Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-12-01 Epub Date: 2024-05-14 DOI:10.1177/23969873241251931

Lina Palaiodimou, Maria-Ioanna Stefanou, Aristeidis H Katsanos, Gian Marco De Marchis, Diana Aguiar De Sousa, Jesse Dawson, Mira Katan, Theodore Karapanayiotides, Konstantinos Toutouzas, Maurizio Paciaroni, David J Seiffge, Georgios Tsivgoulis

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引用次数: 0

Abstract

Introduction: There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.

Methods: We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke. The primary outcome was defined as the composite of ischemic and hemorrhagic events and mortality at follow-up. Secondary outcomes included the components of the composite outcome (ischemic stroke recurrence, intracranial hemorrhage, major bleeding, and all-cause mortality). Pooled estimates were calculated with random-effects model.

Results: Nine studies (two RCTs and seven observational) were included comprising a total of 4946 patients with early OAC-initiation versus 4573 patients with later OAC-initiation following acute ischemic stroke. Early OAC-initiation was associated with reduced risk of the composite outcome (RR = 0.74; 95% CI:0.56-0.98; I² = 46%) and ischemic stroke recurrence (RR = 0.64; 95% CI:0.43-0.95; I² = 60%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR = 0.98; 95% CI:0.57-1.69; I² = 21%), major bleeding (RR = 0.78; 95% CI:0.40-1.51; I² = 0%), and mortality (RR = 0.94; 95% CI:0.61-1.45; I² = 0%) were observed. There were no subgroup differences, when RCTs and observational studies were separately evaluated.

Conclusions: Early OAC-initiation in acute ischemic stroke patients with non-valvular atrial fibrillation appears to have better efficacy and a similar safety profile compared to later OAC-initiation.

查看原文本刊更多论文

急性缺血性脑卒中后心房颤动口服抗凝药的起始时机：系统回顾和荟萃分析。

导言：对于急性缺血性卒中后非瓣膜性心房颤动患者启动口服抗凝药（OAC）的最佳时机，临床上长期存在不确定性。目前国际上的建议是基于专家意见，而在日常实践中，临床医生之间存在很大差异：我们进行了一项最新的系统综述和荟萃分析，包括所有可用的随机对照临床试验（RCT）和观察性队列研究，这些研究调查了急性缺血性卒中后心房颤动早期启动 OAC 与晚期启动 OAC 的区别。主要结果定义为缺血性和出血性事件的复合结果以及随访时的死亡率。次要结局包括综合结局的各个组成部分（缺血性卒中复发、颅内出血、大出血和全因死亡率）。采用随机效应模型计算汇总估计值：共纳入 9 项研究（2 项研究性临床试验和 7 项观察性研究），包括急性缺血性卒中后早期启用 OAC 的 4946 例患者和晚期启用 OAC 的 4573 例患者。与晚期启用 OAC 相比，早期启用 OAC 可降低复合结局风险（RR = 0.74；95% CI：0.56-0.98；I2 = 46%）和缺血性卒中复发风险（RR = 0.64；95% CI：0.43-0.95；I2 = 60%）。在安全性方面，观察到的颅内出血率（RR = 0.98；95% CI:0.57-1.69；I2 = 21%）、大出血率（RR = 0.78；95% CI:0.40-1.51；I2 = 0%）和死亡率（RR = 0.94；95% CI:0.61-1.45；I2 = 0%）相似。对研究性试验和观察性研究分别进行评估后，没有发现亚组差异：结论：与晚期启动 OAC 相比，非瓣膜性心房颤动急性缺血性卒中患者早期启动 OAC 似乎具有更好的疗效和相似的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.