Randomized Controlled Trial

. 2025 Jan 2;8(1):e2456307.

doi: 10.1001/jamanetworkopen.2024.56307.

Net Benefit of Early Anticoagulation for Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial

Alexandros A Polymeris^{1

2}, Mattia Branca³, P N Sylaja⁴, Else Charlotte Sandset^{5

6}, Diana Aguiar de Sousa^{7

8}, Götz Thomalla⁹, Maurizio Paciaroni^{10

11}, Thomas Gattringer¹², Daniel Strbian¹³, Sven Trelle³, Patrik Michel¹⁴, Krassen Nedeltchev¹⁵, Leo H Bonati^{1

16}, George Ntaios¹⁷, Masatoshi Koga¹⁸, Zuzana Gdovinova¹⁹, Robin Lemmens^{20

21}, Natan M Bornstein²², Peter Kelly^{23

24

25}, Martina B Goeldlin²⁶, Stefanie Abend²⁶, Magdy Selim², Mira Katan¹, Thomas Horvath²⁶, Jesse Dawson²⁷, Urs Fischer²⁶; ELAN Investigators

Collaborators, Affiliations

Collaborators

ELAN Investigators:
Adedolapo Kamaldee Adeyemi, Adhiyaman Vedamurthy, Adrian Scutelnic, Akiyama Hisanao, Alastair Wilson, Alexander Pichler, Alexander Salerno, Alexander Vanhoorne, Ami Wilkinson, Ana Paiva Nunes, Anastasia Adamou, André Peeters, Andrea M Humm, Andrea Zini, Aneesh Dhasan, Angelika Alonso, Anna Fischer, Anna Maija Saukkonen, Anna Müller, Anne Berberich, Anne Falcou, Annemie Devroye, Arne Hostens, Arsany Hakim, Arthur Liesz, Arunkumar Annamalai, Arvind Vijaysharan Sharma, Asterios Paliantonis, Aumugam Nallasivan, Azmil Abdul-Rahim, Beata Rezny-Kasprzak, Ben Grimshaw, Bernd Kallmünzer, Biljana Rodic, Brian Clarke, Brian Menezes, Bruno J Weder, Carla Ciobanu, Carlo W Cereda, Caroline Loos, Caterina Kulyk, Catia Gonçalves Martins, Cecilia Ferrari, Christian Fung, Christina Caporale, Christine McAlpine, Christoph Globas, Christoph Gumbinger, Christophe Bonvin, Christos Krogias, Clare Whyte, Claudio Bassetti, Dan Ryan, Daniel Charissé, Daniel Richter, Daniel Schrammel, Daria Giudici, Darius G Nabavi, David Bradley, David Orion, David J Seiffge, David Werring, Davide Strambo, Derek Esson, Dheeraj Khurana, Diana Melancia, Dimitre Staykov, Dimitri Hemelsoet, Dominik Michalski, Eckhard Schlemm, Efstathia Karagkiozi, Elisabeth Olbert, Espen Saxhaug Kristoffersen, Evelyn Marcelis, Fiona Wright, François Delvoye, Friedrich Medlin, Fukano Takayuki, Gaia Sirimarco, Gek Shim, Gemma Marie Smith, Georg Royl, George Pope, Georgia Salanti, Gerli Sibolt, German Guzman-Gutierrez, Gian Marco De Marchis, Giovanni Bianco, Harvey Dymond, Hege Ihle-Hansen, Helen Thomas, Henning R Stetefeld, Himanshu Koundal, Honig Asaf, Ijaz Anwar, Ilaria Leone De Magistris, Imelda Noone, Ingrid Olave Bersas, Ioan-Paul Muresan, Isabelle Vanpanteghem, Jan Gralla, Jan Vynckier, Jelle Demeestere, Jens Offermann, Jeyaraj Durai Pandian, João André Sousa, João Pedro Marto, João Sargento-Freitas, Jochen Vehoff, Johann Pelz, John J McCabe, Joseph Harbison, Joshua Mbroh, Judith Wagner, Julien Niederhauser, Jussi Sipilä, Kanta Tanaka, Karthika Rani, Katarina Klimcikova, Kerry Smith, Klaudia Soltesova, Kosmas Macha, Kosuke Matzusono, Kristina Szabo, Laetitia Yperzeele, Lars Alteheld, Lars Kellert, Liam Healy, Liqun Zhang, Loraine Fisch, Luana Gentile, Ludwig Schelosky, Lukas Kellermair, Lukuman Gbadamosh, Lynn Dixon, Makoto Nakajima, Manabu Inoue, Manju Krishnan, Manuel Bolognese, Marcel Arnold, Maria Giulia Mosconi, Marianne Altmann, Marie Lang, Marios Psychogios, Marjaana Tiainen, Mark Barber, Markus Arnold, Markus Kneihsl, Marta Magriço, Martin Müller, Mary Joan MacLeod, Matthias Greulich, Matthieu Pierre Rutgers, Maximilian Schell, Melissa Garcia-Pons, Mette Pøhner Skahjem, Michael Haley, Michael Marnane, Milan Vosko, Miroslav Mako, Naren Polavarapu, Nicolas Martinez-Majander, Nicole Del Gaudio, Nicoletta G Caracciolo, Nils Peters, Niranjan Mahajan, Norbert Silimon, Oezguer A Onur, Ole Morten Rønning, Peter Ringleb, Peter Slade, Peter Vanacker, Philippe Desfontaines, Priya Nair, Rados Marian, Rajsrinivas Parthasarathy, Rea Hidalgo, Riona Mulcahy, Risa Kato, Rohit Bhatia, Ronan Collins, Ronen R Leker, Roni Eichel, Sabine Fenzl, Ryota Tanaka, Samer Al Hussayni Husseini, Sandra Clarke, Sapna Erat Sreedharan, Sarah Ostanek, Sellimi Amina, Seraina Beyeler, Sharon Storton, Shigeru Fujimoto, Silja Räty, Simon Fandler-Höfler, Sofia Galego, Sohei Yoshimura, Soichiro Matsubara, Stefan Greisenegger, Stefan Oberndorfer, Sucharita Ray, Susanne Renaud, Susanne Riebau, Sven Poli, Svetlana Politz, Sylvan J Albert, Takenobu Kunieda, Takeo Sato, Takeshi Yoshimoto, Tal Anjum, Tatjana Pap, Telma Costa, Teresa Pinho E Melo, Thomas Iype, Tim Cassidy, Tim J Von Oertzen, Timo Kahles, Toni Danilo, Torstein Spetalen, Turgut Tatlisumak, Veerle De Herdt, Victoria Borisova, Vijaya Pamidimukkala, Vikram Huded, Vipul Gupta, Vishav Kumar, Vivek Nambiar, Waltraud Pfeilschifter, Wendy Stoop, Yasuyuki Iguchi, Yngve Müller Seljeseth, Youssif Abousleiman, Yusuke Yakushiji, Zoltan Pencz

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.
² Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³ Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland.
⁴ Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
⁵ Department of Neurology, Oslo University Hospital, Norway.
⁶ The Norwegian Air Ambulance Foundation, Oslo, Norway.
⁷ Stroke Center, Lisbon Central University Hospital-ULS São José, Portugal.
⁸ Instituto de Medicina Molecular JLA, Faculdade de Medicina, Universidade de Lisboa, Portugal.
⁹ Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Internal, Vascular, and Emergency Medicine, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
¹¹ Clinical Neurology Unit, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
¹² Department of Neurology, Medical University of Graz, Graz, Austria.
¹³ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹⁴ Department of Neurology, University Hospital Lausanne, University of Lausanne, Switzerland.
¹⁵ Department of Neurology, Cantonal Hospital Aarau, Switzerland.
¹⁶ Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
¹⁷ Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁸ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹⁹ Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University and University Hospital Louis Pasteur, Košice, Slovakia.
²⁰ Department of Neurosciences, Experimental Neurology, KU Leuven, Leuven, Belgium.
²¹ Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
²² Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.
²³ Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
²⁴ School of Medicine, University College Dublin, Dublin, Ireland.
²⁵ Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.
²⁶ Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
²⁷ School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.

PMID: 39874037
PMCID: PMC11775740
DOI: 10.1001/jamanetworkopen.2024.56307

Randomized Controlled Trial

Net Benefit of Early Anticoagulation for Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial

Alexandros A Polymeris et al. JAMA Netw Open. 2025.

. 2025 Jan 2;8(1):e2456307.

doi: 10.1001/jamanetworkopen.2024.56307.

Authors

Collaborators

ELAN Investigators:
Adedolapo Kamaldee Adeyemi, Adhiyaman Vedamurthy, Adrian Scutelnic, Akiyama Hisanao, Alastair Wilson, Alexander Pichler, Alexander Salerno, Alexander Vanhoorne, Ami Wilkinson, Ana Paiva Nunes, Anastasia Adamou, André Peeters, Andrea M Humm, Andrea Zini, Aneesh Dhasan, Angelika Alonso, Anna Fischer, Anna Maija Saukkonen, Anna Müller, Anne Berberich, Anne Falcou, Annemie Devroye, Arne Hostens, Arsany Hakim, Arthur Liesz, Arunkumar Annamalai, Arvind Vijaysharan Sharma, Asterios Paliantonis, Aumugam Nallasivan, Azmil Abdul-Rahim, Beata Rezny-Kasprzak, Ben Grimshaw, Bernd Kallmünzer, Biljana Rodic, Brian Clarke, Brian Menezes, Bruno J Weder, Carla Ciobanu, Carlo W Cereda, Caroline Loos, Caterina Kulyk, Catia Gonçalves Martins, Cecilia Ferrari, Christian Fung, Christina Caporale, Christine McAlpine, Christoph Globas, Christoph Gumbinger, Christophe Bonvin, Christos Krogias, Clare Whyte, Claudio Bassetti, Dan Ryan, Daniel Charissé, Daniel Richter, Daniel Schrammel, Daria Giudici, Darius G Nabavi, David Bradley, David Orion, David J Seiffge, David Werring, Davide Strambo, Derek Esson, Dheeraj Khurana, Diana Melancia, Dimitre Staykov, Dimitri Hemelsoet, Dominik Michalski, Eckhard Schlemm, Efstathia Karagkiozi, Elisabeth Olbert, Espen Saxhaug Kristoffersen, Evelyn Marcelis, Fiona Wright, François Delvoye, Friedrich Medlin, Fukano Takayuki, Gaia Sirimarco, Gek Shim, Gemma Marie Smith, Georg Royl, George Pope, Georgia Salanti, Gerli Sibolt, German Guzman-Gutierrez, Gian Marco De Marchis, Giovanni Bianco, Harvey Dymond, Hege Ihle-Hansen, Helen Thomas, Henning R Stetefeld, Himanshu Koundal, Honig Asaf, Ijaz Anwar, Ilaria Leone De Magistris, Imelda Noone, Ingrid Olave Bersas, Ioan-Paul Muresan, Isabelle Vanpanteghem, Jan Gralla, Jan Vynckier, Jelle Demeestere, Jens Offermann, Jeyaraj Durai Pandian, João André Sousa, João Pedro Marto, João Sargento-Freitas, Jochen Vehoff, Johann Pelz, John J McCabe, Joseph Harbison, Joshua Mbroh, Judith Wagner, Julien Niederhauser, Jussi Sipilä, Kanta Tanaka, Karthika Rani, Katarina Klimcikova, Kerry Smith, Klaudia Soltesova, Kosmas Macha, Kosuke Matzusono, Kristina Szabo, Laetitia Yperzeele, Lars Alteheld, Lars Kellert, Liam Healy, Liqun Zhang, Loraine Fisch, Luana Gentile, Ludwig Schelosky, Lukas Kellermair, Lukuman Gbadamosh, Lynn Dixon, Makoto Nakajima, Manabu Inoue, Manju Krishnan, Manuel Bolognese, Marcel Arnold, Maria Giulia Mosconi, Marianne Altmann, Marie Lang, Marios Psychogios, Marjaana Tiainen, Mark Barber, Markus Arnold, Markus Kneihsl, Marta Magriço, Martin Müller, Mary Joan MacLeod, Matthias Greulich, Matthieu Pierre Rutgers, Maximilian Schell, Melissa Garcia-Pons, Mette Pøhner Skahjem, Michael Haley, Michael Marnane, Milan Vosko, Miroslav Mako, Naren Polavarapu, Nicolas Martinez-Majander, Nicole Del Gaudio, Nicoletta G Caracciolo, Nils Peters, Niranjan Mahajan, Norbert Silimon, Oezguer A Onur, Ole Morten Rønning, Peter Ringleb, Peter Slade, Peter Vanacker, Philippe Desfontaines, Priya Nair, Rados Marian, Rajsrinivas Parthasarathy, Rea Hidalgo, Riona Mulcahy, Risa Kato, Rohit Bhatia, Ronan Collins, Ronen R Leker, Roni Eichel, Sabine Fenzl, Ryota Tanaka, Samer Al Hussayni Husseini, Sandra Clarke, Sapna Erat Sreedharan, Sarah Ostanek, Sellimi Amina, Seraina Beyeler, Sharon Storton, Shigeru Fujimoto, Silja Räty, Simon Fandler-Höfler, Sofia Galego, Sohei Yoshimura, Soichiro Matsubara, Stefan Greisenegger, Stefan Oberndorfer, Sucharita Ray, Susanne Renaud, Susanne Riebau, Sven Poli, Svetlana Politz, Sylvan J Albert, Takenobu Kunieda, Takeo Sato, Takeshi Yoshimoto, Tal Anjum, Tatjana Pap, Telma Costa, Teresa Pinho E Melo, Thomas Iype, Tim Cassidy, Tim J Von Oertzen, Timo Kahles, Toni Danilo, Torstein Spetalen, Turgut Tatlisumak, Veerle De Herdt, Victoria Borisova, Vijaya Pamidimukkala, Vikram Huded, Vipul Gupta, Vishav Kumar, Vivek Nambiar, Waltraud Pfeilschifter, Wendy Stoop, Yasuyuki Iguchi, Yngve Müller Seljeseth, Youssif Abousleiman, Yusuke Yakushiji, Zoltan Pencz

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.
² Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³ Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland.
⁴ Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
⁵ Department of Neurology, Oslo University Hospital, Norway.
⁶ The Norwegian Air Ambulance Foundation, Oslo, Norway.
⁷ Stroke Center, Lisbon Central University Hospital-ULS São José, Portugal.
⁸ Instituto de Medicina Molecular JLA, Faculdade de Medicina, Universidade de Lisboa, Portugal.
⁹ Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Internal, Vascular, and Emergency Medicine, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
¹¹ Clinical Neurology Unit, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
¹² Department of Neurology, Medical University of Graz, Graz, Austria.
¹³ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹⁴ Department of Neurology, University Hospital Lausanne, University of Lausanne, Switzerland.
¹⁵ Department of Neurology, Cantonal Hospital Aarau, Switzerland.
¹⁶ Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
¹⁷ Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁸ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹⁹ Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University and University Hospital Louis Pasteur, Košice, Slovakia.
²⁰ Department of Neurosciences, Experimental Neurology, KU Leuven, Leuven, Belgium.
²¹ Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
²² Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.
²³ Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
²⁴ School of Medicine, University College Dublin, Dublin, Ireland.
²⁵ Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.
²⁶ Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
²⁷ School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.

PMID: 39874037
PMCID: PMC11775740
DOI: 10.1001/jamanetworkopen.2024.56307

Abstract

Importance: The net clinical effect of early vs later direct oral anticoagulant (DOAC) initiation after atrial fibrillation-associated ischemic stroke is unclear.

Objective: To investigate whether early DOAC treatment is associated with a net clinical benefit (NCB).

Design, setting, and participants: This was a post hoc analysis of the Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation (ELAN) open-label randomized clinical trial conducted across 103 sites in 15 countries in Europe, the Middle East, and Asia between November 6, 2017, and September 12, 2022, with a 90-day follow-up. Participants included patients with atrial fibrillation-associated acute ischemic stroke, excluding those with therapeutic anticoagulation at stroke onset or with severe hemorrhagic transformation of the ischemic infarct.

Intervention: Early DOAC initiation (<48 hours after minor and moderate stroke, 6-7 days after major stroke) vs later initiation (3-4 days after minor stroke, 6-7 days after moderate stroke, and 12-14 days after major stroke).

Main outcomes and measures: The main measure was the NCB of early treatment over later treatment, calculated by subtracting the weighted rate of excess bleeding events (major extracranial or intracranial hemorrhage) attributable to early treatment from the rate of excess ischemic events (recurrent stroke or systemic embolism) possibly prevented by early treatment within 30 days (main analysis) or 90 days (ancillary analysis). An established weighting scheme was used to account for the different clinical impact of bleeding relative to ischemic outcomes. Event rates were derived from adjusted logistic models. The analysis included all evaluable randomized ELAN participants.

Results: Of the original 2013 ELAN participants, 1966 were eligible for analysis (977 [49.7%] assigned to early DOAC initiation, 989 [50.3%] assigned to later DOAC initiation; median [IQR] age 77 [70-84] years; 1075 [54.7%] male). The 30-day NCB of early treatment over later treatment ranged from 1.73 (95% CI, 0.06-3.40) to 1.72 (95% CI, -0.63 to 3.98) weighted events possibly prevented per 100 participants for intracranial hemorrhage weights 1.5 to 3.3. The 90-day NCB ranged from 2.16 (95% CI, 0.30-3.87) to 2.14 (95% CI, -0.26 to 4.41) weighted events per 100 participants.

Conclusions and relevance: This post hoc analysis of a randomized clinical trial estimated a sizeable NCB of early anticoagulation for patients after atrial fibrillation-associated ischemic stroke. Although estimates cannot exclude the possibility of no benefit or small net harm, the findings suggest that early treatment may be more favorable.

Trial registration: ClinicalTrials.gov Identifier: NCT03148457.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Polymeris reported receiving grants from the Swiss Academy of Medical Sciences/Bangerter-Foundation, Swiss Heart Foundation, Swiss National Science Foundation, and Freiwillige Akademische Gesellschaft Basel outside the submitted work. Dr Sandset reported serving as a steering committee member of the OCEANIC trial (Bayer), AXIOMATIC trial (BMS), ANNEXA-i (AstraZeneca), with honoraria paid to her institution. Dr Aguiar de Sousa reported receiving personal fees from Daiichi Sankyo, AstraZeneca, Bial, Johnson & Johnson; and receiving grants from MSD outside the submitted work. Dr Thomalla reported receiving personal fees from Acandis, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Daiichi Sankyo outside the submitted work. Dr Gattringer reported receiving grants from the Austrian Science Fund; and receiving personal fees from BMS/Pfizer Boehringer-Ingelheim, Novartis, Amgen, and AstraZeneca outside the submitted work. Dr Michel reported receiving grants from the Swiss National Science Foundation, Swiss Heart Foundation, and the University of Lausanne outside the submitted work. Dr Koga reported receiving personal fees from Daiichi Sankyo BMS/Pfizer, AstraZeneca Honoraria, and Otsuka Pharmaceutical; receiving research support from Daiichi Sankyo and from Nippon Boehringer Ingelheim; and serving as an expert consultant for BMS/Janssen outside the submitted work. Dr Gdovinova reported receiving personal fees from Pfizer, Boehringer-Ingelheim, and MSD outside the submitted work. Dr Lemmens reported receiving consulting fees from BMS, Boehringer Ingelheim, and Pfizer through his institution outside the submitted work. Dr Bornstein reported receiving personal fees from Ever Neuro Pharma outside the submitted work. Dr Kelly reported receiving grants from Daiichi Sankyo paid to the Stroke Clinical Trials Network Ireland outside the submitted work. Dr Goeldlin reported receiving grants from Bangerter-Rhyner-Foundation/Swiss Academy of Medical Sciences during the conduct of the study; receiving grants from Bangerter-Rhyner-Foundation/Swiss Academy of Medical Sciences, Insel Gruppe AG, European Stroke Organisation Department, and Mittelbauvereinigung Universität Bern Networking outside the submitted work; and receiving congressional bursary from the European Academy of Neurology. Dr Selim reported receiving grants from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging; and receiving personal fees from AegisCN, Alnylam Pharmaceuticals, MedRhythma, UpToDate, NeuGel Therapeutics, and Oxford University Press outside the submitted work. Dr Dawson reported receiving grants from the Stroke Association during the conduct of the study. Dr Fischer reported receiving grants from the Swiss National Science Foundation and the Swiss Heart Foundation during the conduct of the study; receiving grants from Medtronic, Stryker, Phenox, Penumbra, RapidMedical, and Boehringer Ingelheim outside the submitted work; receiving consultancy fees paid to his institution from Medtronic; participating in the advisory board for AstraZeneca (former Alexion/Portola), Bayer, Boehringer Ingelheim, Biogen, AbbVie, Siemens (fees paid to his institution); serving as a member of a clinical event committee for Phenox and of the data and safety monitoring committee of the TITAN, LATE_MT, IN EXTREMIS and RapidPulse trials; and serving as president of the Swiss Neurological Society and president-elect of the European Stroke Organisation. No other disclosures were reported.

Figures

**Figure 1.. Study Flowchart**
DOAC indicates direct oral anticoagulant; ELAN, the Early Versus Late Initiation of Direct Oral Anticoagulants in Post–Ischaemic Stroke Patients With Atrial Fibrillation randomized clinical trial.

**Figure 2.. Net Clinical Benefit of Early Direct Oral Anticoagulant (DOAC) Initiation Over Later DOAC Initiation at 30 Days**
Net clinical benefit is expressed in weighted events possibly prevented per 100 participants. The solid line represents the net clinical benefit estimate across the entire range of intracranial hemorrhage (ICH) weights; and the gray shaded area, 95% Cl.

**Figure 3.. Net Clinical Benefit of Early Direct Oral Anticoagulant (DOAC) Initiation Over Later DOAC Initiation at 90 Days**
Net clinical benefit is expressed in weighted events possibly prevented per 100 participants. The solid line represents the net clinical benefit estimate across the entire range of intracranial hemorrhage (ICH) weights; and the gray shaded area, 95% CIs.

See this image and copyright information in PMC

Cited by

Once- versus twice-daily direct oral anticoagulants after ischemic stroke in atrial fibrillation - A post-hoc analysis of the ELAN trial.
Polymeris AA, Rossel JB, Koga M, Strbian D, Vedamurthy A, Krishnan M, Branca M, Meinel T, Kristoffersen ES, Yoshimoto T, Tanaka K, Kunieda T, Yakushiji Y, Vehoff J, Matsuzono K, Slade P, Demeestere J, Salerno A, Caracciolo NG, Hemelsoet D, Engelter ST, Auer E, Horvath T, Seiffge DJ, Goeldlin M, Dawson J, Fischer U; ELAN Investigators. Polymeris AA, et al. Eur Stroke J. 2025 Aug 11:23969873251360974. doi: 10.1177/23969873251360974. Online ahead of print. Eur Stroke J. 2025. PMID: 40785636 Free PMC article.

References

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Net Benefit of Early Anticoagulation for Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial

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Net Benefit of Early Anticoagulation for Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial

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