Short Oral + Poster Presentation Asia Pacific Stroke Conference 2024

Optimal timing for initiating anticoagulation following acute ischemic stroke in patients with non-valvular atrial fibrillation (106316)

Quentin Siu-hung LI 1 , Emma Gan-hui CAI 2 , Sally Muk-fai IP 2 , Veronica Tsz-yan WAI 2 , Wesley Ling-yin WONG 2 , Jonas Hon-ming YEUNG 3 , Larry Wai-lun CHAN 3
  1. Division of Neurology, Department of Medicine , North District Hospital, Hong Kong
  2. Division of Neurology, Department of Medicine , North District Hospital, Hong Kong
  3. Division of Neurology, Department of Medicine , Alice Ho Miu Ling Nethersole Hospital , Hong Kong

Background:

The optimal timing for starting anticoagulation following an acute ischaemic stroke (AIS) in Hong Kong Chinese patients with non-valvular atrial fibrillation (NVAF) remains unclear.

 

Methods:

This retrospective study assessed 498 NVAF patients who had suffered an AIS or transient ischaemic attack (TIA) from January 2018 to March 2023, across two regional hospitals. Patients were categorised based on when anticoagulation was initiated: within 0-7 days (early group) or after 7 days (later group). The primary endpoints were recurrent AIS/TIA and symptomatic intracranial haemorrhage (sICH) within 30 and 90 days post-initial stroke. Secondary outcomes were the individual rates of these events.

 

Results:

At 30 days, primary outcomes were observed in 10 patients (2.8%) in the early group versus 11 patients (8.1%) in the later group (adjusted OR, 0.34; 95% CI, 0.11-1.10). By 90 days, these figures changed to 17 patients (4.7%) in the early group and 13 patients (9.6%) in the later group (adjusted OR, 0.30; 95% CI, 0.18-1.12). Recurrent ischaemic events at 30 days were reported in 8 patients (2.2%) from the early group and 11 patients (8.1%) from the later group (adjusted OR, 0.22; 95% CI, 0.06-0.86); at 90 days, the rates were 12 patients (3.3%) and 12 patients (8.9%), respectively (adjusted OR, 0.30; 95% CI, 0.11-0.88). sICH rates were low and comparable between groups.

 

Conclusion:

Initiating anticoagulation within the first week post-AIS significantly reduces the risk of recurrent ischaemic events up to 90 days without a marked increase in sICH risk, advocating for early intervention in this cohort.