Patients presenting with an acute ischemic stroke and found to have AF can be safely started on a DOAC much earlier than starting generally occurs in current clinical practice, a new study suggests.
He explained that patients presenting with acute ischemic stroke who are found to have atrial fibrillation need to be started on anticoagulation to reduce the risk for a recurrent stroke. But there are no clear guidelines on when to start anticoagulation in these patients at present, with concerns that starting very early may increase the risk for hemorrhagic transformation and ICH.
The later-treatment strategy followed the current approach of starting treatment at day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke, whereas the earlier-treatment group started DOAC treatment within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke.
Recurrent ischemic stroke occurred in 1.4% in the early-treatment group and 2.5% in the later-treatment group . Symptomatic intracranial hemorrhage occurred in two participants in both groups by 30 days. The researchers note that the trial did not have a statistical superiority or noninferiority design but rather aimed to estimate the treatment effects of early initiation vs later initiation of DOACs.
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