Early Treatment Can Be Initiated for A-Fib Patients With Stroke

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Incidence of primary end point ranged from reduction of about 2.8 percent to increase of about 0.5 percent

By Elana Gotkine HealthDay Reporter

MONDAY, June 5, 2023 (HealthDay News) — For patients with atrial fibrillation who have had an acute ischemic stroke, the incidence of a composite primary end point ranges from a reduction of about 2.8 percent to an increase of 0.5 percent for those receiving early versus later direct oral anticoagulants (DOACs), according to a study published online May 24 in the New England Journal of Medicine to coincide with the annual European Stroke Organization Conference, held from May 24 to 26 in Munich.

Urs Fischer, M.D., from the University of Basel in Switzerland, and colleagues conducted an open-label trial at 103 sites in 15 countries involving 2,013 patients with atrial fibrillation who had an acute ischemic stroke. Participants were randomly assigned to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 to 7 after a major stroke) or later anticoagulation (day 3 or 4 after minor stroke, day 6 or 7 after moderate stroke, or day 12, 13, or 14 after major stroke). Overall, 1,006 patients received early treatment and 1,007 patients received later treatment.

The researchers found that a primary outcome event (recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death within 30 days after randomization) occurred in 2.9 and 4.1 percent in the early- and later-treatment groups (risk difference, −1.18 percent; 95 percent confidence interval, −2.84 to 0.47) by 30 days. Recurrent stroke occurred in 1.4 and 2.5 percent of participants, respectively, in the early- and later-treatment groups by 30 days (odds ratio, 0.57; 95 percent confidence interval, 0.29 to 1.07) and in 1.9 and 3.1 percent, respectively, by 90 days (odds ratio, 0.60; 95 percent confidence interval, 0.33 to 1.06).

“Early treatment initiation can therefore be supported if indicated or if desired,” the authors write. “The rates of the outcomes increased only slightly more at 90 days than at 30 days, findings that suggest there was not an excessive risk associated with early anticoagulation through that period.”

Several authors disclosed ties to the pharmaceutical industry.

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