Early initiation of direct oral anticoagulants after acute stroke with atrial fibrillation is at least as good as later initiation

Clinical Question

In patients with atrial fibrillation who have had an acute ischemic stroke, should direct oral anticoagulants be initiated earlier (0 to 4 days) or later (5 to 10 days) after the onset of symptoms?

Bottom line

For patients with atrial fibrillation and acute ischemic stroke who were not taking a DOAC at the time of the event, early initiation of a DOAC is at least as good as later initiation for patients without contraindications. Further study is needed in the subset of 121 patients who were undergoing thrombectomy, as those in the early initiation group had a nonsignificantly higher rate of the composite outcome (12.3% vs 3.6%). Studies regarding whether early initiation may be superior to late initiation are ongoing. 1b

Study design: Randomized controlled trial (single-blinded)

Funding: Government

Setting: Inpatient (any location)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

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Learned something new

Learned something new

Eric Nicholas Kaziuka

Early vs late use of DOAC post CVA

DOAC's still not covered under government programs in Ontario. So, while in hospital specialists aren't bothered by such trivia, family medicine must again lie in the paper work.


doac after acute cva

no advantage if start up to 10 days after cva


Impact assessment

Very good