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The following is a summary of “Early vs Late Anticoagulation After Ischemic Stroke in Patients With Atrial Fibrillation and Covert Brain Infarcts,” published in the December 2024 issue of Neurology by Kneihsl et al.
Covert brain infarcts (CBIs) in patients with ischemic stroke (IS) and atrial fibrillation (AF) increase the risk of recurrent stroke.
Researchers conducted a retrospective study assessing whether CBIs modify the treatment effect of early vs. late direct oral anticoagulant (DOAC) initiation in patients with IS and AF.
They analyzed a post hoc analysis of the international, multicenter, randomized-controlled ELAN trial involving 1,694 participants, median age 77 years, 45.9% female, comparing early (<48 hours for minor/moderate IS, 6–7 days for major IS) vs. late (>48 hours for minor, 3–4 days for moderate, 12–14 days for major IS) DOAC initiation. The primary outcome was a composite of recurrent IS, symptomatic intracranial hemorrhage (sICH), major extracranial bleeding, systemic embolism, or vascular death within 30 days, and secondary outcomes were individual components.
The results showed 678 participants with CBIs, 2.3% (8/342) in the early treatment group experienced the primary outcome compared to 6.0% (20/336) in the late treatment group (adjusted risk difference: −3.6%, 95% CI −6.6 to −0.6) (P for interaction: 0.063). The risk of IS recurrence was lower in those with CBIs in the early treatment group (adjusted risk difference: −2.7%, 95% CI −5.0 to −0.4) but not in those without CBIs (adjusted risk difference: −0.4%, 95% CI −2.1 to 1.2), no sICH was observed in the early treatment group.
They concluded that patients with IS, AF, and CBIs may benefit from early DOAC initiation to reduce ischemic event recurrence.
Source: neurology.org/doi/10.1212/WNL.0000000000210157
