Key result
Early anticoagulation within 1 week yielded similar ischemic stroke recurrence as later anticoagulation (P=0.1677), whereas DOACs significantly reduced recurrence versus VKAs (RR 0.65; 95% CI 0.52-0.82).
Why the study?
There is uncertainty regarding the optimal timing for initiating oral anticoagulation in patients with acute ischemic stroke due to atrial fibrillation.
Does early initiation of anticoagulation (within 1 week) or use of DOACs reduce ischemic stroke recurrence, mortality, or bleeding compared to later initiation (within 2 weeks) or VKAs in patients with acute ischemic stroke due to atrial fibrillation?
Population
5616 patients with AF-related AIS who received early anticoagulation
Comparison
Anticoagulation within 1 week vs within 2 weeks, and DOACs vs VKAs
Design
Systematic review and meta-analysis of RCTs and prospective observational studies
Authors
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Supports early DOAC use after AF stroke; extends observational data favoring DOACs over VKAs while leaving optimal timing open.
Meta-Analysis (n=5,616)
Does early initiation of anticoagulation (within 1 week) or use of DOACs reduce ischemic stroke recurrence, mortality, or bleeding compared to later initiation (within 2 weeks) or VKAs in patients with acute ischemic stroke due to atrial fibrillation?
p-value: p=0.1677
Early initiation of anticoagulation (within 1 week) for AF-related acute ischemic stroke appears as safe and effective as later initiation, and DOACs are superior to VKAs for preventing recurrent ischemic stroke.
Palaiodimou et al. (2022) conducted a meta-analysis in Acute ischemic stroke due to atrial fibrillation (n=5,616). Early anticoagulation (within 1 week) vs. Anticoagulation within two weeks was evaluated on Ischemic stroke recurrence (p=0.1677). Early anticoagulation within 1 week yielded similar ischemic stroke recurrence as later anticoagulation (P=0.1677), whereas DOACs significantly reduced recurrence versus VKAs (RR 0.65; 95% CI 0.52-0.82).
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