Abstract 15764: Early versus Late Initiation of Non-Vitamin K Antagonist Anticoagulation After Ischemic Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Introduction: Atrial fibrillation (AF) is a common cause of acute ischemic stroke (AIS). Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended for stroke prevention. However, presumed higher risk of hemorrhagic transformation in early (≤ 5 days) start of NOACs delays timing of anticoagulation initiation after AIS. This meta-analysis was conducted to evaluate granularity of data on the timing of initiation of NOACs after AIS in patients with AF. Methods: This meta-analysis followed the PRISMA guidelines and is registered in PROSPERO (CRD42023391198). PubMed, PubMed Central, Embase, and Scopus databases were searched for relevant articles from inception through May 2023. Title and abstract were screened by two independent authors, followed by full text review in Covidence platform. Pertinent data was extracted in Microsoft Excel. Data were analyzed using RevMan v5.4 with odds ratio as effect measure. Results: A total of 6326 studies were identified from database search. Five studies with 7442 patients were included. There was no significant difference between the groups in terms of recurrent stroke (OR 0.86, CI 0.62-1.20;), intracranial hemorrhage (OR 0.71, CI 0.26-1.93), major bleeding (OR 1.22, CI 0.66-2.26) or mortality (OR 0.75, CI 0.44-1.27). However, pooled results from two studies showed a statistically significant lower occurrence of hemorrhagic transformation in early NOAC group as compared to late NOAC group (OR 0.43, CI 0.32-0.60). Conclusions: Based on this meta-analysis, early NOAC initiation after AIS in patients with AF is a safe strategy in terms of efficacy (recurrent stroke) and safety (major bleeding, intracranial hemorrhage, mortality, and hemorrhagic transformation).