Efficacy and safety of early anticoagulation in patients with acute ischemic stroke due to atrial fibrillation:a Meta-analysis

WANG Yunxiang; QI Xuhui; CAI Huanhuan; LU Zhibing

doi:10.12173/j.issn.1004-5511.202302010

Abstract：Objective To evaluate the efficacy and safety of early use of new oral anticoagulants(≤3 days)in patients with acute ischemic stroke(AIS)due to atrial fibrillation(AF).Method After systematic retrieval of CNKI,WanFang Data,VIP,PubMed,The Cochrane Library and Embase database,clinical studies on early anticoagulation therapy for AF-related AIS patients were screened.The search was conducted from the time of database construction to November 4,2022,while the references were searched manually.Literature screening,data extraction and quality assessment were performed independently by 2 investigators.Meta-analysis was performed using RevMan 5.4 software,and the combined dichotomous effect sizes were expressed as relative risk(RR)and 95%confidence interval(CI).Result A total of 2 randomized controlled trials and 5 non-randomized controlled trials including 2 226 patients were included,and the analysis suggested that early anticoagulation treatment(≤3 days)was similar to delayed anticoagulation(＞3 days)in terms of total ischemic events[RR=1.04,95%CI(0.67,1.61),P=0.88],recurrent ischemic strokes or transient ischemic attack[RR=0.88,95%CI(0.58,1.34),P=0.56],major bleeding[RR=1.24,95%CI(0.59,2.62),P=0.56],and symptomatic intracerebral haemorrhage[RR=0.98,95%CI(0.44,2.17),P=0.96].In terms of total cerebral hemorrhages,the incidence was lower than in the delayed anticoagulation group.Conclusion Anticoagulation started early after the occurrence of atrial fibrillation related ischemic stroke is similar to delayed anticoagulation in terms of effectiveness,and does not increase the risk of bleeding in patients.