Research
Early blood-thinning treatment shown to be safe and effective for stroke patients
Patients with atrial fibrillation who have experienced a stroke would benefit greatly from earlier treatment, according to a new study from University College London (UCL).
Published in The Lancet, the CATALYST study brought together data from four trials, including the BHF-funded study OPTIMAS.
The CATALYST study included data from 5,441 patients across the UK, Switzerland, Sweden and the United States, who had all experienced a recent stroke due to a blocked artery and atrial fibrillation. Patients in the study had either started medication early, within four days of their stroke, or later, after five days or more.
Safe and effective
The researchers, led by Professor David Werring, found that starting anticoagulants within four days of having a stroke was safe and effective, with no increase in bleeding into the brain. This also significantly reduced the risk of another stroke due to bleeding or artery blockage by 30 per cent, compared to those who started treatment later.
Atrial fibrillation is a heart rhythm disturbance that affects many people as they get older. It results in an irregular heartbeat, which can lead to a clot forming inside the heart. This clot can travel to the brain, blocking its blood supply and causing a stroke.
1.6 million people
More than 1.6 million people in the UK have been diagnosed with AF – and they are five times more likely to have a stroke than people without AF. People with AF who have had a stroke have an increased risk of having another, but this risk can be reduced by taking anticoagulants.
However, anticoagulants come with the rare but dangerous side effect of bleeding into the brain. There had been a lack of evidence about whether it was safe to start anti-coagulants early after an ischaemic stroke related to atrial fibrillation or atrial flutter.
To tackle this question, the researchers investigated the impact of early compared to delayed anticoagulant treatment.
Delicate balance
Professor Bryan Williams, our chief scientific and medical officer, said: “Doctors must strike a delicate balance between acting fast and avoiding potentially harmful side effects when treating people with atrial fibrillation who have had a stroke and require anticoagulants – blood-thinning medications.
“This study, including data from more than 5,000 patients across four randomised trials, provides further evidence that taking these blood-thinning medications within the first few days of a stroke does not carry an increased risk of bleeding into the brain.
“This kind of evidence is really important and could be transformative, as it should allow people to have treatment earlier, to prevent people with atrial fibrillation having another stroke.”
Professor David Werring, Professor of Clinical Neurology at UCL Queen Square Institute of Neurology, said: “Our new study supports the early initiation of DOACs in clinical practice, offering better protection against further strokes for a wide range of patients.”
The team hope that their findings will influence clinical guidelines and improve outcomes for stroke patients worldwide.