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Comparison of early and delayed anticoagulation therapy after ischemic stroke in patients with atrial fibrillation: a systematic review and meta-analysis

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Abstract

The optimal initiation timing of oral anticoagulants (OACs) remains controversial in patients with atrial fibrillation (AF)-related acute ischemic stroke (AIS). The aim of this study is to compare the efficacy and safety of early OACs initiation with that of the delayed initiation for AIS and AF.We searched systematically the following mainstream databases: PubMed, Embase, and Web of Science from the inception to July 2023 for studies that compared the early initiation with the delayed initiation of OACs for AF-related AIS patients. Outcome measures were the incidence of hemorrhagic events, ischemic events, and combined outcomes, as well as all-cause mortality.There were 12 eligible articles included (10 cohort studies and 2 RCT), involving 11421 patients (5690 patients in the early-initiation group and 5731 in the delayed-initiation group). Meta-analysis revealed that patients receiving OACs at the early stage of stroke had a lower incidence of ischemic events (OR: 0.68; 95% CI: 0.55,0.84; p = 0.0003) and combined outcomes (OR=0.74, 95% CI (0.57,0.95), p=0.02). No significant differences were identified in the incidence of hemorrhagic events (p = 0.26) and all-cause mortality ( p = 0.20) between the groups.Early initiation of anticoagulation therapy would be preferable in lowering the incidence of ischemic events and combined outcomes in AIS patients with AF. It is safe compared to the delayed-initiation strategy. However, the conclusion of this study needs to be further validated by more well-designed RCTs.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the researchers and study participants for their contributions.

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  1. Department of Pharmacy, The First people’s Hospital of Xiaoshan District, No. 199 Shixin South Road, Hangzhou, Zhejiang, 311200, China

    Mengjin Jiang, Congyao Wang & Yaodong Zhang

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Conceptualization: Mengjin Jiang; Methodology: Mengjin Jiang, Yaodong Zhang, Congyao Wang; Formal analysis and investigation: Yaodong Zhang, Congyao Wang; Writing - original draft preparation: Mengjin Jiang, Congyao Wang; Writing - review and editing: Mengjin Jiang, Yaodong Zhang. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Jiang, M., Wang, C. & Zhang, Y. Comparison of early and delayed anticoagulation therapy after ischemic stroke in patients with atrial fibrillation: a systematic review and meta-analysis. J Thromb Thrombolysis 56, 603–613 (2023). https://doi.org/10.1007/s11239-023-02872-0

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