ABSTRACT NUMBER: ESOC2026A565 OUTCOMES OF EARLY VERSUS LATER ANTICOAGULATION IN ASIAN ATRIAL FIBRILLATION–RELATED STROKE: ELAN SUBGROUP ANALYSIS

Abstract Background and aims Asians have a higher incidence of intracerebral hemorrhage than non-Asians. We aimed to evaluate whether early versus late initiation of direct oral anticoagulation (DOAC) after acute ischemic stroke (AIS) yields different safety and efficacy outcomes in Asian versus non-Asian patients. Methods We analyzed ELAN trial data from 2,013 AIS patients with atrial fibrillation (AF) randomized to early (≤48 hours for minor/moderate stroke; 6–7 days for major stroke) or late DOAC initiation. Patients were categorized as Asian or non-Asian by region. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage (SICH), or vascular death at 30 days. Results Among 1,975 patients with complete data, 245 were Asian and 1,730 non-Asian. Asian patients had more severe strokes and worse functional outcomes. The primary outcome occurred in 6.5% of Asian patients (4.8% early vs 8.3% late) and 3.1% of non-Asian patients (2.7% vs 3.6%) (P < 0.01). Higher rates of recurrent ischemic stroke (4.1% [2.4% vs 5.8%] vs. 1.7% [1.3% vs 2.1%], P = 0.02) and systemic embolism (2.0% [0.8% vs 3.3%] vs 0.5% [0.4% vs 0.6%], P = 0.02) accounted for this difference. No significant group differences were found in major extracranial bleeding, SICH, or vascular death. No significant interaction between region and treatment allocation. Conclusions Although Asian patients had worse baseline profiles and outcomes, treatment effects did not differ by region. These findings support the generalizability of early DOAC initiation in Asian AIS patients without requiring region-specific timing modifications. Conflict of interest Takeshi Yoshimoto: nothing to disclosure.