Arrhythmias & electrophysiology
Early vs later non–vitamin K antagonist oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation: A meta-analysis and systematic review of randomized trials
Pooled resultResult — go to the resultRelative risk 0.82 95% CI 0.65–1.05Authors' conclusion
In AF patients with acute ischemic stroke, early initiation of NOACs is not inferior to later initiation of NOACs in reducing composite events, without increased hazard of bleeding, especially in female patients.
Study context
- Population
- Patients with atrial fibrillation (AF) and acute ischemic stroke
- Participants
- 6,442 patients · 3 RCTs
- Comparison
- Early vs later NOAC initiation
- Outcome
- Primary outcomes (composite events)
Methodological detailsrandom effects model, phase 3 or phase 4 RCTs
- Random effects model
- Phase 3 or phase 4 RCTs
Pooled result
As reported in the abstract
Relative risk
0.82
95% CI 0.65–1.05
Early NOAC vs Later NOAC
RR 0.82 (95% CI 0.65–1.05)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Recurrent ischemic stroke | 0.80 (0.56–1.15) | |
| Death | 0.96 (0.81–1.15) | |
| Systemic embolism | 0.43 (0.16–1.11) | |
| 0.10.31310Relative risk (log scale) |
Primary outcomes by sex (subgroup)
- Early vs later anticoagulation, female patients: RR
- 0.54 [0.35-0.83] (95% CI)
- Early vs later anticoagulation, male patients: RR
- 0.97 [0.63-1.50] (95% CI)
- Interaction P=.06
- Early anticoagulation may benefit female patients more than male patients
Safety
Bleeding (early vs later NOAC initiation)
- No difference in major bleeding between groups: RR
- 0.98 (0.55-1.74) (95% CI)
- No difference in symptomatic intracranial hemorrhage between groups: RR
- 0.93 (0.43-1.96) (95% CI)
- No difference in major extracranial bleeding between groups: RR
- 0.73 (0.28-1.95) (95% CI)
Original publication
Early vs later non–vitamin K antagonist oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation: A meta-analysis and systematic review of randomized trials. Heart Rhythm. Published 11 December 2024. doi:10.
Summarised from the published abstract; every number is checked against it