Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events

In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. We included...

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Published inNeurology Vol. 87; no. 18; p. 1856
Main Authors Seiffge, David J, Traenka, Christopher, Polymeris, Alexandros, Hert, Lisa, Peters, Nils, Lyrer, Philippe, Engelter, Stefan T, Bonati, Leo H, De Marchis, Gian Marco
Format Journal Article
LanguageEnglish
Published United States 01.11.2016
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Summary:In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOAC ) and those with late (>7 days, DOAC ) start of DOAC. Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3-11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOAC (5.1%/y) and DOAC (9.3%/y, p = 0.53) was observed. Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
ISSN:1526-632X
DOI:10.1212/WNL.0000000000003283