Early Initiation of DOACs Appears Safe After Stroke in Patients with AF

Sarfaroj Khan 

July 22, 2020


  • In patients with atrial fibrillation (AF), initiation of anticoagulant treatment with direct oral anticoagulants (DOACs) within the first days after ischaemic stroke is safe in terms of extra- and intracranial bleeding complications.

Why this matters

  • Findings warrant randomised controlled studies to establish the added efficacy of starting anticoagulation early after stroke.

Study design

  • The early initiation of direct anticoagulation after stroke in patients with AF (EIDASAF) study of 959 patients with recent (<4 weeks) ischaemic stroke and AF followed up for an average time of 16.1 days after the index event.

  • Primary outcome: rate of major bleeding (intra- and extracranial) in patients on different treatment schemes: DOACs, vitamin K antagonists (VKAs) and not anticoagulated.

  • Funding: Bristol-Myers Squibb and Pfizer to Imperial College London.

Key results

  • 559 (58.3%) patients were treated with anticoagulants (VKAs, n=259 and DOACs, n=300).

  • No statistically significant difference was observed between the mean time of initiating DOACs (7±9.4 days) and VKAs (11.9±19.7 days; P=.182).

  • Early initiation of any anticoagulant vs no anticoagulation was not associated with an increased risk of any major bleeding (OR, 0.49; 95% CI, 0.21-1.16; P=.106), particularly intracranial bleeding (OR, 0.47; 95% CI, 0.17-1.29; P=.143).

  • Treatment with any DOAC (OR, 0.32; 95% CI, 0.10-0.96) but not with a VKA (OR, 0.78; 95% CI, 0.28-2.13) reduced the risk of major bleeding vs no anticoagulation.

  • No significant difference was observed in early recurrences of ischaemic stroke between the three groups.


  • Retrospective design.

  • Risk of potential confounding.

D'Anna L, Filippidis FT, Antony S, Brown Z, Wyatt H, Malik A, Sivakumaran P, Harvey K, Marinescu M, Bentley P, Korompoki E, Veltkamp R. Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation. Eur J Neurol. 2020 Jun 16 [Epub ahead of print]. doi: 10.1111/ene.14396. PMID: 32542878.  Abstract.  

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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