Initiating oral anticoagulation 4-14 days after cardioembolic stroke was not associated with reduced ischemic and hemorrhagic outcomes compared to 0-3 days or >14 days (P=0.933).
Cohort (n=1,289)
Yes
Does initiating anticoagulation between 4 and 14 days compared to 0-3 days or >14 days reduce recurrent ischemic and hemorrhagic events in patients with ischemic stroke and atrial fibrillation?
In patients with ischemic stroke and atrial fibrillation, the guideline-recommended timing of 4-14 days for initiating anticoagulation was not associated with improved ischemic or hemorrhagic outcomes compared to earlier or later initiation.
Absolute Event Rate: 9.7% vs 10.3%
p-value: p=0.933
OBJECTIVE: Guidelines recommend initiating anticoagulation within 4 to 14 days after cardioembolic stroke. Data supporting this did not account for key factors potentially affecting the decision to initiate anticoagulation, such as infarct size, hemorrhagic transformation, or high-risk features on echocardiography. METHODS: We pooled data from stroke registries of 8 comprehensive stroke centers across the United States. We included consecutive patients admitted with ischemic stroke and atrial fibrillation. The primary predictor was timing of initiating anticoagulation (0-3 days, 4-14 days, or >14 days), and outcomes were recurrent stroke/transient ischemic attack/systemic embolism, symptomatic intracerebral hemorrhage (sICH), and major extracranial hemorrhage (ECH) within 90 days. RESULTS: Among 2,084 patients, 1,289 met the inclusion criteria. The combined endpoint occurred in 10.1% (n = 130) subjects (87 ischemic events, 20 sICH, and 29 ECH). Overall, there was no significant difference in the composite endpoint between the 3 groups (0-3 days: 10.3%, 64/617; 4-14 days: 9.7%, 52/535; >14 days: 10.2%, 14/137; p = 0.933). In adjusted models, patients started on anticoagulation between 4 and 14 days did not have a lower rate of sICH (vs 0-3 days; odds ratio OR = 1.49, 95% confidence interval CI = 0.50-4.43), nor did they have a lower rate of recurrent ischemic events (vs >14 days; OR = 0.76, 95% CI = 0.36-1.62, p = 0.482). INTERPRETATION: In this multicenter real-world cohort, the recommended (4-14 days) time frame to start oral anticoagulation was not associated with reduced ischemic and hemorrhagic outcomes. Randomized trials are required to determine the optimal timing of anticoagulation initiation. ANN NEUROL 2020;88:807-816.
Yaghi et al. (Mon,) conducted a cohort in Ischemic stroke and atrial fibrillation (n=1,289). Anticoagulation initiation at 4-14 days vs. Anticoagulation initiation at 0-3 days or >14 days was evaluated on Composite of recurrent stroke/transient ischemic attack/systemic embolism, symptomatic intracerebral hemorrhage (sICH), and major extracranial hemorrhage (ECH) within 90 days (p=0.933). Initiating oral anticoagulation 4-14 days after cardioembolic stroke was not associated with reduced ischemic and hemorrhagic outcomes compared to 0-3 days or >14 days (P=0.933).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: