There has been a theoretical concern that the starting DOACs after an ischaemic stroke with known AF may cause an increase in haemorrhagic transformation of the acute infarct.
A review of four RCTs examining the question of starting within the first 4 days or waiting 5 or more days1. There was an improvement of the primary outcome, a composite of recurrent ischaemic stroke, symptomatic intracerebral haemorrhage 30 days 57 cases (2.1%) versus 83 (3.0%). This an NNT of 111 cases treated to get one benefit.
There was no difference in the symptomatic cerebral haemorrhage. The authors came out in favour of early intervention.
As published in NZ Doctor and Research Review
