{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:50:32Z","timestamp":1793260232353,"version":"4.5.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":377,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke. The primary outcome was defined as the composite of ischemic and hemorrhagic events and mortality at follow-up. Secondary outcomes included the components of the composite outcome (ischemic stroke recurrence, intracranial hemorrhage, major bleeding, and all-cause mortality). Pooled estimates were calculated with random-effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nine studies (two RCTs and seven observational) were included comprising a total of 4946 patients with early OAC-initiation versus 4573 patients with later OAC-initiation following acute ischemic stroke. Early OAC-initiation was associated with reduced risk of the composite outcome (RR\u2009=\u20090.74; 95% CI:0.56\u20130.98; I \u00a02\u2009=\u200946%) and ischemic stroke recurrence (RR\u2009=\u20090.64; 95% CI:0.43\u20130.95; I \u00a02\u2009=\u200960%) compared to late OAC-initiation. Regarding safety outcomes, similar rates of intracranial hemorrhage (RR\u2009=\u20090.98; 95% CI:0.57\u20131.69; I \u00a02\u2009=\u200921%), major bleeding (RR\u2009=\u20090.78; 95% CI:0.40\u20131.51; I \u00a02\u2009=\u20090%), and mortality (RR\u2009=\u20090.94; 95% CI:0.61\u20131.45; I \u00a02\u2009=\u20090%) were observed. There were no subgroup differences, when RCTs and observational studies were separately evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Early OAC-initiation in acute ischemic stroke patients with non-valvular atrial fibrillation appears to have better efficacy and a similar safety profile compared to later OAC-initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873241251931","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T04:40:21Z","timestamp":1715661621000},"page":"885-895","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7757-609X","authenticated-orcid":false,"given":"Lina","family":"Palaiodimou","sequence":"first","affiliation":[{"name":"Second Department of Neurology, \u201cAttikon\u201d University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Ioanna","family":"Stefanou","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, \u201cAttikon\u201d University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6359-0023","authenticated-orcid":false,"given":"Aristeidis H","family":"Katsanos","sequence":"additional","affiliation":[{"name":"Department of Medicine (Neurology), McMaster University\/Population Health Research Institute, Hamilton, Canada 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, University of Basel, Basel, Switzerland 3"},{"name":"Department of Neurology and Stroke Center, Kantonsspital St. Gallen, Switzerland 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7924","authenticated-orcid":false,"given":"Diana","family":"Aguiar De Sousa","sequence":"additional","affiliation":[{"name":"Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7532-2475","authenticated-orcid":false,"given":"Jesse","family":"Dawson","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Katan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland 7"},{"name":"Department of Neurology, University Hospital and University of Basel, Basel, Switzerland 8"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Karapanayiotides","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Faculty of Health Sciences, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece 9"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Toutouzas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, National and Kapodistrian University of Athens, \u201cHippokration\u201d Hospital, Athens, Greece 10"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5483-8795","authenticated-orcid":false,"given":"Maurizio","family":"Paciaroni","sequence":"additional","affiliation":[{"name":"Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy 11"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3849","authenticated-orcid":false,"given":"David J","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 12"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":false,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, \u201cAttikon\u201d University Hospital, School of Medicine, National and Kapodistrian University of Athens, 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