[Anticoagulants after acute ischemic stroke with atrial fibrillation]

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Atrial fibrillation is a common cause of acute ischemic stroke.
• Oral anticoagulant therapy (OAT) is crucial for preventing recurrent stroke in these patients.
• The optimal timing for initiating OAT after acute ischemic stroke is not well-established.

Purpose of the Study:

• To investigate the timing of oral anticoagulant therapy initiation in patients with acute ischemic stroke and atrial fibrillation.
• To identify factors associated with early versus delayed OAT initiation.
• To inform clinical decision-making regarding OAT management post-stroke.

Main Methods:

• Retrospective analysis of 294 patient records from two hospitals.
• Data collected included OAT choice (warfarin or NOAC), timing of initiation, CT findings (bleeding), swallowing capacity, and clinical deterioration.
• Analysis focused on patients surviving the acute phase (n=249).

Main Results:

• 47% of surviving patients received a new OAT prescription at discharge; 17% continued pre-stroke therapy.
• The median time to new OAT prescription was 5 days post-stroke admission, similar for warfarin and NOAC.
• Early OAT initiation was associated with good swallowing capacity and no signs of bleeding on initial CT.

Conclusions:

• The timing of OAT initiation after acute ischemic stroke with atrial fibrillation requires further investigation.
• Patient factors like swallowing ability and absence of intracranial hemorrhage are critical considerations for early OAT.
• A randomized clinical trial is needed to definitively answer the question of early versus delayed OAT onset.