Early Versus Delayed Non–Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study

医学 心房颤动 冲程(发动机) 维生素K拮抗剂 随机对照试验 缺血性中风 敌手 内科学 维生素k 华法林 口服抗凝剂 抗凝治疗 心脏病学 麻醉 缺血 受体 工程类 机械工程
作者
Jonas Oldgren,Signild Åsberg,Ziad Hijazi,Per Wester,Maria Bertilsson,Bo Norrving
出处
期刊:Circulation [Lippincott Williams & Wilkins]
卷期号:146 (14): 1056-1066 被引量:55
标识
DOI:10.1161/circulationaha.122.060666
摘要

There are no evidence-based recommendations on the optimal time point to initiate non-vitamin K antagonist oral anticoagulants (NOACs) after acute ischemic stroke in patients with atrial fibrillation. We aimed to investigate the efficacy and safety of early versus delayed initiation of NOAC in these patients.TIMING (Timing of Oral Anticoagulant Therapy in Acute Ischemic Stroke With Atrial Fibrillation) was a registry-based, randomized, noninferiority, open-label, blinded end-point study at 34 stroke units using the Swedish Stroke Register for enrollment and follow-up. Within 72 hours from stroke onset, patients were randomized to early (≤4 days) or delayed (5-10 days) NOAC initiation, with choice of NOAC at the investigators' discretion. The primary outcome was the composite of recurrent ischemic stroke, symptomatic intracerebral hemorrhage, or all-cause mortality at 90 days. The prespecified noninferiority margin was 3%. Secondary outcomes included the individual components of the primary outcome.Between April 2, 2017, and December 30, 2020, 888 patients were randomized to either early (n=450) or delayed (n=438) initiation of NOAC. No patient was lost to 90-day follow-up. Mean age was 78.3 years (SD, 9.9 years); 46.2% were women; 49.1% had previously known atrial fibrillation; and 17.5% prior stroke. The primary outcome occurred in 31 patients (6.89%) assigned to early initiation and in 38 patients (8.68%) assigned to delayed NOAC initiation (absolute risk difference, -1.79% [95% CI, -5.31% to 1.74%]; Pnoninferiority=0.004). Ischemic stroke rates were 3.11% and 4.57% (risk difference, -1.46% [95% CI, -3.98% to 1.07%]) and all-cause mortality rates were 4.67% and 5.71% (risk difference, -1.04% [95% CI, -3.96% to 1.88%]) in the early and delayed groups, respectively. No patient in either group experienced symptomatic intracerebral hemorrhage.Early initiation was noninferior to delayed start of NOAC after acute ischemic stroke in patients with atrial fibrillation. Numerically lower rates of ischemic stroke and death and the absence of symptomatic intracerebral hemorrhages implied that the early start of NOAC was safe and should be considered for acute secondary stroke prevention in patients eligible for NOAC treatment.URL: http://www.gov; Unique identifier: NCT02961348.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
naiyouqiu1989完成签到,获得积分10
刚刚
Li完成签到 ,获得积分10
刚刚
易琚完成签到,获得积分10
1秒前
夏日的极光完成签到,获得积分10
1秒前
生动茹妖完成签到,获得积分10
1秒前
tyZhang完成签到,获得积分10
1秒前
地精术士完成签到,获得积分10
1秒前
1秒前
今后应助调皮善斓采纳,获得10
2秒前
2秒前
啦啦啦啦完成签到,获得积分10
2秒前
3秒前
3秒前
比比谁的速度快应助77采纳,获得20
3秒前
Hello应助一只鱼采纳,获得10
3秒前
ma完成签到,获得积分20
4秒前
谦让寻凝完成签到 ,获得积分10
5秒前
拼搏的松鼠完成签到,获得积分10
5秒前
5秒前
wjf发布了新的文献求助10
5秒前
5秒前
6秒前
anyilin发布了新的文献求助10
6秒前
7秒前
mc完成签到 ,获得积分10
7秒前
讨厌麻烦完成签到,获得积分10
7秒前
Lucas应助LixiaDu采纳,获得50
7秒前
耶耶耶完成签到,获得积分10
8秒前
8秒前
1996xjm发布了新的文献求助10
8秒前
养乐多敬你完成签到 ,获得积分10
9秒前
9秒前
义气的面包完成签到,获得积分10
9秒前
热塑性复合材料完成签到 ,获得积分10
9秒前
打打应助meng采纳,获得30
9秒前
natuki完成签到,获得积分10
9秒前
蓝冰完成签到,获得积分10
10秒前
Julia完成签到,获得积分10
10秒前
成就映秋完成签到,获得积分10
10秒前
yyy2025完成签到,获得积分10
10秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Social Research Methods (4th Edition) by Maggie Walter (2019) 2390
A new approach to the extrapolation of accelerated life test data 1000
北师大毕业论文 基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 390
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Robot-supported joining of reinforcement textiles with one-sided sewing heads 360
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4009325
求助须知:如何正确求助?哪些是违规求助? 3549162
关于积分的说明 11301105
捐赠科研通 3283572
什么是DOI,文献DOI怎么找? 1810370
邀请新用户注册赠送积分活动 886205
科研通“疑难数据库(出版商)”最低求助积分说明 811301