Timing of Anticoagulation in Relation to Cerebral Infarct Severity

Current guidelines recommend delaying anticoagulation for 12 to 14 days in patients with atrial fibrillation and a major stroke because of concern about hemorrhagic transformation. However, clinical trial data were lacking until recent studies, including the ELAN trial, which showed numerically fewer primary endpoint events (recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial bleeding, or vascular death) at 30 days with early anticoagulation. In this post hoc analysis of ELAN, researchers examined whether stroke severity affected outcomes. They categorized strokes as minor (<1.5 cm in diameter), moderate (>1.5 cm but less than the entire territory of the anterior cerebral artery [ACA] or middl…