Title : When should patients with atrial fibrillation start anticoagulation after an acute ischemic stroke?
Abstract:
When Should Patients with Atrial Fibrillation Start Anticoagulation following an Acute Ischemic Stroke?
Background: As the cornerstone of secondary stroke prevention, patients with acute ischemic stroke (AIS) in the presence of atrial fibrillation (Afib) must begin or continue anticoagulation (AC). Studies comparing the safety and results of beginning and stopping air conditioning during early or late start windows (ESW or LSW) have not yet included a census in this respect. The purpose of this study is to assess the safety and outcome parameters in patients with Afib following AIS between the ESW and LSW after AC restart.
Methods: Using PubMed, Embase, Web of Science, and Scopus, a thorough systematic review was carried out in accordance with the PRISMA standards. The ROBINS-I tool was utilized to conduct a thorough risk of bias assessment for studies that fulfilled the inclusion criteria. In patients with Afib following AIS, we examined the safety and outcome parameters following the return of AC in the ESW versus LSW. Random-effect models were utilized in meta-analyses carried out with R software version 4.3.1.
Findings: Data from seven studies were included in this meta-analysis. Patients who began AC in the LSW experienced lower rates of recurrent ischemic stroke/transient ischemic attack (TIA) (OR 0.72, 95% CI 0.49-1.04; p = 0.083) than those who began AC in the ESW. Likewise, there was no significant difference in the rates of mortality and symptomatic intracranial hemorrhage (sICH) between patients who began AC in the ESW and LSW (OR 1.45, 95% CI 0.39-5.35; p = 0.578) and (OR 0.88, 95% CI 0.65-1.19; p = 0.402), respectively. In conclusion, based on data from five trials, the incidence of significant bleeding was similar for patients who began AC in ESW compared to LSW (OR 0.99, 95% CI 0.50-1.96; p = 0.970).
Conclusion: There were no differences in the outcome markers (stroke/TIA, sICH, death, or major bleeding) between patients with Afib and AIS who are initiating AC in the ESW versus LSW.
Audience Take Away
Understanding the timing of anticoagulation and initiating anticoagulation therapy for patients with atrial fibrillation following acute ischemic stroke will prove vital for physicians. To assist medical practitioners in making well-informed decisions, the safety and outcome metrics pertaining to the initiation of anticoagulation in ESW versus LSW following AIS in patients with atrial fibrillation are presented. By providing a consistent approach to the beginning of anticoagulation in patients with atrial fibrillation and AIS, the findings can help healthcare practitioners make clinical decisions more easily, perhaps resulting in more effective patient treatment. With the goal of minimizing the risk of recurrent stroke or transient ischemic attack (TIA) while balancing concerns about mortality, symptomatic intracranial hemorrhage (sICH), and major bleeding events, healthcare practitioners can use the findings to optimize the management of patients with atrial fibrillation and acute ischemic stroke.
