{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:15:59Z","timestamp":1780506959072,"version":"3.54.1"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>The optimal timing for initiating direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) following acute ischemic stroke (AIS) remains a critical clinical question. This review evaluates findings from three pivotal randomized controlled trials\u2014TIMING, ELAN, and OPTIMAS\u2014comparing early versus delayed DOAC initiation in AF patients with AIS. Collectively, these trials provide strong evidence supporting the safety and efficacy of early initiation of DOACs in patients with AIS and AF. The TIMING trial demonstrated the non-inferiority of early DOAC initiation (\u22644 days) compared to delayed initiation (5-10 days), with numerically lower rates of ischemic stroke and no cases of symptomatic ICH. The ELAN trial further corroborated these findings, showing no significant difference in the composite outcome of recurrent ischemic stroke, systemic embolism, or major hemorrhage between early initiation (\u226448\u2005h for minor\/moderate strokes; days 6-7 for major strokes) and later initiation (days 3-4 to 12-14). OPTIMAS, the largest trial to date, confirmed the non-inferiority of early initiation (\u22644 days) versus delayed initiation (7-14 days), without an increased risk of symptomatic ICH and with comparable rates of recurrent ischemic events.<\/jats:p>","DOI":"10.1177\/10760296251375864","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T11:37:01Z","timestamp":1756813021000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of Early Versus Delayed DOACs Initiation in Acute Ischemic Stroke Patients with AF"],"prefix":"10.1177","volume":"31","author":[{"given":"Zhenglei","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Sanming First Affiliated Hospital of Fujian Medical University, SanMing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-0158","authenticated-orcid":false,"given":"Wengen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou of Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.058159"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.056355"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.060666"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303048"},{"key":"e_1_3_2_10_2","article-title":"Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): A multicentre, blinded-endpoint, phase 4, randomised controlled trial","volume":"23","author":"Werring DJ","year":"2024","unstructured":"Werring DJ, Dehbi HM, Ahmed N, et al. Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): A multicentre, blinded-endpoint, phase 4, randomised controlled trial. 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Multicenter observational study on anticoagulation related bleeding events in emergency department patients. J. Res. Pharm. 2025;28(6):2243\u20102250.","journal-title":"J. Res. 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