This study will compare early with late start of treatment with Non-vitamin K oral anticoagulation (NOAC) in adult patients with acute ischemic stroke and atrial fibrillation; it is a registry-based randomized clinical trial (R-RCT) using The Swedish Stroke Register (Riksstroke). Half of the patients will start NOAC early (within 4 days after stroke onset) while the other half will start late (5-10 days after stroke onset).
Oral anticoagulation therapy is well established and highly recommended for the prevention of recurrent ischemic stroke in patients with atrial fibrillation, but the optimal time point to start after an acute ischemic stroke is not known.
The intervention in this study will be timing of treatment onset. The choice of NOAC (i.e. apixaban, dabigatran, edoxaban or rivaroxaban) after the acute ischemic stroke is at the discretion of the treating physician.
This study will use the Swedish Stroke Register for enrolment, randomization and follow-up, with additional data linkage from other mandatory national registers. Primary outcome will be assessed at 90 days and secondary outcomes (including all-cause mortality and health economic analyses) and will be assessed at 90 days and up to one year after the index ischemic stroke.
- Early start of NOAC Other
Intervention Desc: Initiation of NOAC up until day 4 after acute ischemic stroke in patients with atrial fibrillation ARM 1: Kind: Experimental Label: Early start of NOAC Description: Day 1 to day 4 after ischemic stroke onset
- Late start of NOAC Other
Intervention Desc: Initiation of NOAC between day 5 and day 10 after acute ischemic stroke in patients with atrial fibrillation ARM 1: Kind: Experimental Label: Late start of NOAC Description: Day 5 to day 10 after ischemic stroke onset
|Type||Measure||Time Frame||Safety Issue|
|Primary||Composite outcome of recurrent ischemic stroke, symptomatic intracerebral hemorrhage, or all-cause mortality||90 days|
|Secondary||Recurrent acute ischemic stroke||90 days|
|Secondary||Symptomatic intracerebral hemorrhage (S-ICH)||90 days|
|Secondary||All-cause mortality||90 days|
|Secondary||Functional outcome||90 days|
|Secondary||Major hemorrhages||90 days|