Effect Of Endovascular Treatment On The Timing Of Oral Anticoagulant Drugs In Patients With Acute Cardiogenic Cerebral Embolism

Objective: Cardiac cerebral embolism has a high recurrence rate,high disability rate,and mortality,and anticoagulant therapy is currently the most effective secondary prevention.In recent years,a small number of studies have provided valuable reference recommendations when to initiate anticoagulation.However,the anticoagulation initiation time for patients with cardiogenic cerebral embolism undergoing endovascular treatment remains unknown.This study was designed to investigate the effect of endovascular treatment on the onset time of clotting in patients with acute cardiogenic cerebral embolism.Method: Through the clinical case database of the Cerebrovascular Disease Center of the First Affiliated Hospital of Jinan University,retrospectively collect patients who received cardio-cerebral embolism within 24 hours from January 2016 to May 2018 and received oral anticoagulant therapy.Treatment was divided into the surgical group and the non-surgical group,and the relationship between the severity of stroke at admission(NIHS score),the 24 h NIHSS score,and the infarct volume and anticoagulation initiation time were investigated.Results:A total of 87 patients were included in the study,including 47 in the surgical group and 40 in the non-surgical group.According to the 24 h NIHSS score(NIHSS score <8,mild;8-15,moderate;?16,severe),the median time to start anticoagulant therapy in the surgical group was 6,10,and 19 days,respectively.There were no significant differences between the groups(P>0.05),5,11 and 23 days in the nonsurgical group respectively.According to the infarct volume stratification(V<50,mild;50-100,moderate;>100,severe).The median time to initiation of anticoagulant therapy the operation group was 7,9 and 18 days,respectively,and the non-surgical group was 7,20,and 21 days,respectively.There was no significant difference between the light and severe infarct volume groups(P>0.05).The median score of NIHSS score at admission was 16(13-18),and the median 24 h NIHSS score was 10(3-15).There was a statistically significant difference between the two groups(Z=-4.012,P=0.00004).The NIHSS score decreased by more than 4 points in the surgical group and stratified analysis in the non-surgical group.According to the NIHSS score at admission,it was divided into two levels(8-15,moderate;? 16,severe).The median time of The operation group started anticoagulant therapy was 6 and 9 days,respectively,and the non-surgical group was 10 and 23 days,respectively.There was a statistically significant difference in the severe group(P = 0.001).There was no significant difference between the moderate stroke group(P>0.05),but there's a tendency to start anticoagulant therapy;whether the reduction of NIHSS in the surgical and non-surgical groups was more than 4 points was divided into two groups for stratified analysis.According to the NIHSS score at admission,it was divided into two levels:(8-15,moderate;and ? 16,severe).The median time for initiation of anticoagulant therapy was 5 and 9 days for NIHSS decline >4,and the 11 and 19 days for NIHSS decreased ?4,respectively.The NIHSS decreased by >4 group was significantly earlier than the NIHSS ?4 group anticoagulation time(P<0.05).After the HI type was removed,the NIHSS score was based on the admission of 24 h(NIHSS score <8,light Degree;8-15,moderate;? 16,severe)divided into 3 levels,The median time of initiation of anticoagulant therapy in the operation group was 5,9 and 17 days,respectively,and the non-surgical group was 5,10 and 17 days,respectively.There was no significant difference between the groups(P>0.05).Conclusion:1.Patients with acute CCE endovascular treatment may have reasonable OAC initiation time based on the 24 h NIHSS score and infarct volume.2.Compared with non-surgical patients,patients with acute CCE underwent endovascular treatment,and some patients reduced the NIHSS score at admission,improved neurological function,and advanced OAC initiation time,especially in the severe stroke group;3.For patients with acute CCE who had a NIHSS score of more than 4 points when admitted to hospital for 24 hours,the anticoagulation initiation time was advanced,especially for patients with moderate or severe stroke;4,acute CCE patients secondary to HI-1 may not significantly delay OAC start-up time.