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
De Marchis GM, Seiffge DJ, Schaedelin S, Wilson D, Caso V, Acciarresi M, Tsivgoulis G, Koga M, Yoshimura S, Toyoda K, Cappellari M, Bonetti B, Macha K, Kallmünzer B, Cereda CW, Lyrer P, Bonati LH, Paciaroni M, Engelter ST, Werring DJ (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Abstract
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.
Authors with CRIS profile
Involved external institutions
Universitätsspital Basel
Switzerland (CH)
Universität Basel
Switzerland (CH)
University College London Hospitals (UCLH)
United Kingdom (GB)
Ospedale S. Maria della Misericordia / Azienda Ospedaliera di Perugia
Italy (IT)
Hospital San Giovanni Battista
Italy (IT)
National and Kapodistrian University of Athens
Greece (GR)
National Cerebral and Cardiovascular Center
Japan (JP)
University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI)
Italy (IT)
Ospedale Regionale di Lugano - Civico e Italiano
Switzerland (CH)
San Giuseppe Hospital, Multi Medica
Italy (IT)
Switzerland (CH)
Universität Basel
Switzerland (CH)
University College London Hospitals (UCLH)
United Kingdom (GB)
Ospedale S. Maria della Misericordia / Azienda Ospedaliera di Perugia
Italy (IT)
Hospital San Giovanni Battista
Italy (IT)
National and Kapodistrian University of Athens
Greece (GR)
National Cerebral and Cardiovascular Center
Japan (JP)
University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI)
Italy (IT)
Ospedale Regionale di Lugano - Civico e Italiano
Switzerland (CH)
San Giuseppe Hospital, Multi Medica
Italy (IT)
How to cite
APA:
De Marchis, G.M., Seiffge, D.J., Schaedelin, S., Wilson, D., Caso, V., Acciarresi, M.,... Werring, D.J. (2021). 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. Journal of Neurology Neurosurgery and Psychiatry. https://dx.doi.org/10.1136/jnnp-2021-327236
MLA:
De Marchis, Gian Marco, et al. "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." Journal of Neurology Neurosurgery and Psychiatry (2021).
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