Anticoagulation and stroke . . . and other stories

Earlier this year, a large randomised controlled trial reported that early anticoagulation in people with atrial fibrillation who had sustained a stroke probably carried a small benefit over delayed anticoagulation. However, the confidence intervals around the estimated treatment effects were too wide to make definite recommendations ( N Engl J Med doi:10.1056/NEJMoa2303048). A re-analysis finds that this conclusion isn’t changed when infarct size is taken into account. The important finding is that early treatment with direct acting oral anticoagulants doesn’t carry a higher risk of bleeding complications, intracranial haemorrhage, or other adverse events, even when the infarct is large ( JAMA Neurol doi:10.1001/jamaneurol.2024.1450). Lecanemab and donanemab, both monoclonal …