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Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation.

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Title: Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation.
Authors: D'Anna, L
Filippidis, FT
Antony, S
Brown, Z
Wyatt, H
Malik, A
Sivakumaran, P
Harvey, K
Marinescu, M
Bentley, P
Korompoki, E
Veltkamp, R
Item Type: Journal Article
Abstract: BACKGROUND: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. METHODS: This observational, retrospective, single-centre study included consecutive patients with recent (< 4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intra- and extracranial) bleeding in patients on different treatment schemes: DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. RESULTS: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average time of 16.1 days after the index event. 559 patients of 959 (58.3%) were anticoagulated with either VKAs (259) or DOACs (300). Anticoagulation was started after a mean time of 7± 9.4 in the DOACs group and 11.9± 19.7 in the VKAs group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding (OR 0.49; CI, 0.21-1.16) and in particular of intracranial bleeding (OR 0.47; CI, 0.17-1.29; p = 0.143) compared with no anticoagulation. In contrast to VKAs (OR 0.78; CI, 0.28-2.13), treatment with DOACs (OR 0.32; CI, 0.10-0.96) reduced the rate of major bleeding compared to no-anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. CONCLUSIONS: Starting DOACs within a mean time of 7 days after stroke appears safe. Randomised controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.
Issue Date: Nov-2020
Date of Acceptance: 4-Jun-2020
URI: http://hdl.handle.net/10044/1/80040
DOI: 10.1111/ene.14396
ISSN: 0953-816X
Publisher: Wiley
Start Page: 2168
End Page: 2175
Journal / Book Title: European Journal of Neuroscience
Volume: 27
Issue: 11
Copyright Statement: © 2020 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Sponsor/Funder: National Institute for Health Research
Commission of the European Communities
Funder's Grant Number: ll-LA-0814-20007
754517
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences
Neurosciences & Neurology
atrial fibrillation
direct oral anticoagulants
stroke
vitamin K antagonists
ACUTE ISCHEMIC-STROKE
DIRECT ORAL ANTICOAGULANTS
HEMORRHAGIC TRANSFORMATION
CARDIOEMBOLIC STROKE
WARFARIN
CLASSIFICATION
RIVAROXABAN
THERAPY
RISK
atrial fibrillation
direct oral anticoagulants
stroke
vitamin K antagonists
DOACs
VKAs
atrial fibrillation
stroke
1103 Clinical Sciences
1109 Neurosciences
Neurology & Neurosurgery
Publication Status: Published
Conference Place: England
Online Publication Date: 2020-06-16
Appears in Collections:Faculty of Medicine
School of Public Health
Department of Brain Sciences



This item is licensed under a Creative Commons License Creative Commons