부산대학교 도서관

Background: The timing of anticoagulation initiation following an acute ischemic stroke (AIS) in the setting of atrial fibrillation (AF) is an area of active research. Data on non-vitamin K antagonist oral anticoagulant (NOAC) initiation in this population are limited. We performed a meta-analysis to assess the safety and efficacy of early NOAC vs. late NOAC after AIS. Methods: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023391198). Databases were searched for relevant articles published before July 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. Results: Among 6326 studies screened, five studies with 7442 patients were included for analysis. Recurrent stroke occurred in 1.79% of patients in the early NOAC (≤5 days from index event) group vs 2.12% in the late NOAC group (OR 0.86, CI 0.62-1.20; no statistical difference). Similarly, there was no significant difference between groups with regards to intracranial hemorrhage (OR 0.71, CI 0.26-1.93), major bleeding (OR 1.22, CI 0.66-2.26), 90-day mortality (OR 0.75, CI 0.44-1.27), or composite outcome of recurrent stroke, intracranial hemorrhage, and mortality (OR 0.88, CI 0.63-1.22). However, the pooled results from 2 studies for hemorrhagic transformation showed a significantly lower occurrence in the early NOAC initiation group (OR 0.43, CI 0.32-0.60). Conclusion: Based on this meta-analysis, early NOAC initiation after AIS in patients with AF is a safe strategy in terms of efficacy (recurrent stroke) and safety (major bleeding, intracranial hemorrhage, mortality, and hemorrhagic transformation). Further trials may shed more light on the early versus late NOAC approach. [ABSTRACT FROM AUTHOR]