Abstract WP144: Early Initiation of Anticoagulation is Safe After Ischemic Stroke With Atrial Fibrillation, Meta-Analysis and Systemic Review

Abstract

Background: Large randomized clinical trials have established the superiority of Direct oral anticoagulants (DOACs) over Vitamin-K antagonists in atrial fibrillation (AF) related to Acute Ischemic stroke (AIS). However, the data regarding outcomes of early versus late administration of DOACs is limited, but few recent studies & clinical trials provided some evidence. Methodology: The Preferred Reporting Items for Systematic Reviews & Meta-Analyses (PRISMA) standards were followed for this systematic review & meta-analysis". Our search strategy used the Population (AF-related AIS patients taking DOACs), Intervention (early anticoagulation; before 3-4 days), Comparison (late anticoagulation; after 3-4 days), Outcomes & Study type (PICOS) question format. The outcomes of interest were Intracranial hemorrhage (ICH), ischemic stroke & all-cause mortality. The data was pooled using Mantel-Haenszel random effect model & the Higgins I 2 test was used to determine the heterogeneity in each analysis. Results: After the database search & study screening, we included 3 prospective cohorts & 1 RCT in our review. All four eligible studies were of good quality (the Newcastle Ottawa Scale & Cochrane Risk of Bias tool 2). Of the 1831 patients who received DOACs in A-F related AIS, 966 were given before 3-4 days & 865 people received them after 3-4 days. The adverse event of ICH (RR 0.65 [95% CI: 0.41 - 1.01] p = 0.68, I 2 = 0%) was similar in both early & late groups. No significant difference in Risk of Ischemic stroke (RR 0.67 [95% CI: 0.36 - 1.24] p = 0.28, I 2 = 22%) & all-cause mortality (RR 0.72 [95% CI: 0.45 - 1.17] p = 0.52, I 2 = 0%) was noted between the two groups. Conclusion: Our meta-analysis found that initiating DOACs within 3-4 days of AF-associated stroke is safe & does not affect outcomes such as ICH incidence, stroke recurrence, or all-cause mortality.