Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

Abstract

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 AE 9.4 days in the DOAC group and 11.9 AE 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.

Ischemic stroke in oral anticoagulated patients with atrial fibrillation

“…However, strokes suffered by our anticoagulated patients were still of at least moderate clinical severity (mean NIHSS of 9.3) exceeding that reported in previous studies (mean weighted NIHSS score 5) 25‐31 . Previous anticoagulation affected recanalization therapy in our and previous studies as these patients more frequently undergo mechanical recanalization and less often thrombolysis 11,12 …”

“…Data included in the present study were derived from the database of the EIDASAF study as previously published 12 . Briefly, EIDASAF was an observational, retrospective, single‐center study based on consecutive patient data from the Hyper Acute Stroke Unit of Imperial College Healthcare NHS Trust collected from 2010 to 2017.…”

Extent of white matter lesion is associated with early hemorrhagic transformation in acute ischemic stroke related to atrial fibrillation

“…Data included in the present study were derived from the database of the EIDASAF study (D'Anna et al, 2020 were provided according to current international recommendations for acute ischemic stroke. Attending physicians made all the decisions regarding the timing of initiation of anticoagulant treatment.…”

“…Data included in the present study were derived from the database of the EIDASAF study (D'Anna et al, 2020). EIDASAF was an observa- were provided according to current international recommendations for acute ischemic stroke.…”

“…Data included in the present study were derived from the database of the EIDASAF study (D'Anna et al., 2020). EIDASAF was an observational, retrospective, single‐center study based on consecutive patient data collected from 2010 to 2017 from the Hyper Acute Stroke Unit of Imperial College London collected.…”