November 19, 2018Journal of Neurology Neurosurgery & PsychiatryOpen Access

Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ischaemic stroke or transient ischaemic attack (TIA) with atrial fibrillation (n=1355). Intervention: Early oral anticoagulation (0-4 days) vs. Late oral anticoagulation (≥5 days or never started). Primary outcome: Composite of TIA, stroke (ischaemic stroke or intracranial haemorrhage) or death within 90 days (adjusted OR 1.17, 95% CI 0.48 to 2.84, p=0.736).

View Full Paper

Ask AI

Bookmark

Key result

Early oral anticoagulation (0-4 days) after acute ischaemic stroke or TIA associated with atrial fibrillation was not associated with a significant difference in the 90-day composite rate of stroke, TIA, or death compared with late anticoagulation (adjusted OR 1.17 for late vs early, p=0.736).

Why the study?

The optimal time to start oral anticoagulation in patients with ischaemic stroke due to non-valvular atrial fibrillation is unknown.

Does early oral anticoagulant initiation reduce the composite outcome of TIA, stroke, or death in patients with ischaemic stroke or TIA and non-valvular atrial fibrillation?

Population

1355 patients with ischaemic stroke or TIA and AF

Comparison

Early (0-4 days) vs later (≥5 days or never started) OAC initiation

Design

Post hoc analysis of a prospective multicentre observational inception cohort study

Follow-up

90 days

Authors

DWDuncan WilsonStroke Association GAGareth AmblerUniversity of London GBGargi BanerjeeQueen Mary University of London

Discussion

Member takes

Implication

No 90-day outcome difference seen with early versus late anticoagulation; leaves optimal timing unresolved pending randomized trials.

Study Design

Type

Cohort (n=1,355)

Multicenter

Yes

Structured PICO

Does early oral anticoagulant initiation reduce the composite outcome of TIA, stroke, or death in patients with ischaemic stroke or TIA and non-valvular atrial fibrillation?

Population

1,355 patients (mean age 76, 43% female) with recent ischaemic stroke or TIA and atrial fibrillation treated with oral anticoagulants, followed for 90 days.

Exposure

Early oral anticoagulant (OAC) initiation (0-4 days after qualifying stroke or TIA)

Comparator

Late oral anticoagulant (OAC) initiation (≥5 days or never started)

Outcome

Composite outcome of TIA, stroke (ischaemic stroke or intracranial haemorrhage) or death within 90 days of the qualifying stroke or TIAcomposite

Main Result

Odds Ratio: 1.17 (95% CI 0.48–2.84)

Absolute Event Rate: 2% vs 5%

p-value: p=0.736

Early initiation of oral anticoagulation (0-4 days) after acute ischemic stroke or TIA in patients with atrial fibrillation was not associated with a significant difference in 90-day composite outcomes compared to late initiation.

Limitations

Observational nature with unmeasured treatment biases such as clinician characteristics and patient frailty
Low number of events within 90 days precludes further investigation into predictors of early haemorrhage
Stroke to MRI time was not standardised, preventing detailed assessment of baseline infarct volume
Exclusion of older patients with more severe strokes who could not tolerate MRI
Patients selected for early OAC and late OAC might still have differed in important respects despite adjustment for important baseline factors

Cite This Study

Wilson et al. (2018) conducted a cohort in Ischaemic stroke or transient ischaemic attack (TIA) with atrial fibrillation (n=1,355). Early oral anticoagulation (0-4 days) vs. Late oral anticoagulation (≥5 days or never started) was evaluated on Composite of TIA, stroke (ischaemic stroke or intracranial haemorrhage) or death within 90 days (adjusted OR 1.17, 95% CI 0.48 to 2.84, p=0.736). Early oral anticoagulation (0-4 days) after acute ischaemic stroke or TIA associated with atrial fibrillation was not associated with a significant difference in the 90-day composite rate of stroke, TIA, or death compared with late anticoagulation (adjusted OR 1.17 for late vs early, p=0.736).

synapsesocial.com/papers/6a7eeef56f6aff5b979a17b9 https://doi.org/10.1136/jnnp-2018-318890

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

View Full Paper

Ask AI

Bookmark

Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider