Atrial fibrillation is the most common type of heart rhythm disturbance and is often called an irregular heartbeat. It increases the risk of blood clots forming in the heart, which can travel to the brain causing an ischaemic stroke. After such a stroke there is a risk of a second stroke, which is highest within the next 30 days.
To prevent this from happening, patients are given anticoagulants which are powerful blood-thinning drugs. Treatment with these drugs is effective, but they also carry the risk of causing bleeding into the brain (haemorrhagic stroke). Warfarin used to be the most commonly used drug, but there are now newer drugs which cause less brain bleeding. These new drugs are called direct oral anticoagulants.
What is the research aiming to do?
Due to the risk of bleeding, doctors are often unsure when they should start anticoagulants after a stroke or not. Should they do it early to prevent further stroke or wait to reduce the chances of bleeding? This study will investigate whether early initiation of the direct anticoagulants will be as safe at later initiation, and whether it could also lead to fewer recurrent strokes. Importantly, the newer anticoagulant drugs will be used in the study, as this is expected to be the safest approach.
The study is part of the wider ‘ELAN’ trial, which is an international clinical trial investigating the safety of early treatment with anticoagulants in 600 ischaemic stroke patients with atrial fibrillation. Up to 150 patients will come from the UK study. Participants will be randomly assigned to start the anticoagulant drug early or later and will be followed up at 30 days after stroke by telephone and at 90 days after stroke in the clinic.
What difference could this research make?
The researchers hope that the results of the ELAN trial will help inform clinical stroke practice in the future.