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Introduction <p>The optimal timing for anticoagulation after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) remains unclear. This meta-analysis compared the efficacy and safety of early versus late anticoagulation initiation.</p> Methods <p>A systematic search of PubMed, Embase, Cochrane CENTRAL, and ScienceDirect (up to June 2025) identified randomized controlled trials (RCT) comparing early and late anticoagulation in adults with AIS and AF. Outcomes included a composite of recurrent ischemic stroke, symptomatic intracerebral hemorrhage, or death, plus individual outcomes for mortality, recurrent stroke, hemorrhagic events, and functional independence. Data were pooled using random-effects models to calculate risk ratios (RR) with 95% confidence intervals (CI).</p> Results <p>Four RCT (6722 patients) were included. The primary outcome occurred in 3.9% with early and 4.8% with late anticoagulation (RR 0.81; 95% CI 0.63–1.04; <i>p</i> = 0.10; I²=3.8%). Among patients receiving reperfusion therapy, rates were 3.2% vs. 3.9% (RR 0.83; 95% CI 0.53–1.28; <i>p</i> = 0.40). Mortality was 6.9% vs. 7.2% (RR 0.96; 95% CI 0.80–1.14; <i>p</i> = 0.61), ischemic stroke 2.3% vs. 2.9% (RR 0.77; 95% CI 0.53–1.13; <i>p</i> = 0.19), hemorrhagic events 0.8% vs. 1.3% (RR 0.68; 95% CI 0.41–1.13; <i>p</i> = 0.14), and functional independence (mRS 0–2) 66.3% vs. 65.4% (RR 1.01; 95% CI 0.95–1.07; <i>p</i> = 0.75).</p> Conclusion <p>Early anticoagulation after AIS in AF patients showed comparable efficacy and safety to delayed initiation, supporting its use in appropriately selected patients with predominantly mild-to-moderate ischemic stroke.</p>

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Early versus late anticoagulation treatment after acute ischemic stroke with atrial fibrillation: a meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Mariana Letícia de Bastos Maximiano,
  • Ocilio Ribeiro Gonçalves,
  • Filipe Virgilio Ribeiro,
  • Mariana Lee Han,
  • Altair Pereira de Melo Neto,
  • João Vitor Andrade Fernandes,
  • Marianna Leite,
  • Anderson Matheus Pereira da Silva,
  • Ahmet Günkan

摘要

Introduction

The optimal timing for anticoagulation after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) remains unclear. This meta-analysis compared the efficacy and safety of early versus late anticoagulation initiation.

Methods

A systematic search of PubMed, Embase, Cochrane CENTRAL, and ScienceDirect (up to June 2025) identified randomized controlled trials (RCT) comparing early and late anticoagulation in adults with AIS and AF. Outcomes included a composite of recurrent ischemic stroke, symptomatic intracerebral hemorrhage, or death, plus individual outcomes for mortality, recurrent stroke, hemorrhagic events, and functional independence. Data were pooled using random-effects models to calculate risk ratios (RR) with 95% confidence intervals (CI).

Results

Four RCT (6722 patients) were included. The primary outcome occurred in 3.9% with early and 4.8% with late anticoagulation (RR 0.81; 95% CI 0.63–1.04; p = 0.10; I²=3.8%). Among patients receiving reperfusion therapy, rates were 3.2% vs. 3.9% (RR 0.83; 95% CI 0.53–1.28; p = 0.40). Mortality was 6.9% vs. 7.2% (RR 0.96; 95% CI 0.80–1.14; p = 0.61), ischemic stroke 2.3% vs. 2.9% (RR 0.77; 95% CI 0.53–1.13; p = 0.19), hemorrhagic events 0.8% vs. 1.3% (RR 0.68; 95% CI 0.41–1.13; p = 0.14), and functional independence (mRS 0–2) 66.3% vs. 65.4% (RR 1.01; 95% CI 0.95–1.07; p = 0.75).

Conclusion

Early anticoagulation after AIS in AF patients showed comparable efficacy and safety to delayed initiation, supporting its use in appropriately selected patients with predominantly mild-to-moderate ischemic stroke.