Key result
Early oral anticoagulation linked to ~18% lower composite adverse outcomes after ischemic stroke.
Why the study?
Determining the optimal timing for oral anticoagulant initiation post-ischemic stroke while balancing recurrent stroke prevention against bleeding risk remains critical in patients with non-valvular atrial fibrillation.
Does early initiation of oral anticoagulants improve clinical outcomes and reduce bleeding risks in patients with ischemic stroke and non-valvular atrial fibrillation?
Cohort (n=9,884)
Yes
Does early initiation of oral anticoagulants improve clinical outcomes and reduce bleeding risks in patients with ischemic stroke and non-valvular atrial fibrillation?
Hazard Ratio: 0.82 (95% CI 0.71–0.94)
p-value: p=0.024
Early initiation of NOACs within 3 days for mild ischemic stroke and 6 days for moderate ischemic stroke in patients with NVAF improves clinical outcomes without increasing bleeding risk, though caution is required for severe strokes.
Early OAC initiation was associated with lower adverse outcomes in mild-moderate stroke; hypothesis-generating and should not yet change practice.
Oral anticoagulants (OAC) are essential in preventing stroke recurrence in patients with ischemic stroke (IS) and non-valvular atrial fibrillation (NVAF), though they carry a bleeding risk. Balancing the benefits and risks of anticoagulant therapy and determining the optimal timing for initiation are critical. This real-world study investigated optimal timing for OAC initiation post-IS and evaluated drug selection using data from the National Health and Medical Big Data (Eastern) Center, covering IS records from 1564 hospitals in Jiangsu (2018-2021). Using 1:1 propensity score matching (PSM) and Cox model analysis, we compared outcomes between OAC initiators and non-initiators at different time points. Results showed that initiating OAC within 3 days for mild IS (HR, 0.82 [95 % CI, 0.71-0.94, p = 0.024]), within 6 days for moderate IS (HR, 0.76 [95 % CI, 0.65-0.89, p = 0.004]), and within 11 days for severe IS (HR, 0.89 [95 % CI, 0.78-0.97, p = 0.032]) was associated with better outcomes. New oral anticoagulants (NOACs) demonstrated favorable effectiveness and safety profiles compared to warfarin, without increasing bleeding risk (HR, 0.85 [95 % CI, 0.73-0.98, p = 0.038]). Based on these observational findings, we suggest considering early NOAC initiation for mild and moderate IS, while carefully assessing stroke progression and bleeding risk before anticoagulation in severe IS.
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Lv et al. (2025) conducted a cohort in Ischemic stroke combined with non-valvular atrial fibrillation (n=9,884). Early initiation of oral anticoagulants vs. Late or non-initiation of oral anticoagulants was evaluated on Primary composite outcome (death, thromboembolism, or major bleeding events during hospitalization) (HR 0.82, 95% CI 0.71-0.94, p=0.024). Initiating oral anticoagulants within 3 days for mild ischemic stroke and within 6 days for moderate ischemic stroke reduced composite adverse outcomes compared to non-initiation or delayed initiation.
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