Early vs Late Anticoagulation After Ischemic Stroke in Patients With Atrial Fibrillation and Covert Brain Infarcts
Year: 2024
Type: article
Abstract: BACKGROUND AND OBJECTIVES: Covert brain infarcts (CBIs) in patients with first-ever ischemic stroke (IS) and atrial fibrillation (AF) are associated with an increased risk of stroke recurrence. We aimed to assess whether CBIs modify the treatment effect of early vs late initiation of direct oral anticoagulants (DOACs) in patients with IS and AF. METHODS: values. RESULTS: for interaction: 0.063). With early DOAC treatment, IS recurrence risk was lower in participants with CBI (aRD: -2.7%, 95% CI -5.0 to -0.4), but not in participants without CBI (aRD: -0.4, 95% CI -2.1 to 1.2). No sICH was observed in the early treatment group. DISCUSSION: The presence of CBI may indicate a subgroup of patients with first-ever IS and AF who particularly benefits from early DOAC initiation to prevent ischemic event recurrence, without increasing harm. Our findings should be considered in clinical decision making regarding timely DOAC treatment in patients with stroke and AF. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with covert brain infarcts, atrial fibrillation, and first-ever ischemic stroke, early (vs late) initiation of DOACs is associated with lower risk of recurrent stroke with no increase in harm. TRIAL REGISTRATION INFORMATION: : November 6, 2017.
Source: Neurology
Authors: Markus Kneihsl, Arsany Hakim, Martina B. Goeldlin, Thomas R. Meinel, Mattia Branca, Roman Rohner, Sabine Fenzl, Stefanie Abend, Gek C. Shim, Christoph Gumbinger, Liqun Zhang, Espen Saxhaug Kristoffersen, Philippe Desfontaines, Peter Vanacker, Angelika Alonso, Sven Poli, Ana Paiva Nunes, Nicoletta G. Caracciolo, Thomas Gattringer, Timo Kahles, Daria Giudici, Jelle Demeestere, Jesse Dawson, Urs Fischer, for the ELAN investigators
Institutions: Medical University of Graz, University Hospital of Basel, University of Bern, University Hospital of Bern, University Hospital of North Durham, University Hospital Heidelberg, St George's Hospital, St George's, University of London, University of Oslo, Akershus University Hospital, Centre Hospitalier Chrétien, Centre Hospitalier Universitaire de Liège, University of Antwerp, AZ Groeninge, Antwerp University Hospital, Heidelberg University, Medizinische Fakultät Mannheim, Hertie Institute for Clinical Brain Research, University of Tübingen, Sapienza University of Rome, Kantonsspital Aarau, University of Perugia, KU Leuven, Queen Elizabeth University Hospital, University of Glasgow
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Safety of Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with Non-valvular atrial fibrillation (ELAN safety), ELAN benefit, a nested project within the Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN) trial
OpenAlex ID: W4405595481