Tariq Shaima Yasmeen, Ahmad Ali Raza
Cardiology, Sahiwal Teaching Hospital, Sahiwal, PAK.
Hematology and Oncology, Hameed Latif Hospital Lahore, Lahore, PAK.
Cureus. 2025 Jul 19;17(7):e88296. doi: 10.7759/cureus.88296. eCollection 2025 Jul.
This systematic review evaluates the optimal timing of anticoagulation in atrial fibrillation patients with acute ischemic stroke or transient ischemic attack. A comprehensive search across PubMed (94 records), Web of Science (121 records), Scopus (156 records), and the Cochrane Library (83 records) yielded 454 records. After screening 324 records and assessing 44 full texts, 13 studies were included: five randomized controlled trials and eight cohort studies, excluding those without comparisons of early versus delayed anticoagulation. The review analyzes studies comparing early and delayed initiation of oral anticoagulants (primarily direct oral anticoagulants (DOACs) and warfarin), focusing on outcomes such as recurrent ischemic stroke, symptomatic intracranial hemorrhage (sICH), and composite endpoints including recurrent stroke, sICH, systemic embolism, or mortality. Findings suggest that early anticoagulation, especially with DOACs, is safe and may reduce recurrent events without increasing the risk of sICH, particularly in cases with mild to moderate severity. However, varying definitions of timing, study designs, and limited data on severe strokes or in low-resource settings highlight research gaps. Future studies should investigate long-term outcomes and diverse populations to refine guidelines, particularly in resource-constrained environments.
本系统评价评估了急性缺血性卒中或短暂性脑缺血发作的房颤患者抗凝治疗的最佳时机。通过全面检索PubMed（94条记录）、Web of Science（121条记录）、Scopus（156条记录）和Cochrane图书馆（83条记录），共获得454条记录。在筛选324条记录并评估44篇全文后，纳入了13项研究：5项随机对照试验和8项队列研究，排除了未比较早期与延迟抗凝的研究。该评价分析了比较口服抗凝剂（主要是直接口服抗凝剂（DOACs）和华法林）早期与延迟起始治疗的研究，重点关注复发性缺血性卒中、症状性颅内出血（sICH）以及包括复发性卒中、sICH、全身性栓塞或死亡在内的复合终点等结局。研究结果表明，早期抗凝，尤其是使用DOACs，是安全的，并且可能在不增加sICH风险的情况下减少复发性事件，特别是在轻度至中度严重程度的病例中。然而，时间定义的差异、研究设计以及关于严重卒中或低资源环境下的数据有限，凸显了研究空白。未来的研究应调查长期结局并纳入不同人群，以完善指南，特别是在资源受限的环境中。
