Early versus late start of direct oral anticoagulants after acute ischaemic stroke linked to atrial fibrillation: an observational study and individual patient data pooled analysis.

IF 5.4 2区医学 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Biomaterials Science & Engineering Pub Date : 2022-02-01 Epub Date: 2021-10-11 DOI:10.1136/jnnp-2021-327236

Gian Marco De Marchis, David J Seiffge, Sabine Schaedelin, Duncan Wilson, Valeria Caso, Monica Acciarresi, Georgios Tsivgoulis, Masatoshi Koga, Sohei Yoshimura, Kazunori Toyoda, Manuel Cappellari, Bruno Bonetti, Kosmas Macha, Bernd Kallmünzer, Carlo W Cereda, Philippe Lyrer, Leo H Bonati, Maurizio Paciaroni, Stefan T Engelter, David J Werring

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引用次数: 10

Abstract

Objective: The optimal timing to start direct oral anticoagulants (DOACs) after an acute ischaemic stroke (AIS) related to atrial fibrillation (AF) remains unclear. We aimed to compare early (≤5 days of AIS) versus late (>5 days of AIS) DOAC-start.

Methods: This is an individual patient data pooled analysis of eight prospective European and Japanese cohort studies. We included patients with AIS related to non-valvular AF where a DOAC was started within 30 days. Primary endpoints were 30-day rates of recurrent AIS and ICH.

Results: A total of 2550 patients were included. DOACs were started early in 1362 (53%) patients, late in 1188 (47%). During 212 patient-years, 37 patients had a recurrent AIS (1.5%), 16 (43%) before a DOAC was started; 6 patients (0.2%) had an ICH, all after DOAC-start. In the early DOAC-start group, 23 patients (1.7%) suffered from a recurrent AIS, while 2 patients (0.1%) had an ICH. In the late DOAC-start group, 14 patients (1.2%) suffered from a recurrent AIS; 4 patients (0.3%) suffered from ICH. In the propensity score-adjusted comparison of late versus early DOAC-start groups, there was no statistically significant difference in the hazard of recurrent AIS (aHR=1.2, 95% CI 0.5 to 2.9, p=0.69), ICH (aHR=6.0, 95% CI 0.6 to 56.3, p=0.12) or any stroke.

Conclusions: Our results do not corroborate concerns that an early DOAC-start might excessively increase the risk of ICH. The sevenfold higher risk of recurrent AIS than ICH suggests that an early DOAC-start might be reasonable, supporting enrolment into randomised trials comparing an early versus late DOAC-start.

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与房颤相关的急性缺血性卒中后早期或晚期直接口服抗凝剂:一项观察性研究和个体患者数据汇总分析

目的:心房颤动(AF)相关急性缺血性卒中(AIS)后直接口服抗凝剂(DOACs)的最佳时机尚不清楚。我们的目的是比较早期(AIS≤5天)和晚期(AIS >5天)doac开始。方法:这是对8项欧洲和日本前瞻性队列研究的个体患者数据汇总分析。我们纳入了在30天内开始DOAC的与非瓣膜性房颤相关的AIS患者。主要终点为30天内AIS和ICH复发率。结果:共纳入2550例患者。1362例(53%)患者早期开始DOACs, 1188例(47%)患者晚期开始DOACs。在212例患者年中，37例患者复发AIS(1.5%)， 16例(43%)在DOAC开始前;6例(0.2%)发生脑出血，均在doac启动后发生。在早期doac开始组中，23例患者(1.7%)患有复发性AIS, 2例患者(0.1%)患有脑出血。在doac开始较晚的组中，14例(1.2%)患有复发性AIS;4例(0.3%)出现脑出血。在倾向评分调整后的doac开始较晚组和开始较早组的比较中，AIS复发(aHR=1.2, 95% CI 0.5 ~ 2.9, p=0.69)、ICH (aHR=6.0, 95% CI 0.6 ~ 56.3, p=0.12)或任何卒中的风险无统计学差异。结论:我们的研究结果并没有证实早期doac开始可能会过度增加脑出血风险的担忧。AIS复发的风险比ICH高7倍，这表明早期doac开始可能是合理的，这支持了比较早期和晚期doac开始的随机试验的入组。

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

ACS Biomaterials Science & Engineering Materials Science-Biomaterials

CiteScore

10.30

自引率

3.40%

发文量

413

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