Early versus late oral anticoagulants after acute ischemic stroke in atrial fibrillation patients: a meta-analysis of randomized controlled trials.
Proc (Bayl Univ Med Cent)Jun 15, 2026 (epub)
AlMothana Manasrah, Mohammad Tanashat, Ahmed Mazen Amin et al.
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In 30 seconds
This meta-analysis of randomized controlled trials evaluated the timing of oral anticoagulant (OAC) initiation in patients with atrial fibrillation (AF) after acute ischemic stroke. Involving 6522 patients, the study found no significant differences in recurrent ischemic stroke or major bleeding between early and late OAC initiation, with a relative risk of 0.82 for recurrent stroke.
Key findings
- No significant difference in recurrent ischemic stroke between early and late OAC initiation (RR 0.82; 95% CI 0.61-1.11; P = 0.19).
- Major extracranial bleeding was not significantly different (RR 0.47; 95% CI 0.22-1.01; P = 0.05).
- Intracranial hemorrhage rates were similar (RR 0.93; 95% CI 0.44-1.96; P = 0.84).
- Mortality rates showed no significant difference (RR 0.79; 95% CI 0.50-1.24; P = 0.30).
Why it matters
Understanding the optimal timing for OAC initiation after ischemic stroke in AF patients is crucial for preventing recurrent strokes while minimizing bleeding risks. This study suggests that early initiation may be as safe as later initiation.