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Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis

2022Journal article Open access
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dc.contributor.authorPalaiodimou, L
dc.contributor.authorStefanou, MI
dc.contributor.authorKatsanos, AH
dc.contributor.authorPaciaroni, M
dc.contributor.authorSacco, S
dc.contributor.authorDe Marchis, GM
dc.contributor.authorShoamanesh, A
dc.contributor.authorMalhotra, K
dc.contributor.authorAguiar de Sousa, D
dc.contributor.authorLambadiari, V
dc.contributor.authorKantzanou, M
dc.contributor.authorVassilopoulou, S
dc.contributor.authorToutouzas, K
dc.contributor.authorFilippou, DK
dc.contributor.authorSeiffge, DJ
dc.contributor.authorTsivgoulis, G
dc.date.accessioned2023-07-12T14:09:48Z
dc.date.available2023-07-12T14:09:48Z
dc.date.issued2022
dc.description.abstractIntroduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Clin Med . 2022 Aug 25;11(17):4981pt_PT
dc.identifier.doi10.3390/jcm11174981pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4603
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherMultidisciplinary Digital Publishing Institute (MDPI)pt_PT
dc.subjectAnticoagulantspt_PT
dc.subjectAtrial Fibrillationpt_PT
dc.subjectAnticoagulants, Direct-Acting Oralpt_PT
dc.subjectHemorrhage, Intracerebralpt_PT
dc.subjectIschemic Strokept_PT
dc.subjectVitamin-K antagonistpt_PT
dc.subjectSecondary Preventionpt_PT
dc.subjectHSJ NEUpt_PT
dc.titleEarly Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue17pt_PT
oaire.citation.startPage4981pt_PT
oaire.citation.titleJournal of Clinical Medicinept_PT
oaire.citation.volume11pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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