Key result
Early initiation of direct oral anticoagulants in acute ischemic stroke with atrial fibrillation has a low likelihood of causing harm regarding hemorrhage and may prevent further stroke.
Why the study?
Early initiation of anticoagulants after embolic stroke due to AF remains debated due to bleeding concerns, and resumption after intracranial hemorrhage is a gray zone.
Does early initiation of anticoagulants prevent recurrent stroke without significantly increasing bleeding risk in patients with acute ischemic stroke and atrial fibrillation?
Does early initiation of anticoagulants prevent recurrent stroke without significantly increasing bleeding risk in patients with acute ischemic stroke and atrial fibrillation?
Early initiation of DOACs after acute ischemic stroke in patients with atrial fibrillation appears safe and effective for secondary prevention without a significant excess risk of hemorrhage.
Optimal anticoagulation timing in AF-related stroke and post-ICH resumption remain uncertain; leaves open need for RCTs.
Embolic stroke due to atrial fibrillation is often underdiagnosed and has high morbidity and mortality among ischemic stroke. So it is of paramount importance to start anticoagulants as early as possible to prevent further ischemic stroke. However, early initiation of anticoagulants has created much debate, major & minor bleeding related to it are a major concern, and resumption of anticoagulants after intracranial hemorrhage is still a gray zone. Here, we described a narrative review to shed some light on the major concerns such as the optimal time to start an anticoagulant, the best agent to administer, the resumption of anticoagulant after a hemorrhagic stroke, and anticoagulant therapy in chronic rheumatic heart disease (CRHD) based on the recently published article. J MEDICINE 2024; 25: 155-158
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Sayeed et al. (2024) conducted a review in Acute Ischemic Stroke with Atrial Fibrillation. Anticoagulants (DOACs/NOACs) vs. Delayed initiation or Vitamin K Antagonists was evaluated. Early initiation of direct oral anticoagulants in acute ischemic stroke with atrial fibrillation has a low likelihood of causing harm regarding hemorrhage and may prevent further stroke.
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