Abstract 14464: Meta-Analysis Comparing Early vs Delayed Anticoagulation After Stroke in Patients With Atrial Fibrillation

Abstract

Introduction: Secondary prevention with anticoagulants is recommended for patients with acute ischemic stroke and atrial fibrillation (AF), but the timing of initiation of anticoagulation is debated. We performed a meta-analysis of the available studies. Methods: Studies comparing early (≤ 7 days) vs delayed (> 7 days) start of anticoagulation after acute stroke in patients with AF were searched from online databases. The primary endpoints of interest were recurrent ischemic stroke, intracranial haemorrhage (ICH), and mortality at the longest available follow up. Random-effects model was used to estimate risk ratios (RR) with 95% confidence intervals (CI). Results: Four studies (2 randomized trials and 2 observational studies), with a total of 5,606 patients - 2,918 in the early group and 2,688 in the delayed group were included. The mean age was 79 years and 55% of patients were men. The follow up duration varied from 30 days to 6 months. No significant differences were found between the early and delayed anticoagulation groups with regards to risk of recurrent ischemic stroke (RR 0.80, 95% CI 0.51-1.27, p = 0.35) (Figure 1), ICH (RR 0.62, 95% CI 0.17-2.24, p = 0.47) or mortality (RR 0.88, 95% CI 0.64-1.22, p = 0.45) (Figure 2). Conclusions: In patients with acute ischemic stroke and AF, early initiation of anticoagulation has similar risk of recurrent stroke, ICH, and mortality, when compared with delayed initiation.