Author(s):
Palaiodimou, L ; Stefanou, MI ; Katsanos, AH ; Paciaroni, M ; Sacco, S ; De Marchis, GM ; Shoamanesh, A ; Malhotra, K ; Aguiar de Sousa, D ; Lambadiari, V ; Kantzanou, M ; Vassilopoulou, S ; Toutouzas, K ; Filippou, DK ; Seiffge, DJ ; Tsivgoulis, G
Date: 2022
Persistent ID: http://hdl.handle.net/10400.17/4603
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): Anticoagulants; Atrial Fibrillation; Anticoagulants, Direct-Acting Oral; Hemorrhage, Intracerebral; Ischemic Stroke; Vitamin-K antagonist; Secondary Prevention; HSJ NEU
Description
Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.
