Lina Palaiodimou, Maria-Ioanna Stefanou, Aristeidis H Katsanos, Gian Marco De Marchis, Diana Aguiar De Sousa, Jesse Dawson, Mira Katan, Theodore Karapanayiotides, Konstantinos Toutouzas, Maurizio Paciaroni, David J Seiffge, Georgios Tsivgoulis
{"title":"急性缺血性脑卒中后心房颤动口服抗凝药的起始时机：系统回顾和荟萃分析。","authors":"Lina Palaiodimou, Maria-Ioanna Stefanou, Aristeidis H Katsanos, Gian Marco De Marchis, Diana Aguiar De Sousa, Jesse Dawson, Mira Katan, Theodore Karapanayiotides, Konstantinos Toutouzas, Maurizio Paciaroni, David J Seiffge, Georgios Tsivgoulis","doi":"10.1177/23969873241251931","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.</p><p><strong>Methods: </strong>We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke. The primary outcome was defined as the composite of ischemic and hemorrhagic events and mortality at follow-up. Secondary outcomes included the components of the composite outcome (ischemic stroke recurrence, intracranial hemorrhage, major bleeding, and all-cause mortality). Pooled estimates were calculated with random-effects model.</p><p><strong>Results: </strong>Nine studies (two RCTs and seven observational) were included comprising a total of 4946 patients with early OAC-initiation versus 4573 patients with later OAC-initiation following acute ischemic stroke. Early OAC-initiation was associated with reduced risk of the composite outcome (RR = 0.74; 95% CI:0.56-0.98; <i>I</i><sup>2</sup> = 46%) and ischemic stroke recurrence (RR = 0.64; 95% CI:0.43-0.95; <i>I</i><sup>2</sup> = 60%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR = 0.98; 95% CI:0.57-1.69; <i>I</i><sup>2</sup> = 21%), major bleeding (RR = 0.78; 95% CI:0.40-1.51; <i>I</i><sup>2</sup> = 0%), and mortality (RR = 0.94; 95% CI:0.61-1.45; <i>I</i><sup>2</sup> = 0%) were observed. There were no subgroup differences, when RCTs and observational studies were separately evaluated.</p><p><strong>Conclusions: </strong>Early OAC-initiation in acute ischemic stroke patients with non-valvular atrial fibrillation appears to have better efficacy and a similar safety profile compared to later OAC-initiation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"885-895"},"PeriodicalIF":5.8000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569516/pdf/","citationCount":"0","resultStr":"{\"title\":\"Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis.\",\"authors\":\"Lina Palaiodimou, Maria-Ioanna Stefanou, Aristeidis H Katsanos, Gian Marco De Marchis, Diana Aguiar De Sousa, Jesse Dawson, Mira Katan, Theodore Karapanayiotides, Konstantinos Toutouzas, Maurizio Paciaroni, David J Seiffge, Georgios Tsivgoulis\",\"doi\":\"10.1177/23969873241251931\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.</p><p><strong>Methods: </strong>We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke. The primary outcome was defined as the composite of ischemic and hemorrhagic events and mortality at follow-up. Secondary outcomes included the components of the composite outcome (ischemic stroke recurrence, intracranial hemorrhage, major bleeding, and all-cause mortality). Pooled estimates were calculated with random-effects model.</p><p><strong>Results: </strong>Nine studies (two RCTs and seven observational) were included comprising a total of 4946 patients with early OAC-initiation versus 4573 patients with later OAC-initiation following acute ischemic stroke. Early OAC-initiation was associated with reduced risk of the composite outcome (RR = 0.74; 95% CI:0.56-0.98; <i>I</i><sup>2</sup> = 46%) and ischemic stroke recurrence (RR = 0.64; 95% CI:0.43-0.95; <i>I</i><sup>2</sup> = 60%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR = 0.98; 95% CI:0.57-1.69; <i>I</i><sup>2</sup> = 21%), major bleeding (RR = 0.78; 95% CI:0.40-1.51; <i>I</i><sup>2</sup> = 0%), and mortality (RR = 0.94; 95% CI:0.61-1.45; <i>I</i><sup>2</sup> = 0%) were observed. 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Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis.
Introduction: There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.
Methods: We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke. The primary outcome was defined as the composite of ischemic and hemorrhagic events and mortality at follow-up. Secondary outcomes included the components of the composite outcome (ischemic stroke recurrence, intracranial hemorrhage, major bleeding, and all-cause mortality). Pooled estimates were calculated with random-effects model.
Results: Nine studies (two RCTs and seven observational) were included comprising a total of 4946 patients with early OAC-initiation versus 4573 patients with later OAC-initiation following acute ischemic stroke. Early OAC-initiation was associated with reduced risk of the composite outcome (RR = 0.74; 95% CI:0.56-0.98; I2 = 46%) and ischemic stroke recurrence (RR = 0.64; 95% CI:0.43-0.95; I2 = 60%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR = 0.98; 95% CI:0.57-1.69; I2 = 21%), major bleeding (RR = 0.78; 95% CI:0.40-1.51; I2 = 0%), and mortality (RR = 0.94; 95% CI:0.61-1.45; I2 = 0%) were observed. There were no subgroup differences, when RCTs and observational studies were separately evaluated.
Conclusions: Early OAC-initiation in acute ischemic stroke patients with non-valvular atrial fibrillation appears to have better efficacy and a similar safety profile compared to later OAC-initiation.
期刊介绍：
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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