TY - JOUR
TI - 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
AU - De Marchis, Gian Marco
AU - Seiffge, David J.
AU - Schaedelin, Sabine and
AU - Wilson, Duncan
AU - Caso, Valeria
AU - Acciarresi, Monica
AU - Tsivgoulis,
AU - Georgios
AU - Koga, Masatoshi
AU - Yoshimura, Sohei
AU - Toyoda, Kazunori
AU - and Cappellari, Manuel
AU - Bonetti, Bruno
AU - Macha, Kosmas and
AU - Kallmuenzer, Bernd
AU - Cereda, Carlo W.
AU - Lyrer, Philippe
AU - Bonati,
AU - Leo H.
AU - Paciaroni, Maurizio
AU - Engelter, Stefan T.
AU - Werring,
AU - David J.
JO - JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
PY - 2022
VL - 93
TODO - 2
SP - 119-125
PB - BMJ Publishing Group
SN - null
TODO - 10.1136/jnnp-2021-327236
TODO - stroke; cerebrovascular disease
TODO - 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.
ER -