Clinical trial - anticoagulation and stroke
When is the right time to start DOACs in patients with acute stroke and atrial fibrillation?
Guidelines
European
- day rule 1-3-6-12 based on NIHSS
> TIA: 1 day
> minor stroke: 3 days
> moderate stroke: 6 days
> severe stroke: 12 days
AHA-ASA
- risk of hemorrhagic transformation
> low: anticoagulation btw 2 and 14 days
> high: anticogulation beyond day 14
Clinical trials
TIMING trial (2022)
- early initiation was noninferior to delayed start of NOAC
ELAN trial (2023)
- early initiaiton of DOAC is superior to delayed
OPTIMAS trial
- coming
