Haneen A AlShareef

Title: Timing of initiating Oral Anticoagulants administration in Stroke patient who developed Atrial Fibrillation: A systematic Review and Meta analysis

Abstract

Atrial fibrillation related ischemic stroke represents a significant clinical challenge due to its elevated risk of recurrence and poor outcomes. Oral anticoagulation is the cornerstone of secondary stroke prevention; however, the optimal timing of initiation following acute ischemic stroke remains controversial. Clinicians must balance the prevention of early recurrent embolic events against the risk of hemorrhagic transformation.

This presentation summarizes findings from a systematic review and meta-analysis comparing early versus delayed initiation of oral anticoagulation in patients with atrial fibrillation associated ischemic stroke. Randomized controlled trials and observational studies published between 2019 and 2024 were included, encompassing more than 32,000 patients. Outcomes assessed included recurrent ischemic events or transient ischemic attacks, intracranial hemorrhage, major bleeding, and all-cause mortality.

The pooled analysis demonstrated no significant difference in all-cause mortality or major bleeding between early and delayed anticoagulation initiation. Sensitivity analyses revealed that early anticoagulation was associated with a reduction in recurrent ischemic events without an increased risk of intracranial hemorrhage. These findings support early, individualized, imaging-guided anticoagulation strategies in clinical practice.