Early Stroke Treatment Could Prevent Future Strokes

New research suggests that stroke patients experiencing atrial fibrillation may benefit from earlier treatment than current guidelines recommend. This study reveals that initiating blood-thinning medication sooner could significantly reduce the risk of recurrent strokes.

Study Highlights

A recent study, led by researchers at UCL (University College London), indicates that starting direct oral anticoagulants (DOACs) within four days of a stroke is safe. It also shows that doing so decreases the chance of another stroke by 30% compared to later treatment. The research involved data from four randomized trials with 5,441 patients.

“Our new study supports the early initiation of DOACs in clinical practice, offering better protection against further strokes for a wide range of patients.”

—David Werring, Professor, UCL Queen Square Institute of Neurology

Approximately 1.6 million people in the UK have atrial fibrillation. According to the CDC, stroke is a leading cause of death and disability in the United States, with about 795,000 people experiencing a stroke each year (CDC 2024).

Deeper Dive

Atrial fibrillation, an irregular heartbeat, elevates stroke risk. This condition can result in blood clots that travel to the brain. Current guidelines in the UK vary on when to start blood-thinning treatments after a stroke, especially for moderate or severe cases, often suggesting a delay.

The CATALYST study built on findings from the British Heart Foundation-funded OPTIMAS study. The latter analyzed 3,621 patients with atrial fibrillation who had experienced a stroke. Early treatment did not increase the risk of brain bleeding.

The researchers hope their findings will influence clinical guidelines and improve outcomes for stroke patients worldwide.

Expert Insights

Dr. Hakim-Moulay Dehbi, the first author, emphasized that by combining data from four clinical trials, they confidently identified that early DOAC initiation is effective. Professor Nick Freemantle highlighted the benefits of early treatment, emphasizing the prompt delivery of crucial stroke prevention therapy.

Professor Bryan Williams from the British Heart Foundation, noted the need for doctors to balance fast action with avoiding side effects in treating stroke patients with atrial fibrillation.

Limitations

The study’s timing for starting blood-thinning medication was based on prior trial designs. Not all participants were assigned to the same timing groups. Furthermore, the study did not encompass many patients with severe strokes, which could limit the generalizability of the findings.