RT Journal Article SR Electronic T1 Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation JF Stroke and Vascular Neurology JO Stroke Vasc Neurol FD BMJ Publishing Group Ltd SP 405 OP 412 DO 10.1136/svn-2022-002082 VO 8 IS 5 A1 Xu, Yaning A1 Liu, Chengchun A1 Li, Wei A1 Nie, Ximing A1 Huang, Shuhan A1 Li, Xiaoshu A1 Wu, Ya A1 Jin, Wang-Sheng A1 Jiang, Jiaojin A1 Dong, Jun A1 Yang, Yi A1 Sun, Zhiqiang A1 Han, Wenjun A1 Wang, Yanjiang A1 Liu, Liping A1 Zhang, Meng YR 2023 UL http://svn.bmj.com/content/8/5/405.abstract AB Background The timing for initiating anticoagulant therapy in acute ischaemic stroke (AIS) patients with atrial fibrillation who recanalised after endovascular treatment (EVT) is unclear. The objective of this study was to evaluate the effect of early anticoagulation after successful recanalisation in AIS patients with atrial fibrillation.Methods Patients with anterior circulation large vessel occlusion and atrial fibrillation who were successfully recanalised by EVT within 24 hours after stroke in the Registration Study for Critical Care of Acute Ischemic Stroke after Recanalization registry were analysed. Early anticoagulation was defined as the initiation of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) within 72 hours after EVT. Ultra-early anticoagulation was defined if it was initiated within 24 hours. The primary efficacy outcome was the score on the modified Rankin Scale (mRS) at day 90, and the primary safety outcome was symptomatic intracranial haemorrhage within 90 days.Results Overall, 257 patients were enrolled, of whom 141 (54.9%) initiated anticoagulation within 72 hours after EVT, including 111 within 24 hours. A significant shift towards better mRS scores at day 90 was associated with early anticoagulation (adjusted common OR 2.08 (95% CI 1.27 to 3.41)). Symptomatic intracranial haemorrhage was comparable between patients treated with early and routine anticoagulation (adjusted OR 0.20 (95% CI 0.02 to 2.18)). Comparison of different early anticoagulation regimens showed that ultra-early anticoagulation was more significantly associated with favourable functional outcomes (adjusted common OR 2.03 (95% CI 1.20 to 3.44)) and reduced the incidence of asymptomatic intracranial haemorrhage (OR 0.37 (95% CI 0.14 to 0.94)).Conclusions In AIS patients with atrial fibrillation, early anticoagulation with UFH or LMWH after successful recanalisation is associated with favourable functional outcomes without increasing the risk of symptomatic intracranial haemorrhages.Trial registration number ChiCTR1900022154.Data are available upon reasonable request.