Timing of oral anticoagulant therapy in acute ischemic stroke with atrial fibrillation: study protocol for a registry-based randomised controlled trial
Open accessAbstract
BACKGROUND: Oral anticoagulation therapy is recommended for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Current guidelines do not provide evidence-based recommendations on optimal time-point to start anticoagulation therapy after an acute ischemic stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) may offer advantages compared to warfarin because of faster and more predictable onset of action and potentially a lower risk of intracerebral haemorrhage also in the acute phase after an ischemic stroke. The TIMING study aims to establish the efficacy and safety of early vs delayed initiation of NOACs in patients with acute ischemic stroke and AF. METHODS/DESIGN: The TIMING study is a national, investigator-led, registry-based, multicentre, open-label, randomised controlled study. The Swedish Stroke Register is used for enrolment, randomisation and follow-up of 3000 patients, who are randomised (1:1) within 72 h from ischemic stroke onset to either early (≤ 4 days) or delayed (≥ 5-10 days) start of NOAC therapy. The primary outcome is the composite of recurrent ischemic stroke, symptomatic intracerebral haemorrhage, or all-cause mortality within 90 days after randomisation. Secondary outcomes include: individual components of the primary outcome at 90 and 365 days; major haemorrhagic events; functional outcome by the modified Rankin Scale at 90 days; and health economics. In an optional biomarker sub-study, blood samples will be collected after randomisation from approximately half of the patients for central analysis of cardiovascular biomarkers after study completion. The study is funded by the Swedish Medical Research Council. Enrolment of patients started in April 2017. CONCLUSION: The TIMING study addresses the ongoing clinical dilemma of when to start NOAC after an acute ischemic stroke in patients with AF. By the inclusion of a randomisation module within the Swedish Stroke Register, the advantages of a prospective randomised study design are combined with the strengths of a national clinical quality register in allowing simplified enrolment and follow-up of study patients. In addition, the register adds the possibility of directly assessing the external validity of the study findings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02961348 . Registered on 8 November 2016.
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- [29]Terent A, Asberg S, Oldgren J, Hijazi Z, Norrving B. Antikoagulantia efter akut ischemisk stroke med förmaksflimmer. Läkartidningen. 2016;113:DUFT [Swedish]. http://www.lakartidningen.se/EditorialFiles/FT/%5bDUFT%5d/DUFT.pdf. 26928683
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- Authors
- Åsberg, S., Hijazi, Z., Norrving, B., Terént, A., Öhagen, P., & Oldgren, J.
- Affiliations
- Uppsala University (SE)
- Lund University (SE)
- Corresponding author
- Åsberg, Signild
- Venue
- Trials
- Published
- 2017-12
- Volume
- 18
- Issue
- 1
- Pages
- 581-581
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC5712199
- OpenAlex
- W2771591850
- Cited by
- 43
- References
- 37
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 3 · 2022: 9 · 2021: 7 · 2020: 6 · 2019: 2 · 2018: 3
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Vetenskapsrådet (2015-00881)
- Uppsala-Örebro Regional Research Council (RFR-655101)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- oral anticoagulation, direct oral anticoagulants, atrial fibrillation, acute ischemic stroke, timing of anticoagulation initiation, recurrent ischemic stroke, intracerebral hemorrhage, all-cause mortality, functional outcome, cardiovascular biomarkers
- MeSH terms
- Administration, Oral, Anticoagulants, Atrial Fibrillation, Cerebral Hemorrhage, Brain Ischemia, Clinical Protocols, Drug Administration Schedule, Humans, Prospective Studies, Recurrence, Registries, Research Design, Risk Factors, Sweden, Time Factors, Treatment Outcome, Recovery of Function, Stroke, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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