Timing of DOAC initiation in nonvalvular AF patients does not influence outcomes

The timing of direct oral anticoagulants (DOACs) administration, either within 3 days or ≥4 days of stroke onset, in patients with nonvalvular atrial fibrillation (AF) does not alter the risk of adverse outcomes such as stroke or systemic embolism, major bleeding, and death, as shown in a recent study.

The analysis involved 499 nonvalvular AF patients with acute ischaemic stroke or transient ischaemic attack who started DOACs during acute hospitalization: 223 patients (median age, 74 years; 78 women) were assigned to the early treatment group (≤3 days of stroke onset) and 276 (median age, 75 years; 101 women) to the late treatment (≥4 days) group.

Compared with those in the late group, patients in the early group had lower baseline National Institutes of Health Stroke Scale score and smaller infarcts. The overall rate at which DOAC treatment persisted at 2 years was 85.2 percent, excluding patients who died or were lost to follow-up.

Multivariable Cox shared frailty models showed that the early and late treatment groups did not significantly differ in terms of the 2-year risks of stroke or systemic embolism (hazard ratio [HR], 0.86, 95 percent confidence interval [CI], 0.47–1.57), major bleeding (HR, 1.39, 95 percent CI, 0.42–4.60), and death (HR, 0.61, 95 percent CI, 0.28–1.33).

The risks of outcomes at 3 months were likewise comparable between the two treatment groups.