Abstract 074: Early Versus Late Anticoagulation In AF‐related Ischemic Stroke: A Systematic Review and Meta‐analysis of RCTs

Abstract

Introduction In AF‐associated ischemic stroke, there is increased risk of early stroke recurrence, making anticoagulation treatment is highly recommended for secondary stroke prevention [1‐2]. On the other hand, high rates of ICH were also reported in this population, making it very challenging for physicians to decide when to start anticoagulation treatment [3]. We aim to investigate safety and efficacy of early versus late anticoagulation in AF patients with AIS. Methods This meta‐analysis followed the Preferred Reporting Items for Systematic reviews and Meta‐Analysis (PRISMA) guidelines. We searched PubMed, Cochrane Library, WOS, and Scopus up to June 30, 2023, to collect randomized controlled trials comparing early versus late anticoagulation for acute ischemic stroke in AF patients. The primary outcome assessed in this study was the composite efficacy outcome (as defined by individual studies). Secondary outcomes included recurrent ischemic stroke, all‐cause mortality, ICH, and mRS 0‐2 at 90 days. Using the R statistical programming language, risk ratios (RRs) with 95% confidence intervals (95% CIs) were calculated using a common‐effect model for each outcome [4]. Results Four RCTs were included, involving 3050 patients (with 1527 patients in the early group). In the pooled analysis, early treatment group showed a significantly lower risk of composite efficacy outcome (RR: 0.71, 95% CI: 0.53‐0.96, p‐value: 0.02) compared to late treatment group. Early treatment group demonstrated a lower risk in terms of recurrent ischemic stroke (RR: 0.75, 95% CI: 0.52‐1.08), intracranial hemorrhage (RR: 0.93, 95% CI: 0.59‐1.46), and all‐cause mortality (RR: 0.88, 95% CI: 0.64‐1.22), however these results were not statistically significant. Moreover, the pooled analysis of two studies that reported mRS 0‐2 outcome at 3 months, both treatment groups were found to have similar rates but statistically insignificant. Conclusion This meta‐analysis, which pooled data from 3050 ischemic stroke patients with AF, early initiation of anticoagulation treatment was associated with lower risk of composite efficacy outcome. However, no statistically significant differences were found between the two groups regarding ischemic stroke, all‐cause mortality, ICH, and mRS 0‐2 at 90 days. Early anticoagulation treatment in AF patients with AIS may be as safe and effective as late anticoagulation treatment and might provide more benefit. However, more RCTs need to be conducted.