Collaboration on the optimal timing of anticoagulation after ischaemic stroke and atrial fibrillation: a systematic review and prospective individual participant data meta-analysis of randomised controlled trials (CATALYST)

Dehbi, HM; Fischer, U; Åsberg, S; Milling, TJ; Abend, S; Ahmed, N; Branca, M; Davis, LA; Engelter, ST; Freemantle, N; Gattringer, T; Ghukasyan Lakic, T; Hijazi, Z; James, M; Koga, M; Lawrence, P; Lemmens, R; Lip, GYH; Massingham, S; Nash, PS; Ndoutoumou, A; Norrving, B; Salanti, G; Sprigg, N; Thomalla, G; Vanniyasingam, T; Wester, P; Warach, SJ; Oldgren, J; Dawson, J; Werring, DJ

doi:10.1016/s0140-6736(25)00439-8

Collaboration on the optimal timing of anticoagulation after ischaemic stroke and atrial fibrillation: a systematic review and prospective individual participant data meta-analysis of randomised controlled trials (CATALYST)

LancetPublished 23 Jun 2025Systematic review and individual participant data meta-analysis of randomised controlled trials

Pooled resultResultOdds ratio 0.70 95% CI 0.50–0.98

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Authors' conclusion

For people with acute ischaemic stroke and atrial fibrillation, early DOAC initiation (within 4 days) reduced the risk of the composite outcome of recurrent ischaemic stroke, symptomatic intracerebral haemorrhage, or unclassified stroke within 30 days.

Study context

Population: Acute ischaemic stroke and AF
Participants: 5,441 participants · 4 RCTs

Comparison: Early vs later direct oral anticoagulant (DOAC) initiation after ischaemic stroke
Earlyn = 2,683
Latern = 2,746reference
Outcome: Recurrent ischaemic stroke, symptomatic intracerebral haemorrhage or unclassified stroke
Follow-up: 30 days of randomisation

Methodological detailsprospective, one-stage IPD meta-analysis, generalised linear mixed-effects model

Prospective
One-stage IPD meta-analysis
Generalised linear mixed-effects model

Pooled result

As reported in the abstract

Odds ratio

0.70

95% CI 0.50–0.98

P = 0.039

Events by group

Early2.1%57 of 2683

Later3.0%83 of 2746

Early vs Later

OR 0.70 (95% CI 0.50–0.98); P = 0.039

Further pooled results

Outcome	Early	Later	← Lower odds with early ←→ Higher odds with early →	OR (CI)	P value
Recurrent ischaemic stroke	1.7%	2.6%	0.512	0.66 (0.45–0.96)	P = 0.029
			0.512Odds ratio (log scale)

Safety

Outcome	Early	Later	← Lower odds with early ←→ Higher odds with early →	OR (CI)	P value
Symptomatic intracerebral haemorrhage	0.4%	0.4%	0.512	1.02 (0.43–2.46)	P = 0.96
			0.512Odds ratio (log scale)

Original publication

Collaboration on the optimal timing of anticoagulation after ischaemic stroke and atrial fibrillation: a systematic review and prospective individual participant data meta-analysis of randomised controlled trials (CATALYST). Lancet. Published 23 June 2025. doi:10.1016/s0140-6736(25)00439-8

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Summarised from the published abstract; every number is checked against it