Research shows that people with an irregular heartbeat who have had a stroke are 35% less likely to have a second stroke if they receive blood-thinning medications earlier than currently recommended.
There are more than 1.6 million people in Britain with atrial fibrillation – an irregular heartbeat. The condition can lead to the formation of a clot in the heart, which can travel to the brain, block blood flow and cause a stroke.
In Great Britain more than 100,000 people suffer a stroke every year, and so do patients with atrial fibrillation five times more likely to have a stroke than those without the condition.
People with atrial fibrillation who have had a stroke are also at increased risk of stroke, but this risk can be reduced by taking anticoagulants.
However, anticoagulants can cause cerebral hemorrhages. British guidelines suggest that patients with an irregular heartbeat who have had a moderate or severe stroke should wait at least five days before starting blood-thinning medicines.
Now two new studies, presented at the 2024 World Stroke Congress, suggest that people with atrial fibrillation who have a stroke and take blood-thinning medications earlier than currently recommended are not only less likely to have a second stroke, but are also not at increased risk. of a cerebral hemorrhage than those who take them later.
An international team of researchers conducted a meta-analysis of four randomized controlled trials on the safety and efficacy of starting anticoagulants early, compared to later, in people with acute stroke and atrial fibrillation.
The academics compared more than 5,000 patients who were given blood thinners within four days of a stroke with those who started anticoagulants on the fifth day or later. They found that 2.12% of patients who received anticoagulation within four days had another stroke within 30 days, compared with 3.02% of those who started it later – a difference of 35%.
A second study presented at the conference, funded by the British Heart Foundation and published in the LancetResearch found that giving anticoagulants within four days of a stroke – rather than delaying treatment – did not increase the risk of a brain haemorrhage, even in those who had had a more serious stroke.
The team analyzed data from 3,621 patients with atrial fibrillation who had had a stroke between 2019 and 2024, across 100 UK hospitals. Half of the participants started anticoagulant treatment within four days after the stroke (early), and the other half started seven to 14 days after the stroke (delayed). Early treatment appeared to be as effective as delayed treatment and did not increase the risk of bleeding in the brain.
David Werring, professor of clinical neurology at University College London and lead author of both studies, said: “It is not a miracle cure, but at a population level it is very important. If we can sooner give anticoagulants to 20,000 people per year – the estimated number of people with atrial fibrillation who have a stroke each year in Britain – this means we could potentially prevent up to 200 strokes. And crucially, there appears to be no increased risk of cerebral haemorrhage if this treatment is started earlier.”
Commenting on the findings, Prof. Bryan Williams, the British Heart Foundation’s chief scientific and medical officer, said: “These results could be transformative, making the case for earlier treatment that could help more people with atrial fibrillation avoid another stroke. occur, and the associated complications.”