Arrhythmias & electrophysiology
Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial
An erratum to this article was published (Circulation, 2 Jul 2024 ↗)
Authors' conclusion
We found no evidence of major treatment effect heterogeneity or safety concerns with early compared with late direct oral anticoagulation initiation in people with and without HT. However, early direct oral anticoagulation initiation may worsen functional outcomes in people with PH.
Study context
- Population
- People with ischemic stroke and AF, by hemorrhagic transformation (HT: hemorrhagic infarction [hemorrhagic infarction (HI)] or parenchymal hemorrhage [parenchymal hemorrhage (PH)]) on prerandomization imaging247 (12.5%) with HT
- Participants
- 1,970 people
- Comparison
- Early vs late DOAC initiation, by hemorrhagic transformation
- Primary endpoint
- Composite of:
- Recurrent ischemic stroke
- Symptomatic intracranial hemorrhage
- Major extracranial bleeding
- Systemic embolism
- Vascular death
- Follow-up
- 30 days
Methodological detailspost hoc analysis, core laboratory imaging rating
- Post hoc analysis
- Core laboratory imaging rating
Primary result
As reported in the abstract
Primary composite outcome, by HT
Early vs LateAdjusted risk difference (95% CI)
HT
−2.2%(−7.8% to 3.5%)
HI
−4.7%(−10.8% to 1.4%)
PH
6.1%(−8.5% to 20.6%)
No HT
−0.9%(−2.6% to 0.8%)
Secondary outcomes
| Outcome | Adjusted risk difference (95% CI) | |
|---|---|---|
| Poor functional outcome (mRS 3-6), by HT · 90 daysEarlyvs LateHT | 11.5% (−0.8% to 23.8%) | |
| Poor functional outcome (mRS 3-6), by HT · 90 daysEarlyvs LateHI | 7.4% (−6.4% to 21.2%) | |
| Poor functional outcome (mRS 3-6), by HT · 90 daysEarlyvs LatePH | 25.1% (0.2%–50.0%) | |
| Poor functional outcome (mRS 3-6), by HT · 90 daysEarlyvs LateNo HT | −2.6% (−7.1% to 1.8%) | |
| −200204060Difference (linear scale) |
Safety
Symptomatic intracranial hemorrhage
- Numbers identical in people with and without HT
Original publication
Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial. Circulation. Published 16 May 2024. doi:10.
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