RT Journal Article
SR Electronic
T1 Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 320
OP 325
DO 10.1136/jnnp-2018-318890
VO 90
IS 3
A1 Wilson, Duncan
A1 Ambler, Gareth
A1 Banerjee, Gargi
A1 Shakeshaft, Clare
A1 Cohen, Hannah
A1 Yousry, Tarek A
A1 Al-Shahi Salman, Rustam
A1 Lip, Gregory Y H
A1 Houlden, Henry
A1 Brown, Martin M
A1 Muir, Keith W
A1 Jäger, Hans Rolf
A1 Werring, David J
A1 
YR 2019
UL http://jnnp.bmj.com/content/90/3/320.abstract
AB Background and purpose The optimal time to start oral anticoagulant (OAC) in patients with ischaemic stroke due to non-valvular atrial fibrillation (AF) is unknown. We reviewed OAC timing in relation to 90-day clinical outcomes as a post hoc analysis from a prospective multicentre observational study.Methods We included patients with data on time to initiation of OAC from CROMIS-2 (Clinical Relevence Of Microbleeds In Stroke-2), a prospective observational inception cohort study of 1490 patients with ischaemic stroke or transient ischaemic attack (TIA) and AF treated with OAC. The primary outcome was the composite outcome of TIA, stroke (ischaemic stroke or intracranial haemorrhage) or death within 90 days of the qualifying stroke or TIA. We performed adjusted logistic regression analyses to compare early (0–4 days) and later (≥5 days or never started) OAC initiation.Results We included 1355 patients, mean age 76 (SD 10), 580 (43%) women. OAC was started early in 358 (26%) patients and later (or not at all) in 997 (74%) patients. The event rate within 90 days was 48/997 (5%) in the late-OAC group (2 intracranial haemorrhages, 18 ischaemic strokes or TIAs and 31 deaths (three deaths were as a result of new ischaemic strokes)) versus 7/358 (2%) in the early-OAC group (5 ischaemic strokes or TIAs and 2 deaths). In adjusted analyses, late OAC was not associated with the composite outcome (adjusted OR 1.17, 95% CI 0.48 to 2.84, p=0.736).Conclusion In adjusted analyses, early OAC after acute ischaemic stroke or TIA associated with AF was not associated with a difference in the rate of the composite outcome of stroke, TIA or death at 90 days, compared with late OAC. However, despite adjustment for important baseline factors, patients selected for early OAC and late OAC might still have differed in important respects; evaluation of OAC timing in adequately powered randomised trials is required.Clinical trial registration NCT02513316.