학술논문
Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis.
Document Type
Academic Journal
Author
Palaiodimou L; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Stefanou MI; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Katsanos AH; Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton, Canada.; De Marchis GM; Department of Clinical Research, University of Basel, Basel, Switzerland.; Department of Neurology and Stroke Center, Kantonsspital St. Gallen, Switzerland.; Aguiar De Sousa D; Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.; Dawson J; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.; Katan M; Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.; Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.; Karapanayiotides T; Second Department of Neurology, School of Medicine, Faculty of Health Sciences, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.; Toutouzas K; First Department of Cardiology, National and Kapodistrian University of Athens, 'Hippokration' Hospital, Athens, Greece.; Paciaroni M; Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy.; Seiffge DJ; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Tsivgoulis G; Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Source
Publisher: SAGE Publications Ltd Country of Publication: England NLM ID: 101688446 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2396-9881 (Electronic) Linking ISSN: 23969873 NLM ISO Abbreviation: Eur Stroke J Subsets: MEDLINE
Subject
Language
English
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; I 2 = 60%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR = 0.98; 95% CI:0.57-1.69; I 2 = 21%), major bleeding (RR = 0.78; 95% CI:0.40-1.51; I 2 = 0%), and mortality (RR = 0.94; 95% CI:0.61-1.45; I 2 = 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.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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; I
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.
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.