Safety of an early initiation of anticoagulant therapy for atrial fibrillation associated acute cerebral infarction

doi:10.3969/j.issn.1004-583X.2026.02.003

Abstract

Abstract:

Objective To investigate the potential of an early initiation of anticoagulation therapy versus conventional initiation in effectively reducing the risk of stroke recurrence and improving functional prognosis without increasing the bleeding risk in patients with atrial fibrillation-related acute cerebral infarction. Methods A total of 80 patients with atrial fibrillation-related acute cerebral infarction admitted within 24 hours of onset were prospectively allocated. Patients were randomly assigned to the early group (anticoagulation initiated on day 3) and conventional group (initiated on day 6), with 40 cases in each group. The 90-day recurrence rate of cerebral infarction, severe bleeding events (intracranial/gastrointestinal hemorrhage), functional independence (the modified Rankin Scale [mRS]≤2), and adverse event incidence were observed. Results Patients in the early group demonstrated a significantly lower 90-day recurrence rate of cerebral infarction than the conventional group (15.0% vs 50.0%, P<0.01). Additionally, the proportion of patients achieving functional independence (mRS≤2) was significantly higher in the early groupthan the conventional group (75.0% vs 50.0%, P<0.05). No significant difference was observed in the incidence of major bleeding events between the two groups (5.0% vs 7.5%, P>0.05). Subgroup analysis indicated that patients with a high stroke risk (CHA₂DS₂-VASc≥4) benefited more from an early anticoagulation therapy. Conclusion An early initiation of anticoagulation therapy (day 3) in patients with atrial fibrillation-related acute cerebral infarction demonstrated significant clinical benefits, including reduced risk of stroke recurrence and improved functional recovery, without significantly increased the bleeding risk.

Key words: stroke, atrial fibrillation, early anticoagulation therapy, functional independence, prevention of recurrence, safety evaluation

CLC Number:

R743

Zhang Yanping, Li Ke, Zhang Zhuang. Safety of an early initiation of anticoagulant therapy for atrial fibrillation associated acute cerebral infarction[J]. Clinical Focus, 2026, 41(2): 116-121.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.02.003

https://www.lchc.cn/EN/Y2026/V41/I2/116

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References 25

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组别	例数	性别[例(%)]		发病年龄 (岁)	高血压病史 [例(%)]	糖尿病病史 [例(%)]	心脏病病史 [例(%)]	NIHSS评分 (分)
组别	例数	男性	女性	发病年龄 (岁)	高血压病史 [例(%)]	糖尿病病史 [例(%)]	心脏病病史 [例(%)]	NIHSS评分 (分)
观察组	40	26(65.0)	14(35.0)	73±5	32(80.0)	27(67.5)	19(47.5)	12.3±2.1
对照组	40	22(55.0)	18(45.0)	71±6	36(90.0)	29(72.5)	21(52.5)	12.1±2.4
χ²/t值		0.785		1.156	1.614	0.229	0.184	0.412
P值		0.123		0.250	0.105	0.302	0.668	0.682

组别	例数	性别[例(%)]		发病年龄 (岁)	高血压病史 [例(%)]	糖尿病病史 [例(%)]	心脏病病史 [例(%)]	NIHSS评分 (分)
组别	例数	男性	女性	发病年龄 (岁)	高血压病史 [例(%)]	糖尿病病史 [例(%)]	心脏病病史 [例(%)]	NIHSS评分 (分)
观察组	40	26(65.0)	14(35.0)	73±5	32(80.0)	27(67.5)	19(47.5)	12.3±2.1
对照组	40	22(55.0)	18(45.0)	71±6	36(90.0)	29(72.5)	21(52.5)	12.1±2.4
χ²/t值		0.785		1.156	1.614	0.229	0.184	0.412
P值		0.123		0.250	0.105	0.302	0.668	0.682

组别	例数	主要疗效终点 (卒中复发)	次要疗效终点 [功能独立 (mRS≤2)]	安全性终点 (严重出血事件)
早期组	40	6(15.0)	30(75.0)	2(5.0)
常规组	40	20(50.0)	20(50.0)	3(7.5)
χ²值		11.250	5.333
P值		<0.01	0.021	0.500^*

组别	例数	主要疗效终点 (卒中复发)	次要疗效终点 [功能独立 (mRS≤2)]	安全性终点 (严重出血事件)
早期组	40	6(15.0)	30(75.0)	2(5.0)
常规组	40	20(50.0)	20(50.0)	3(7.5)
χ²值		11.250	5.333
P值		<0.01	0.021	0.500^*

亚组	早期组复发/总数(例)	常规组复发/总数(例)	复发率差(%)	P值(亚组内)	交互P值
年龄
≤75岁 >75岁	2/23 4/17	9/22 11/18	-32.2 -37.6	0.009 0.013	0.724
基线NIHSS评分
8~12分 13~15分	2/25 4/15	9/25 11/15	-28.0 -46.7	0.020 0.007	0.452
CHA₂DS₂-VASc评分
<4分 ≥4分	2/17 4/23	3/15 17/25	-8.4 -50.6	0.500 <0.01	0.032
HAS-BLED评分
<3分 ≥3分	1/30 1/10	1/20 2/10	1.7 -10.0	0.673 0.527	0.341