Abstract 17841: Early versus Late Anticoagulation for Ischemic Stroke Associated With Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis

Abstract

Introduction: The optimal timing for initiating oral anticoagulation in patients who have experienced ischemic stroke is debatable. We conducted an updated systematic review and meta-analysis on the outcomes of patients who received early oral anticoagulation (within <4 days) compared to those who received late oral anticoagulation (within 4-10 days) following the onset of ischemic stroke. Methods: We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “timing of anticoagulation,” “oral anticoagulants,” and “ischemic stroke.” After the screening, We extracted the data from 1980 to May 2023 in a data extraction sheet. We extracted data for three outcomes: Recurrent Ischemic Stroke (IS), Symptomatic Intracranial Hemorrhage (ICH), and all-cause mortality. We used a variance-weighted random-effects model to analyze early vs. late anticoagulation data, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using RevMan software. Results: Our analysis included a total of 08 studies (n= 8119 patients). Early anticoagulation (<4 days) was associated with a lower risk of recurrent ischemic stroke, OR= 0.77(95% CI: 0.60- 0.99, I 2 = 21% ) as compared to late anticoagulation (4-10 days). However, there was no significant difference between the timing for symptomatic ICH, OR=1.27 (95% CI: 0.35- 4.64, I 2 = 0% ). Early anticoagulation was also associated with a reduction in all-cause mortality between the two patient groups. OR=0.63(95% CI: 0.43- 0.93, I 2 = 38% ).(Figure1) Conclusions: Early anticoagulation therapy may significantly reduce the recurrence of ischemic stroke and overall mortality with no significant impact on the risk of symptomatic ICH. More randomized control trials are needed to increase the robustness and reliability of these results.