| Abstract [eng] |
Background: ischemic stroke is one of the leading causes of death and disability worldwide, and atrial fibrillation-related stroke is more severe and has a higher risk of recurrence. It is effectively reduced by anticoagulants, but early resumption of therapy after acute ischemic stroke is associated with an increased risk of intracerebral hemorrhage. Currently, the 1–3–6–12 rule is recommended, however, there is no clear evidence regarding when to initiate oral anticoagulants. Objective: to review the trials that aimed to determine the optimal timing for initiating direct oral anticoagulants for nonvalvular atrial fibrillation patients after acute ischemic stroke. Methods: the search for eligible studies was performed in PubMed, Clinical Key, Science Direct and Google Scholar databases. Full text studies were included if they investigated the optimal timing of initiating direct oral anticoagulants for nonvalvular atrial fibrillation patients after ischemic stroke and how it is associated with outcomes. Included articles were in English and Lithuanian languages. Results: the research in reviewed studies included patients with nonvalvular atrial fibrillation after ischemic stroke. The association of early (between 48 hours and 6 days) administration of direct oral anticoagulants with the incidence of primary outcomes was investigated and compared with late (between ≥ 4 and > 14 days) administration. It has been established that early initiation of anticoagulants can reduce the risk of recurrence of ischemic events, but it may not affect the occurrence of intracranial or extracranial hemorrhage. Conclusions: Early initiation of anticoagulation after ischemic stroke in patients with nonvalvular atrial fibrillation is critical because of the high risk of stroke recurrence. More randomized trials are needed to determine the optimal time to start treatment. |
