title: Early initiation of new oral anticoagulants in acute stroke and TIA patients with nonvalvular atrial fibrillation.
abstract: OBJECTIVE
  The aim of this study was to investigate whether early initiation of new oral anticoagulants (NOAC) for acute stroke or transient ischemic attack (TIA) patients with nonvalvular atrial fibrillation (NVAF) are safe.
  
  
  METHODS
  Between March 2011 and September 2012, stroke or TIA patients with NVAF who started NOAC within 2 weeks were enrolled retrospectively. Symptomatic intracerebral hemorrhage (ICH), hemorrhagic transformation (HT) on T2*-weighted MRI, recurrence of stroke or TIA, systemic embolism and any bleeding complications after initiation of NOAC were evaluated.
  
  
  RESULTS
  41 patients (25 males; mean age 76.2 years) started NOAC; of which, 39 (95%) patients had stroke, and 2 (5%) had TIA. The median (interquartile range) interval from onset to treatment with NOAC was 2 (1-6) days. Symptomatic ICH was not observed. HT on initial T2* and new HT on follow-up T2* were 5 (12%) and 11 (31%), but it was asymptomatic. Of 5 patients who had HT on the initial T2*, enlargement of hemorrhage on follow-up T2* (hemorrhagic infarction (HI) Type 1→HI Type 2) was observed in 1 patient, but it was asymptomatic. None of the patients had recurrent stroke or TIA, systemic embolism, and any bleeding complications.
  
  
  CONCLUSIONS
  The NOAC may be safe in acute stroke or TIA patients with NVAF. A large, prospective study is needed to confirm this.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan. shibaken@med.kawasaki-m.ac.jp
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Naoki
authors.initials: N
authors.lastname: Saji
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sakai
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Hemorrhagic transformation; Intracerebral hemorrhage; New anticoagulants; Stroke; TIA