ArticleStroke2022
Practical "1-2-3-4-Day" Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study.
Article in Stroke, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03826927 (New Oral Anticoagulants in Stroke Patients-Long Term Prevention of Recurrent Stroke in Patients With Atrial Fibrillation- a National Prospective Registry), which is not on this map. Cited by 49 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
New Oral Anticoagulants in Stroke Patients-Long Term Prevention of Recurrent Stroke in Patients With Atrial Fibrillation- a National Prospective Registry (NOACISP Long Term)
Who cites it
49 citing papers in PubMed, 5 syntheses or guidelines pooled it, 77 citations in OpenAlex.
- Timing of anticoagulation therapy in patients with acute ischemic stroke and atrial fibrillation: a GRADE-based expert opinion recommendation.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Pooled it
- Pooled it
- Comparison of early and delayed anticoagulation therapy after ischemic stroke in patients with atrial fibrillation: a systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2023Pooled it
- Is There a Role for Vitamin K Antagonist in the Management of Atrial Fibrillation in 2023?Current cardiology reports · 2023Pooled it
- Anticoagulation Timing After Stroke in Atrial Fibrillation: Evidence from a Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Early Anticoagulation in Acute Ischemic Stroke With Atrial Fibrillation.Journal of stroke · 2026Review
- Review
- Optimal timing of anticoagulation after ischemic stroke in atrial fibrillation: a systematic review and network meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Research Advances in Timing of Anticoagulant Therapy Following Cardioembolic Stroke.Clinical Medicine Insights. Cardiology · 2026Review
- Early Versus Late Anticoagulation for Acute Ischemic Stroke in Atrial Fibrillation: A Systematic Review and Meta-Analysis of 17,380 Patients.Neurology international · 2025Review
- Early Anticoagulation After Large Ischemic Stroke in the Initiation of Anticoagulation After Cardioembolic Stroke Study.Journal of clinical neurology (Seoul, Korea) · 2025Article
- Early Anticoagulation in Large Volume Cardioembolic Stroke: Rethinking the Optimal Initiation Time.Journal of clinical neurology (Seoul, Korea) · 2025Article
- Deep Learning-Based Automatic Classification of Stroke Size in Patients With Atrial Fibrillation.Journal of stroke · 2025Article
- AI-Assisted Edema Map Optimization Improves Infarction Detection in Twin-Spiral Dual-Energy CT.Brain sciences · 2025Article
- The optimal timing for initiating oral anticoagulant in ischemic stroke combined with non-valvular atrial fibrillation patients: A real-world big data analysis.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Article
- Optimal Timing of Anticoagulation Initiation in Stroke Patients With Atrial Fibrillation: A Systematic Review.Cureus · 2025Review
- Practice patterns of vascular neurologists in timing anticoagulation for high risk stroke mechanisms versus atrial fibrillation.Scientific reports · 2025Article
- Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis.Journal of stroke · 2025Article
- Predicting Atrial Fibrillation After Stroke by Combining Polygenic Risk Scores and Clinical Features.Stroke · 2025Article
- Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement.International journal of stroke : official journal of the International Stroke Society · 2025Review
Corrections and comments
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Authors and funding
21 authors at 12 institutions in 5 countries.
Funding
Abstract
backgroundThe "1-3-6-12-day rule" for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity.
methodsThe combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0-7), moderate (8-15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation.
resultsIn the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)-initiating DOACS within 1, 2, 3, and 4 days, respectively-than Late Group (n=1012) (1.9% versus 3.9%; adjusted hazard ratio, 0.50 [95% CI, 0.27-0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27-0.999]). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data.
conclusionsIn Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.