublishedDoi":"10.21203/rs.3.rs-4117392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4117392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo understand anticoagulation therapy in acute ischemic stroke (AIS) patients with related atrial fibrillation (AF) after receiving reperfusion treatments in the real world.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study collected basic clinical data, the initiation time of anticoagulation therapy, treatment plans, and prognosis of acute ischemic stroke patients with atrial fibrillation who underwent intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or a combination of IVT and EVT from January 2019 to January 2022 in four tertiary hospitals in Jiangxi Province. A multivariate logistic regression analysis was used to analyze the factors influencing anticoagulation therapy in these patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 410 patients met the selection criteria, including 168 (41.0%) in the IVT group, 144 (35.1%) in the EVT group, and 98 (23.9%) in the IVT\u0026thinsp;+\u0026thinsp;EVT group. Initiation of anticoagulation therapy within 14 days post-AIS was found in 175 patients in total (42.7%), which is significantly different in three groups (49.7% in IVT group, 30.3% in EVT group, and 20.0% in IVT\u0026thinsp;+\u0026thinsp;EVT groups, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Multivariate logistic regression analysis revealed that prior use of antiplatelet drugs was more common in patients receiving early anticoagulation therapy (OR\u0026thinsp;=\u0026thinsp;0.122, 95% CI: 0.065\u0026ndash;0.228, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Patients receiving no anticoagulation had higher-3- days post-reperfusion NIHSS score (OR\u0026thinsp;=\u0026thinsp;1.109, 95% CI: 1.073\u0026ndash;1.147, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and more in-hospital hemorrhagic transformation (OR\u0026thinsp;=\u0026thinsp;2.572, 95% CI: 1.423\u0026ndash;4.648, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Of all patients, 281 had a favorable 90-day prognosis [mRS score 0\u0026ndash;2], including 152 (86.9%) in the early anticoagulation group and 129 (54.9%) in the late anticoagulation group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Postoperative 90-day outcomes included 25 (6.1%) cases of recurrent ischemic stroke (P\u0026thinsp;=\u0026thinsp;0.55) and 27 (6.6%) bleeding events (p\u0026thinsp;=\u0026thinsp;0.32).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEarly initiation of anticoagulation therapy improves 90-day outcomes in nonvalvular AF post-related AIS patients with related AF after receiving reperfusion treatments; however, the initiation of anticoagulation in most patients might be much later than the currently recommended timing in real world.\u003c/p\u003e","manuscriptTitle":"Anticoagulation Therapy After Reperfusion Treatment for Non-Valvular Atrial Fibrillation-Related Acute Ischemic Stroke—A Multicenter Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 13:24:58","doi":"10.21203/rs.3.rs-4117392/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0f6c460-c059-4b1d-98be-e3d9a444750e","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-03T15:04:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 13:24:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4117392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4117392","identity":"rs-4117392","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}