Early initiation of DOACs after ischemic stroke reduced the rate of major bleeding compared with no anticoagulation (OR 0.32; 95% CI 0.10-0.96).
Observational (n=959)
No
Does early initiation of DOACs or VKAs reduce major bleeding in patients with recent ischaemic stroke and atrial fibrillation compared to no anticoagulation?
Early initiation of DOACs (mean 7 days) after an ischaemic stroke in patients with atrial fibrillation appears safe and is associated with a lower rate of major bleeding compared to no anticoagulation.
Effect estimate: OR 0.32 (95% CI 0.10-0.96)
BACKGROUND AND PURPOSE: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. METHODS: This observational, retrospective, single-centre study included consecutive patients with recent (<4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intracranial and extracranial) bleeding in patients on different treatment schemes, i.e. DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. RESULTS: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average of 16.1 days after the index event. A total of 559 out of 959 patients (58.3%) were anticoagulated with either VKAs (n = 259) or DOACs (n = 300). Anticoagulation was started after a mean of 7 ± 9.4 days in the DOAC group and 11.9 ± 19.7 days in the VKA group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.21-1.16 and in particular of intracranial bleeding (OR, 0.47; 95% CI, 0.17-1.29; P = 0.143) compared with no anticoagulation. In contrast to VKAs (OR, 0.78; 95% CI, 0.28-2.13), treatment with DOACs (OR, 0.32; 95% CI, 0.10-0.96) reduced the rate of major bleeding compared with no anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. CONCLUSIONS: Starting DOACs within a mean of 7 days after stroke appeared to be safe. Randomized controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.
D’Anna et al. (Ter,) conduziram uma observacional em acidente vascular cerebral isquêmico e fibrilação atrial (n=959). A iniciação precoce de anticoagulantes orais diretos (DOACs) vs. antagonistas da vitamina K (VKAs) ou nenhuma anticoagulação foi avaliada quanto à taxa de sangramentos maiores (intracranianos e extracranianos) (OR 0,32, IC 95% 0,10-0,96). A iniciação precoce de DOACs após acidente vascular cerebral isquêmico reduziu a taxa de sangramentos maiores em comparação com nenhuma anticoagulação (OR 0,32; IC 95% 0,10-0,96).