Key result
Early initiation of DOACs (≤3 days) after stroke onset was associated with a comparable risk of stroke or systemic embolism at 2 years compared to late initiation (HR 0.86; 95% CI 0.47-1.57).
Why the study?
Outcomes comparing earlier versus later initiation of direct oral anticoagulants after stroke onset in ischemic stroke patients with nonvalvular AF required investigation.
Does early initiation of DOACs (≤3 days) compared to late initiation (≥4 days) reduce stroke, systemic embolism, major bleeding, or death in patients with nonvalvular atrial fibrillation and acute ischemic stroke or TIA?
Population
499 nonvalvular AF patients with acute ischemic stroke or TIA who started DOACs during acute hospitalization
Comparison
Early (≤3 days) vs late (≥4 days) DOAC initiation after onset
Design
Prospective multicenter observational study
Follow-up
2 years
Authors
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Should not yet change practice on DOAC timing after AF stroke; leaves open randomized confirmation of long-term equivalence.
Observational (n=499)
Yes
Does early initiation of DOACs (≤3 days) compared to late initiation (≥4 days) reduce stroke, systemic embolism, major bleeding, or death in patients with nonvalvular atrial fibrillation and acute ischemic stroke or TIA?
Hazard Ratio: 0.86 (95% CI 0.47–1.57)
Early initiation of DOACs within 3 days of acute ischemic stroke or TIA in patients with nonvalvular atrial fibrillation is associated with similar risks of recurrent stroke, bleeding, and death compared to later initiation.
Mizoguchi et al. (2020) conducted an observational in Nonvalvular atrial fibrillation with acute ischemic stroke or transient ischemic attack (n=499). Early initiation of DOACs (≤3 days) vs. Late initiation of DOACs (≥4 days) was evaluated on Stroke or systemic embolism at 2 years (HR 0.86, 95% CI 0.47-1.57). Early initiation of DOACs (≤3 days) after stroke onset was associated with a comparable risk of stroke or systemic embolism at 2 years compared to late initiation (HR 0.86; 95% CI 0.47-1.57).
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