ArticleEuropean stroke journal2022
Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN): Protocol for an international, multicentre, randomised-controlled, two-arm, open, assessor-blinded trial.
Article in European stroke journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Risk of Ischemic Stroke After Transient Ischemic Attack in Patients Receiving Comprehensive Versus Noncomprehensive Diagnostic Workup: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2025Pooled 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
- Anticoagulants for acute ischaemic stroke.The Cochrane database of systematic reviews · 2021Pooled it
- Once- versus twice-daily direct oral anticoagulants after ischemic stroke in atrial fibrillation - A post-hoc analysis of the ELAN trial.European stroke journal · 2026Trial
- Net Benefit of Early Anticoagulation for Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial.JAMA network open · 2025Trial
- Trial
- Outcomes of Early Versus Later Anticoagulation in Asian Atrial Fibrillation-Related Stroke: ELAN Subgroup Analysis.Journal of stroke · 2026Article
- AI-assisted hemorrhage detection following endovascular stroke treatment: a retrospective diagnostic accuracy study.Neurological research and practice · 2026Article
- Optimal Timing of Oral Anticoagulant Therapy Initiation Post-acute Ischemic Stroke: A Narrative Review.Cureus · 2025Review
- Once- versus twice-daily direct oral anticoagulants after ischemic stroke in atrial fibrillation - A post-hoc analysis of the ELAN trial.European stroke journal · 2025Article
- Impact of Stroke Severity and Vascular Risk Factors on Early Versus Late Anticoagulation in Patients With Stroke and Atrial Fibrillation.Journal of stroke · 2025Article
- Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis.Journal of stroke · 2025Article
- Article
- Wearables and Atrial Fibrillation: Advances in Detection, Clinical Impact, Ethical Concerns, and Future Perspectives.Cureus · 2025Review
- Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment.Annals of neurology · 2024Review
- Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study.Stroke and vascular neurology · 2024Observational
- Early or late initiation of dabigatran versus vitamin-K-antagonists in acute ischemic stroke or TIA: The PRODAST study.International journal of stroke : official journal of the International Stroke Society · 2023Observational
- Application of the "1-2-3-4-day" rule to stroke severity at baseline versus at 24 h to start direct oral anticoagulant for atrial fibrillation within 7 days from symptom onset.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023Observational
- Early Administration of Edoxaban After Acute Ischemic Stroke in Patients With Non-valvular Atrial Fibrillation: A Pilot Randomized Trial.Journal of stroke · 2023Article
- Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke.European stroke journal · 2023Article
Corrections and comments
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Authors and funding
27 authors at 17 institutions in 15 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Rationale: Direct oral anticoagulants (DOAC) are highly effective in preventing ischaemic strokes in people with atrial fibrillation (AF). However, it is unclear how soon they should be started after acute ischaemic stroke (AIS). Early initiation may reduce early risk of recurrence but might increase the risk of haemorrhagic complications. Aim: To estimate the safety and efficacy of early initiation of DOACs compared to late guideline-based initiation in people with AIS related to AF. Methods and design: An international, multicentre, randomised (1:1) controlled, two-arm, open, assessor-blinded trial is being conducted. Early treatment is defined as DOAC initiation within 48 h of a minor or moderate stroke, or at day 6-7 following major stroke. Late treatment is defined as DOAC initiation after day 3-4 following minor stroke, after day 6-7 following moderate stroke and after day 12-14 following major stroke. Severity of stroke is defined according to imaging assessment of infarct size. Sample size: ELAN will randomise 2000 participants 1:1 to early versus late initiation of DOACs. This assumes a risk difference of 0.5% favouring the early arm, allowing an upper limit of the 95% confidence interval up to 1.5% based on the Miettinen & Nurminen formula. Outcomes: The primary outcome is a composite of symptomatic intracranial haemorrhage, major extracranial bleeding, recurrent ischaemic stroke, systemic embolism or vascular death at 30 ± 3 days after randomisation. Secondary outcomes include the individual components of the primary outcome at 30 ± 3 and 90 ± 7 days and functional status at 90 ± 7 days. Discussion: ELAN will estimate whether there is a clinically important difference in safety and efficacy outcomes following early anticoagulation with a DOAC compared to late guideline-based treatment in neuroimaging-selected people with an AIS due to AF.
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Registered trials
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