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Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation

Background and Purpose  Oral anticoagulants (OACs) prevent stroke recurrence and vascular embolism in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). Based on empirical consensus, current guidance recommends a “1–3–6–12 days” rule to resume OACs after AIS. This study investig...

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Autores principales: Chang, Po-Yin, Wang, Wei-Ting, Wu, Wei-Lun, Chang, Hui-Chin, Chen, Chen-Huan, Tsai, Yi-Wen, Chiou, Shih-Hwa, Lip, Gregory Y. H., Cheng, Hao-Min, Chiang, Chern-En
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251709/
https://www.ncbi.nlm.nih.gov/pubmed/34649296
http://dx.doi.org/10.1055/a-1669-4987
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author Chang, Po-Yin
Wang, Wei-Ting
Wu, Wei-Lun
Chang, Hui-Chin
Chen, Chen-Huan
Tsai, Yi-Wen
Chiou, Shih-Hwa
Lip, Gregory Y. H.
Cheng, Hao-Min
Chiang, Chern-En
author_facet Chang, Po-Yin
Wang, Wei-Ting
Wu, Wei-Lun
Chang, Hui-Chin
Chen, Chen-Huan
Tsai, Yi-Wen
Chiou, Shih-Hwa
Lip, Gregory Y. H.
Cheng, Hao-Min
Chiang, Chern-En
author_sort Chang, Po-Yin
collection PubMed
description Background and Purpose  Oral anticoagulants (OACs) prevent stroke recurrence and vascular embolism in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). Based on empirical consensus, current guidance recommends a “1–3–6–12 days” rule to resume OACs after AIS. This study investigated the suitability of guideline-recommended timing for OAC initiation. Methods  Using data of 12,307 AF patients hospitalized for AIS, for the period 2012 to 2016, in Taiwan's National Health Insurance Research Database, we constructed a sequence of cohorts of OAC users and propensity score-matched nonusers, creating one cohort on each day of OAC initiation for 30 days since admission. Composite outcome included effectiveness (cardiovascular death, ischemic stroke, myocardial infarction, transient ischemic attack, systemic embolism, and venous thromboembolism) and safety (intracranial hemorrhage, gastrointestinal bleeding, and hematuria) outcomes. Comparing with nonusers, we examined the risks in the early OAC use (within 1–3–6–12 days) or guideline-recommended delayed use. Indirect comparison between the early and delayed use was conducted using mixed treatment comparison. Results  Across the AIS severity, the risks of composite or effectiveness outcome were lower in OAC users than nonusers, and the risks were similar between the early and delayed use groups. In patients with severe AIS, early OAC use was associated with an increased risk of safety outcome, with a hazard ratio (HR) of 1.67 (confidence interval [CI]: 1·30–2·13) compared with nonusers and a HR of 1.44 (CI: 0·99–2·09) compared with the delayed use. Conclusion  Our study findings support an early OAC initiation in AF patients with mild-to-moderate AIS and a routine delayed use of OACs can be considered in those with severe AIS to avoid a serious bleeding event.
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spelling pubmed-92517092022-07-05 Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation Chang, Po-Yin Wang, Wei-Ting Wu, Wei-Lun Chang, Hui-Chin Chen, Chen-Huan Tsai, Yi-Wen Chiou, Shih-Hwa Lip, Gregory Y. H. Cheng, Hao-Min Chiang, Chern-En Thromb Haemost Background and Purpose  Oral anticoagulants (OACs) prevent stroke recurrence and vascular embolism in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). Based on empirical consensus, current guidance recommends a “1–3–6–12 days” rule to resume OACs after AIS. This study investigated the suitability of guideline-recommended timing for OAC initiation. Methods  Using data of 12,307 AF patients hospitalized for AIS, for the period 2012 to 2016, in Taiwan's National Health Insurance Research Database, we constructed a sequence of cohorts of OAC users and propensity score-matched nonusers, creating one cohort on each day of OAC initiation for 30 days since admission. Composite outcome included effectiveness (cardiovascular death, ischemic stroke, myocardial infarction, transient ischemic attack, systemic embolism, and venous thromboembolism) and safety (intracranial hemorrhage, gastrointestinal bleeding, and hematuria) outcomes. Comparing with nonusers, we examined the risks in the early OAC use (within 1–3–6–12 days) or guideline-recommended delayed use. Indirect comparison between the early and delayed use was conducted using mixed treatment comparison. Results  Across the AIS severity, the risks of composite or effectiveness outcome were lower in OAC users than nonusers, and the risks were similar between the early and delayed use groups. In patients with severe AIS, early OAC use was associated with an increased risk of safety outcome, with a hazard ratio (HR) of 1.67 (confidence interval [CI]: 1·30–2·13) compared with nonusers and a HR of 1.44 (CI: 0·99–2·09) compared with the delayed use. Conclusion  Our study findings support an early OAC initiation in AF patients with mild-to-moderate AIS and a routine delayed use of OACs can be considered in those with severe AIS to avoid a serious bleeding event. Georg Thieme Verlag KG 2021-12-31 /pmc/articles/PMC9251709/ /pubmed/34649296 http://dx.doi.org/10.1055/a-1669-4987 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Chang, Po-Yin
Wang, Wei-Ting
Wu, Wei-Lun
Chang, Hui-Chin
Chen, Chen-Huan
Tsai, Yi-Wen
Chiou, Shih-Hwa
Lip, Gregory Y. H.
Cheng, Hao-Min
Chiang, Chern-En
Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title_full Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title_fullStr Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title_full_unstemmed Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title_short Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation
title_sort oral anticoagulation timing in patients with acute ischemic stroke and atrial fibrillation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251709/
https://www.ncbi.nlm.nih.gov/pubmed/34649296
http://dx.doi.org/10.1055/a-1669-4987
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