Early versus late initiation of anticoagulation to prevent stroke in patients with atrial fibrillation
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by An Thien Duc Le |
Posted on July 26th, 2023
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It had been previously demonstrated that the usage of anticoagulants reduces the likelihood of ischemic stroke and systemic embolism in those who are experiencing atrial fibrillation. But there is currently no consensus on the timing of anticoagulant initiation. Late initiation can increase the risk of ischemic events, and early initiation can increase the risk of hemorrhage. Thus, a study was conducted to compare the effectiveness and safety between early and late initiation of anticoagulants.
The study included 2013 patients who were affected with persistent atrial fibrillation and had experienced an ischemic stroke episode with symptoms lasting more than 24 hours. The effect size of the ischemic event was characterized with either a CT or MRI scan, with an infraction that affected less than 1.5 cm of cerebrovascular vessels categorized as a minor event. Infarction affecting the cerebral artery was categorized as a moderate event. A major event was characterized by either an infarct larger than 1.5 cm or impacted the brainstem and cerebellum. Besides disease severity, analyses were further characterized by the age of the patient. Half of the patients were randomly assigned to the early treatment group with anticoagulants initiated within 48 hours after a minor or moderate stroke onset and on the 6th or 7th day after a major incident. The patients in the late treatment group were given anticoagulants on the 3th day following a minor event, 6th day after a moderate event, and 13th day after a major incident.
After 30 days of follow-up, the researchers concluded that there was little difference in the rate of ischemic stroke, or systemic embolism, between early and late initiation of anticoagulants. A similar conclusion was reached when comparing the rate of recurrent ischemic stroke after 90 days. The study did not find any significant difference in the rate of intracranial hemorrhage between the two groups.
The study included 2013 patients who were affected with persistent atrial fibrillation and had experienced an ischemic stroke episode with symptoms lasting more than 24 hours. The effect size of the ischemic event was characterized with either a CT or MRI scan, with an infraction that affected less than 1.5 cm of cerebrovascular vessels categorized as a minor event. Infarction affecting the cerebral artery was categorized as a moderate event. A major event was characterized by either an infarct larger than 1.5 cm or impacted the brainstem and cerebellum. Besides disease severity, analyses were further characterized by the age of the patient. Half of the patients were randomly assigned to the early treatment group with anticoagulants initiated within 48 hours after a minor or moderate stroke onset and on the 6th or 7th day after a major incident. The patients in the late treatment group were given anticoagulants on the 3th day following a minor event, 6th day after a moderate event, and 13th day after a major incident.
After 30 days of follow-up, the researchers concluded that there was little difference in the rate of ischemic stroke, or systemic embolism, between early and late initiation of anticoagulants. A similar conclusion was reached when comparing the rate of recurrent ischemic stroke after 90 days. The study did not find any significant difference in the rate of intracranial hemorrhage between the two groups.