SynthesisNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Early versus late anticoagulation treatment after acute ischemic stroke with atrial fibrillation: a meta-analysis of randomized controlled trials.
Synthesis in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe 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.
methodsA 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).
resultsFour 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).
conclusionEarly 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.
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