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Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and

Lina Palaiodimou1, Maria-Ioanna Stefanou1, Aristeidis H Katsanos2

  • 1Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Journal of Clinical Medicine
|September 9, 2022
PubMed

Insights

Initiating oral anticoagulation within one week for acute ischemic stroke (AIS) due to atrial fibrillation (AF) shows similar safety and efficacy to starting within two weeks. Direct oral anticoagulants (DOACs) are more effective than vitamin-K antagonists (VKAs) for preventing recurrent AIS and improving survival.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Optimal timing for initiating oral anticoagulation in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) remains uncertain.
  • Early anticoagulation is crucial for secondary stroke prevention but carries risks of hemorrhage.

Purpose of the Study:

  • To systematically review and meta-analyze studies comparing early anticoagulation initiation (within 1 week vs. 2 weeks) for AF-related AIS.
  • To compare the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) within these early time windows.

Main Methods:

  • Systematic review and meta-analysis of randomized-controlled trials (RCTs) and prospective observational studies.
  • Inclusion of 5616 patients with AF-related AIS receiving early anticoagulation.
  • Outcomes assessed: ischemic stroke (IS) recurrence, all-cause mortality, symptomatic intracerebral hemorrhage (sICH), and any intracranial hemorrhage (ICH).

Main Results:

  • Initiating anticoagulation within the first week showed similar rates of recurrent IS, sICH, and all-cause mortality compared to initiation within two weeks.
  • Direct oral anticoagulants (DOACs) significantly reduced IS recurrence compared to vitamin-K antagonists (VKAs) (RR: 0.65; 95%CI: 0.52-0.82).
  • DOACs were associated with a lower likelihood of sICH and all-cause mortality compared to VKAs.

Conclusions:

  • Early anticoagulation initiation (within one week) for AF-related AIS appears to have comparable efficacy and safety to initiation within two weeks.
  • DOACs demonstrate superior effectiveness in reducing IS recurrence and improving survival compared to VKAs in this patient population.
  • Findings support considering early anticoagulation, particularly with DOACs, for patients with AF-related AIS.

Keywords:
anticoagulantatrial fibrillationdirect oral anticoagulantsintracerebral haemorrhageischemic strokesecondary preventionvitamin-K antagonists

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