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. 2025 May;27(2):284-288.
doi: 10.5853/jos.2024.05477. Epub 2025 May 31.

Impact of Stroke Severity and Vascular Risk Factors on Early Versus Late Anticoagulation in Patients With Stroke and Atrial Fibrillation

Masatoshi Koga  1 , Mattia Branca  2 , Daniel Strbian  3 , Takeshi Yoshimoto  4 , Kanta Tanaka  1 , Sohei Yoshimura  1 , Yusuke Yakushiji  5 , Shigeru Fujimoto  6 , Adhiyaman Vedamurthy  7 , Manju Krishnan  8 , Marjaana Tiainen  3 , Jochen Vehoff  9 , Gerli Sibolt  3 , Kosuke Matsuzono  6 , Caterina Kulyk  10 , Silja Räty  3 , Peter Slade  8 , Alexander Salerno  11 , Dimitri Hemelsoet  12 , Thomas Horvath  13 , Takenobu Kunieda  5 , Makoto Nakajima  14 , Hisanao Akiyama  15 , Yasuyuki Iguchi  16 , Manabu Inoue  1 , Masafumi Ihara  4 , Kazunori Toyoda  1 , David Seiffge  13 , Martina Goeldlin  13 , Jesse Dawson  17 , Urs Fischer  13
Affiliations

Impact of Stroke Severity and Vascular Risk Factors on Early Versus Late Anticoagulation in Patients With Stroke and Atrial Fibrillation

Masatoshi Koga et al. J Stroke. 2025 May.
No abstract available

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Conflict of interest statement

Conflicts of interest

MK: honoraria from Bayer Yakuhin, Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, BMS/Pfizer, BMS/Janssen Pharmaceuticals, Otsuka Pharmaceutical, and AstraZeneca; research support from Daiichi Sankyo and Nippon Boehringer Ingelheim, all outside of the submitted work. MB is affiliated with CTU Bern, the University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern was involved in the design, conduct, and analysis of clinical studies funded by non-profit and for-profit organizations. Pharmaceutical and medical device companies have provided direct funding for some of these studies. For an updated list of CTU Bern’s conflicts of interest, see: https://dcr.unibe.ch/services/declaration_of_interest/index_eng.html. DS: Advisory board participation for AstraZeneca and unrestricted educational grant from Boehringer Ingelheim. TY: honoraria from Takeda Pharmaceutical, Nippon Boehringer Ingelheim, Daiichi Sankyo, Stryker, and Tonbridge Medical. MN: honoraria from Bayer, Pfizer, Daiichi Sankyo, Japan Blood Products Organization, Otsuka Pharmaceutical, Stryker, Medtronic, Biogen, Eizai, Kowa, Takeda, and Abbot Medical; research support from Daiichi Sankyo and Otsuka Pharmaceutical, all outside of the submitted work. JD: Speaker fees: Pfizer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, and Bayer. Research funding from Pfizer, BMS, and the Stroke Association. UF: Received research support from the Swiss National Science Foundation and the Swiss Heart Foundation; PI of the ELAN trial, Co-PI of the DISTAL, TECNO, SWIFT DIRECT and SWITCH trials; research grants from Medtronic (BEYOND SWIFT, SWIFT DIRECT) and from Stryker, Rapid medical, Penumbra and Phenox (DISTAL); consultancies for Medtronic, Stryker, and CSL Behring (fees paid to institution); participated on an advisory board for Alexion/Portola, Boehringer Ingelheim, Biogen and Acthera (fees paid to institution); member of a clinical event committee of the COATING study (Phenox) and member of the data and safety monitoring committee (DSMB) of the TITAN, LATE_MT and IN EXTREMIS trials; president of the Swiss Neurological Society.

The remaining authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Forest plot showing the OR with 95% CI for the comparison of early versus late DOAC initiation for the composite outcome at 30 days by dichotomized/ binary risk factors, and the interaction between the timing of DOAC initiation and risk factors. DOAC, direct oral anticoagulant; mRS, modified Rankin Scale; MI, myocardial infarction; BP, blood pressure; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; CI, confidence interval.
Figure 2.
Figure 2.
Forest plot showing the OR with 95% CI comparing early versus late DOAC initiation for the composite outcome at 90 days by dichotomized/binary risk factors, and the interaction between the timing of DOAC initiation and risk factors. DOAC, direct oral anticoagulant; mRS, modified Rankin Scale; MI, myocardial infarction; BP, blood pressure; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; CI, confidence interval.
See this image and copyright information in PMC

References

    1. Paciaroni M, Agnelli G, Falocci N, Caso V, Becattini C, Marcheselli S, et al. Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: effect of anticoagulation and its timing: the RAF study. Stroke. 2015;46:2175–2182. - PubMed
    1. Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38:423–430. - PubMed
    1. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–1100. - PubMed
    1. Saposnik G, Fang J, Kapral MK, Tu JV, Mamdani M, Austin P, et al. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke. 2012;43:1315–1322. - PubMed
    1. Fischer U, Koga M, Strbian D, Branca M, Abend S, Trelle S, et al. Early versus later anticoagulation for stroke with atrial fibrillation. N Engl J Med. 2023;388:2411–2421. - PubMed