RT Journal Article
SR Electronic
T1 Early versus late start of direct oral anticoagulants after acute ischaemic stroke linked to atrial fibrillation: an observational study and individual patient data pooled analysis
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 119
OP 125
DO 10.1136/jnnp-2021-327236
VO 93
IS 2
A1 Gian Marco De Marchis
A1 David J. Seiffge
A1 Sabine Schaedelin
A1 Duncan Wilson
A1 Valeria Caso
A1 Monica Acciarresi
A1 Georgios Tsivgoulis
A1 Masatoshi Koga
A1 Sohei Yoshimura
A1 Kazunori Toyoda
A1 Manuel Cappellari
A1 Bruno Bonetti
A1 Kosmas Macha
A1 Bernd Kallmünzer
A1 Carlo W. Cereda
A1 Philippe Lyrer
A1 Leo H. Bonati
A1 Maurizio Paciaroni
A1 Stefan T. Engelter
A1 David J. Werring
YR 2022
UL http://jnnp.bmj.com/content/93/2/119.abstract
AB Objective The optimal timing to start direct oral anticoagulants (DOACs) after an acute ischaemic stroke (AIS) related to atrial fibrillation (AF) remains unclear. We aimed to compare early (≤5 days of AIS) versus late (>5 days of AIS) DOAC-start.Methods This is an individual patient data pooled analysis of eight prospective European and Japanese cohort studies. We included patients with AIS related to non-valvular AF where a DOAC was started within 30 days. Primary endpoints were 30-day rates of recurrent AIS and ICH.Results A total of 2550 patients were included. DOACs were started early in 1362 (53%) patients, late in 1188 (47%). During 212 patient-years, 37 patients had a recurrent AIS (1.5%), 16 (43%) before a DOAC was started; 6 patients (0.2%) had an ICH, all after DOAC-start. In the early DOAC-start group, 23 patients (1.7%) suffered from a recurrent AIS, while 2 patients (0.1%) had an ICH. In the late DOAC-start group, 14 patients (1.2%) suffered from a recurrent AIS; 4 patients (0.3%) suffered from ICH. In the propensity score-adjusted comparison of late versus early DOAC-start groups, there was no statistically significant difference in the hazard of recurrent AIS (aHR=1.2, 95% CI 0.5 to 2.9, p=0.69), ICH (aHR=6.0, 95% CI 0.6 to 56.3, p=0.12) or any stroke.Conclusions Our results do not corroborate concerns that an early DOAC-start might excessively increase the risk of ICH. The sevenfold higher risk of recurrent AIS than ICH suggests that an early DOAC-start might be reasonable, supporting enrolment into randomised trials comparing an early versus late DOAC-start.Data are available upon reasonable request. The data used during this study are available from the corresponding author on reasonable request.