• Norihito Shimamura, Masato Naraoka, Kazutaka Uchida, Kou Tokuda, Nobuyuki Sakai, Hirotoshi Imamura, Hiroshi Yamagami, Kanta Tanaka, Masayuki Ezura, Tadashi Nonaka, Yasushi Matsumoto, Masunari Shibata, Hajime Ohta, Masafumi Morimoto, Norihito Fukawa, Taketo Hatano, Yukiko Enomoto, Masataka Takeuchi, Takahiro Ota, Fuminori Shimizu, Naoto Kimura, Yuki Kamiya, Takeshi Morimoto, and Shinichi Yoshimura.
• Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. Electronic address: shimab@hirosaki-u.ac.jp.
• World Neurosurg. 2022 Jun 1; 162: e503e510e503-e510.

ObjectiveThe initiation of anticoagulant administration after large vessel occlusion (LVO) or stenosis with nonvalvular arterial fibrillation (NAVF) is controversial. We evaluate the timing of anticoagulation and its relationship with clinical factors.MethodsWe enrolled 595 anterior circulation LVO or stenosis with NAVF cases from 38 stroke centers. Laboratory data; activities of daily living; the Alberta Stroke Program Early CT Score (ASPECTS); the National Institutes of Health Stroke Scale (NIHSS) score; occluded artery; treatment methods; date of the initiation of apixaban administration and outcome were recorded. Multivariate analyses were performed after univariate analysis.ResultsThe median start of apixaban administration after the stroke was 2 days (interquartile range, 1-5; range, 0-14). Multivariate analysis of variance showed that non-internal carotid artery occlusion (F value 4.60), reperfusion therapy (31.1), high ASPECTS (6.27) before anticoagulant intake, and absence of intracranial hemorrhage (12.9) were significantly correlated with early apixaban administration. Multiple logistic regression analysis for independent living at 90 days after the stroke showed significant factors: aging (odds, 0.94; 95% confidence interval [CI], 0.91-0.97); male (odds, 0.46; 95% CI, 0.26-0.79); prestroke independence (odds, 20.7; 95% CI, 6.48-93.9); number of white blood cells (odds, 0.99; 95% CI, 0.97-1.00); non-internal carotid artery occlusion; NIHSS score at 72 hours after the stroke (odds 0.92; 95% CI, 0.89-0.96); ASPECTS before apixaban intake (odds, 1.15; 95% CI, 1.00-1.31) and initiation of apixaban (odds, 0.91; 95% CI, 0.83-0.99).ConclusionsEarly administration of apixaban is induced by nonsevere infarction, reperfusion therapy or none of intracranial hemorrhage and it correlates with an independent long-term outcome.Copyright © 2022 Elsevier Inc. All rights reserved.

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