Timing of Anticoagulation After Emergency Endovascular Therapy for Acute Ischemic Stroke With Atrial Fibrillation 2

Recruiting now · Not applicable

Conditions studied: Ischemic Stroke, Atrial Fibrillation

In brief

This study evaluates the safety and efficacy of early versus delayed initiation of direct oral anticoagulants (DOACs) in patients with acute ischemic stroke related to atrial fibrillation who develop hemorrhagic transformation after endovascular treatment.

Key facts

Study ID

NCT07139314

Run by

Capital Medical University

People needed

240

Starts

2025-09-24

Expected to finish

2026-08-31

Last updated by the study team

2026-02-05

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Aged 18 years or over.
• Clinical diagnosis of large vessel occlusion acute ischemic stroke.
• Emergency endovascular treatment was performed within 24 hours of stroke onset.
• Atrial fibrillation (including paroxysmal, persistent or permanent atrial fibrillation), confirmed by at least one of the following:
• 12-lead ECG recording;
• Inpatient ECG telemetry;
• Prolonged ECG monitoring (e.g. Holter monitor);
• Previously established diagnosis of atrial fibrillation verified by medical records.
• CT or MRI demonstrating one of the following findings:
• Parenchymatous hematoma type 1: defined as hematoma occupying less than 30% of the infarcted tissue, no substantive mass effect (Heidelberg classification);
• Parenchymatous hematoma type 2: defined as heamtoma occupying 30% or more of the infarcted tissue, with obvious mass effect (Heidelberg classification);
• Intracerebral hemorrhage outside the infarcted brain tissue or intracranial-extracerebral hemorrhage (Heidelberg classification).
• Time from stroke onset to randomization ranged from 7 days to 4 weeks.
• Written informed consent obtained from the patient or a legally authorized representative.

You may not qualify if…

• Atrial fibrillation due to reversible causes (e.g. thyrotoxicosis, pericarditis, recent surgery, or myocardial infarct).
• Contraindication to the use of direct oral anticoagulants (DOACs):
• Known allergy or intolerance to both factor Xa inhibitors and direct thrombin inhibitors;
• Definite indication for vitamin K antagonist (VKA) treatment (e.g. mechanical heart valve, valvular atrial fibrillation);
• Severe renal impairment (defined as creatinine exceeding 1.5 times of the upper limit of normal range) and significant hepatic dysfunction (defined as ALT or AST > twice the upper limit of normal range) ;
• Concomitant use of medications with significant interactions with DOACs, including azole antifungals, HIV protease inhibitors, or strong CYP3A4 inducers;
• Baseline platelet count < 100 x 109/L;
• History of coagulopathy or systemic hemorrhage.
• Prior DOAC use within 48 hours of stroke onset, or recent treatment with vitamin K antagonist (VKA) leading to INR ≥1.7 at randomization.
• Pregnant or breastfeeding women, or positive pregnancy test at admission.
• History of major surgery or severe trauma within 1 month prior to stroke onset.
• History of active bleeding within 1 month prior to stroke onset (e.g. gastrointestinal bleeding, urinary tract bleeding).
• Dual antiplatelet therapy at baseline, or strong likelihood of requiring dual antiplatelet therapy during the trial.
• Evidence of cerebral amyloid angiopathy.
• CT or MRI evidence of non-stroke pathology likely to account for the presenting clinical symptoms (e.g. mass lesion, encephalitis).
• Modified Rankin scale (mRS) score > 1 prior to stroke onset.
• Inability to complete the 90-day follow-up.
• Currently participating in another drug clinical trial.
• Any other reason deemed by the investigator to make the patient unsuitable for participation in the trial.

Where it is running

• Ma'anshan People's Hospital — Ma’anshan, Anhui, China (enrolling)
• Xuanwu Hospital — Beijing, Beijing Municipality, China (enrolling)
• Aviation General Hospital — Beijing, Beijing Municipality, China (enrolling)
• Beijing Shijingshan Hospital — Beijing, Beijing Municipality, China (enrolling)
• Zhangzhou Municipal Hospital of Fujian Province — Zhangzhou, Fujian, China (enrolling)
• Heyuan People's Hospital — Heyuan, Guangdong, China (enrolling)
• Qinzhou First People's Hospital — Qinzhou, Guangxi, China (enrolling)
• Baoding Sixth Hospital — Baoding, Hebei, China (enrolling)
• The First Affiliated Hospital of Harbin Medical University — Harbin, Heilongjiang, China (enrolling)
• The Hongda Hospital of Jiamusi University — Jiamusi, Heilongjiang, China (enrolling)
• Fangcheng County People's Hospital — Nanyang, Henan, China (enrolling)
• Nanyang Central Hospital — Nanyang, Henan, China (enrolling)
• Lushan County People's Hospital — Pingdingshan, Henan, China (enrolling)
• Xinyang Central Hospital — Xinyang, Henan, China (enrolling)
• Queshan County People's Hospital — Zhumadian, Henan, China (enrolling)
• Tianyou Hospital, Wuhan University of Science and Technology — Wuhan, Hubei, China (enrolling)
• Northern Jiangsu People's Hospital — Yangzhou, Jiangsu, China (enrolling)
• Yingkou Central Hospital — Yingkou, Liaoning, China (enrolling)
• Ordos Central Hospital, — Ordos, Neimenggu, China (enrolling)
• Feicheng Hospital Of Shandong Yiyang Health Group — Feicheng, Shandong, China (enrolling)
• Jinan Zhangqiu District People's Hospital — Jinan, Shandong, China (enrolling)
• Qilu Hospital of Shandong University — Jinan, Shandong, China (enrolling)
• Laizhou City People's Hospital, — Laizhou, Shandong, China (enrolling)
• Linyi People's Hospital — Linyi, Shandong, China (enrolling)
• Linshu County People's Hospital — Lishui, Shandong, China (enrolling)

Full record on ClinicalTrials.gov

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