Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Palaiodimou, Lina; Stefanou, Maria-Ioanna; Katsanos, Aristeidis H; Paciaroni, Maurizio; Sacco, Simona; De Marchis, Gian Marco; Shoamanesh, Ashkan; Malhotra, Konark; de Sousa, Diana Aguiar; Lambadiari, Vaia; Kantzanou, Maria; Vassilopoulou, Sofia; Toutouzas, Konstantinos; Filippou, Dimitrios K; Seiffge, David J; Tsivgoulis, Georgios (2022). Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 11(17) MDPI 10.3390/jcm11174981

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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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Seiffge, David Julian


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

15 Sep 2022 08:37

Last Modified:

05 Dec 2022 16:24

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Uncontrolled Keywords:

anticoagulant atrial fibrillation direct oral anticoagulants intracerebral haemorrhage ischemic stroke secondary prevention vitamin-K antagonists





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