The optimal timing for initiating oral anticoagulant in ischemic stroke combined with non-valvular atrial fibrillation patients: A real-world big data analysis

Oral anticoagulants (OAC) are essential in preventing stroke recurrence in patients with ischemic stroke (IS) and non-valvular atrial fibrillation (NVAF), though they carry a bleeding risk. Balancing the benefits and risks of anticoagulant therapy and determining the optimal timing for initiation are critical. This real-world study investigated optimal timing for OAC initiation post-IS and evaluated drug selection using data from the National Health and Medical Big Data (Eastern) Center, covering IS records from 1564 hospitals in Jiangsu (2018-2021). Using 1:1 propensity score matching (PSM) and Cox model analysis, we compared outcomes between OAC initiators and non-initiators at different time points. Results showed that initiating OAC within 3 days for mild IS (HR, 0.82 [95 ​% CI, 0.71-0.94, p ​= ​0.024]), within 6 days for moderate IS (HR, 0.76 [95 ​% CI, 0.65-0.89, p ​= ​0.004]), and within 11 days for severe IS (HR, 0.89 [95 ​% CI, 0.78-0.97, p ​= ​0.032]) was associated with better outcomes. New oral anticoagulants (NOACs) demonstrated favorable effectiveness and safety profiles compared to warfarin, without increasing bleeding risk (HR, 0.85 [95 ​% CI, 0.73-0.98, p ​= ​0.038]). Based on these observational findings, we suggest considering early NOAC initiation for mild and moderate IS, while carefully assessing stroke progression and bleeding risk before anticoagulation in severe IS.