| Retiming Post-Ischemic Stroke | |
|---|---|
| (RAF) Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation. Effect of Anticoagulation and Its Timing: The RAF study _____ A prospective cohort study of patients with acute stroke and A fib suggesting that initiation of AC at 4-14 days was associated with reduced incidence of central and peripheral embolic and bleeding complications | LINK |
| Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study _____ Prospective registry data here was used to divide patients into stroke subgroups based on NIHSS ranges (TIA, Mild, Mod, Severe) and early/late DOAC initiation. Apparent reduction in stroke/embolism in early-initiation groups with similar bleeding leads to the suggestion of a 1-2-3-4 day AC restart rule based on NIHSS | LINK |
| (AREST) Early Apixaban Use Following Stroke in Patients With Atrial Fibrillation _____ A RCT examining the safety of early initiation of apixaban at variable time frames from 0 to 9 days depending on the severity of the index stroke/TIA compared to warfarin initiation at 1 or 2 weeks in adults with atrial fibrillation. The trial was stopped early due to guideline updates recommending DOAC use, but results demonstrated non-significant trends toward reduced recurrent & fatal stroke/TIA, death, and symptomatic hemorrhage in the apixaban group. | LINK |
| (TIMING) Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation _____ A randomized noninferiority trial randomizing to early (≤4 days) or delayed (5-10 days) initiation of NOAC in adults with atrial fibrillation and stroke within 72 hours, finding early NOAC initiation to be noninferior to delayed initiation for risk of recurrent stroke, ICH, or all-cause mortality at 90 days, with numerically lower rates of ischemic stroke and death in the early initiation group. | LINK |
| Retiming Post-Intracranial Hemorrhage | |
|---|---|
| Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients with Atrial Fibrillation _____ A retrospective study of first-time ICH patients with A fib in the Swedish Stroke Register suggesting that in the absence of significant hemorrhage risk, anticoagulation is associated with reduced stroke and vascular death, with greatest benefit in starting 7-8 weeks after ICH | LINK |
| Anticoagulation Resumption After Intracerebral Hemorrhage _____ A review discussing considerations in decision making regarding resumption and timing of starting anticoagulation after intracerebral hemorrhage | LINK |
| (APACHE-AF) Abixaban versus no anticoagulation after anticoagulation-associated intracerebral haemorrhage in patients with atrial fibrillation in the Netherlands: a randomised, open-label, phase 2 trial _____ A small randomized phase 2 trial with AC-associated ICH patients randomized to apixaban vs AC avoidance, suggesting a similar risk of non-fatal stroke, vascular death, and adverse outcomes within both groups in 1.9 years of follow up | LINK |
| (SoSTART) Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial _____ A randomized non-inferiority trial in which patients with ICH and A fib were assigned to start or avoid longterm AC with the outcome of recurrent ICH, suggesting that restarting AC was not non-inferior to avoiding AC though results are very limited due to small sample size | LINK |