Early start of DOAC (≤7 days) after ischemic stroke showed no significant difference in recurrent ischemic events compared to late start (5.1%/y vs 9.3%/y, p=0.53).
Cohort (n=204)
No
Does early start of DOACs (≤7 days) compared to late start (>7 days) affect the rate of intracranial hemorrhage and recurrent ischemic events in patients with recent acute ischemic stroke and atrial fibrillation?
Early initiation of DOACs (≤7 days) after acute ischemic stroke in patients with atrial fibrillation appears safe, with a low risk of intracranial hemorrhage and no significant difference in recurrent ischemic events compared to late initiation.
Absolute Event Rate: 5.1% vs 9.3%
p-value: p=0.53
Objective: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non–vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. Methods: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOACearly) and those with late (>7 days, DOAClate) start of DOAC. Results: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3–11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOACearly (5.1%/y) and DOAClate (9.3%/y, p = 0.53) was observed. Conclusions: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
Seiffge et al. (Sat,) conducted a cohort in Acute ischemic stroke (AIS) or TIA and nonvalvular atrial fibrillation (n=204). Early start of DOAC (≤7 days since event) vs. Late start of DOAC (>7 days) was evaluated on Rates of intracranial hemorrhage (ICH) and recurrent ischemic events (AIS or TIA) (p=0.53). Early start of DOAC (≤7 days) after ischemic stroke showed no significant difference in recurrent ischemic events compared to late start (5.1%/y vs 9.3%/y, p=0.53).