Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Publisher DOI
PubMed ID
36078915
Abstract
Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.
Date Issued
2022-08-25
Publication Type
Article
Subject(s)
Subjects
anticoagulant atrial fibrillation direct oral anticoagulants intracerebral haemorrhage ischemic stroke secondary prevention vitamin-K antagonists
Language(s)
en
Author(s)
Palaiodimou, Lina | |
Stefanou, Maria-Ioanna | |
Katsanos, Aristeidis H | |
Paciaroni, Maurizio | |
Sacco, Simona | |
De Marchis, Gian Marco | |
Shoamanesh, Ashkan | |
Malhotra, Konark | |
de Sousa, Diana Aguiar | |
Lambadiari, Vaia | |
Kantzanou, Maria | |
Vassilopoulou, Sofia | |
Toutouzas, Konstantinos | |
Filippou, Dimitrios K | |
Tsivgoulis, Georgios |
Additional Credits
Journal
Journal of clinical medicine
Publisher
MDPI
ISSN
2077-0383
Access(Rights)
open.access