ESOC 2026 | The optimal timing of anticoagulation after AF-associated ischemic stroke

What we’re presenting in this conference, among other things, is a sub-study of the Catalyst collaboration of trials that investigated the optimal timing of anticoagulation after an atrial fibrillation-associated ischemic stroke. There have been four randomized trials on this issue that have been completed and have been meta-analyzed, their individual patient data that is in the context of this Catalyst collaboration. What the main meta-analysis of Catalyst showed, that was published some time ago, what it showed is that when starting early, that is within four days as opposed to later that is on day five or later you reduce the risk of recurrent stroke that’s including ischemic stroke or intracerebral hemorrhage or undifferentiated stroke. So a question that we were interested in is whether there is still net benefit coming out of this approach out of starting early considering the fact that when you examine all of these outcomes together you’re implying that they’re equivalent in their clinical importance but we actually do know that an ischemic stroke is not the same as an ICH as an intracerebral hemorrhage. So that’s what we wanted to do with this meta-analysis of Catalyst, investigate whether there is also net benefit coming out of the early treatment approach besides just reducing the number of events. And we investigated this using established methodology. And what we found is that after you weight events for, say, the potentially more severe impact that an intracerebral hemorrhage may have compared to ischemic stroke, you still find that early treatment is associated with a net clinical benefit, a positive effect, about one weighted event prevented per 100 participants, although with large uncertainty around this point estimate. That was in a population of 5,500 patients from the Catalyst meta-analysis and it’s still supports or it further supports, I should say, the findings of the main meta-analysis that early treatment to be beneficial. Another thing and a sub-analysis that we did within this context of looking at the net clinical benefit is we also examined what the actual severity and disability coming out of these events that happened either with early or with later treatment is in the context of Catalyst. There was a total of about 120 recurrent strokes, either ischemic or hemorrhagic, that these patients had in Catalyst. 50 with early, 70 with later treatment. And when you compare the subsequent disability, so that was 15-70 events in the first month, in the first 30 days. And then you look at the disability at 90 days. So when you compare the subsequent disability coming out of these events, this does not differ between the early and the later approach. So no evidence that starting early leads to more disabling strokes, coupled with the fact that we find a net benefit when we do this calculation, coupled with the fact that early treatment reduces the actual number of strokes, everything speaks in favor of starting early.

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