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

NCT ID: NCT07139301

Last Updated: 2025-09-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

438 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-04

Study Completion Date

2026-08-31

Brief Summary

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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 after emergency endovascular therapy (EVT).

Detailed Description

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This is a multicenter, prospective, open-label, randomized controlled trial evaluating the safety and efficacy of different initiation timings of direct oral anticoagulants (DOACs) therapy in patients with acute ischemic stroke related to atrial fibrillation after emergency endovascular therapy (EVT).

Conditions

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Ischemic Stroke Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Early anticoagulation

Early initiation of any direct oral anticoagulant (DOAC) within 96 hours (4 days) of the onset of acute ischemic stroke

Group Type EXPERIMENTAL

Early anticoagulation

Intervention Type DRUG

Early initiation of direct oral anticoagulants will be started within four days after symptom onset.

Delayed anticoagulation

Delayed initiation of any direct oral anticoagulant (DOAC) between 5-14 days of the onset of acute ischemic stroke

Group Type ACTIVE_COMPARATOR

Delayed anticoagulation

Intervention Type DRUG

Delayed initiation of direct oral anticoagulants will be started between 5-14 days after symptom onset.

Interventions

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Early anticoagulation

Early initiation of direct oral anticoagulants will be started within four days after symptom onset.

Intervention Type DRUG

Delayed anticoagulation

Delayed initiation of direct oral anticoagulants will be started between 5-14 days after symptom onset.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Aged 18 years or over.
2. Clinical diagnosis of large vessel occlusion acute ischemic stroke.
3. Emergency endovascular treatment was performed within 24 hours of stroke onset.
4. Atrial fibrillation (including paroxysmal, persistent or permanent atrial fibrillation), confirmed by at least one of the following:

1. 12-lead ECG recording
2. Inpatient ECG telemetry
3. Prolonged ECG monitoring (e.g. Holter monitor)
4. Previously established diagnosis of atrial fibrillation verified by medical records.
5. CT or MRI demonstrating one of the following findings:

1. No hemorrhagic transformation;
2. Hemorrhagic infarction type 1 (HI1), defined as small petechiae along the margins of the infarct (Heidelberg classification);
3. Hemorrhagic infarction type 2 (HI2), defined as confluent petechiae within the infarcted area without space-occupying effect (Heidelberg classification).
6. Time from stroke onset to randomization was within 72 hours.
7. Written informed consent obtained from the patient or a legally authorized representative.

Exclusion Criteria

1. Atrial fibrillation due to reversible causes (e.g. thyrotoxicosis, pericarditis, recent surgery, or myocardial infarct).
2. Contraindication to the use of direct oral anticoagulants (DOACs):

1. Known allergy or intolerance to both factor Xa inhibitors and direct thrombin inhibitors;
2. Definite indication for vitamin K antagonist (VKA) treatment (e.g. mechanical heart valve, valvular atrial fibrillation);
3. 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) ;
4. Concomitant use of medications with significant interactions with DOACs, including azole antifungals, HIV protease inhibitors, or strong CYP3A4 inducers;
5. Baseline platelet count \< 100 x 109/L;
6. History of coagulopathy or systemic hemorrhage.
3. Prior DOAC use within 48 hours of stroke onset, or recent treatment with vitamin K antagonist (VKA) leading to INR ≥1.7 at randomization.
4. Pregnant or breastfeeding women, or positive pregnancy test at admission.
5. History of major surgery or severe trauma within 1 month prior to stroke onset.
6. History of active bleeding within 1 month prior to stroke onset (e.g. gastrointestinal bleeding, urinary tract bleeding).
7. Dual antiplatelet therapy at baseline, or strong likelihood of requiring dual antiplatelet therapy during the trial.
8. Evidence of cerebral amyloid angiopathy.
9. CT or MRI evidence of non-stroke pathology likely to account for the presenting clinical symptoms (e.g. mass lesion, encephalitis).
10. Modified Rankin scale (mRS) score \> 1 prior to stroke onset.
11. Inability to complete the 90-day follow-up.
12. Currently participating in another drug clinical trial.
13. Any other reason deemed by the investigator to make the patient unsuitable for participation in the trial.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Capital Medical University

OTHER

Sponsor Role lead

Responsible Party

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Ji Xunming,MD,PhD

Professor of Neurology, Xuanwu Hospital, Capital Medical University

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Xuanwu Hospital, Beijing, Beijing 100053

Beijing, , China

Site Status RECRUITING

Guoluo Prefecture People's Hospital

Guoluo, , China

Site Status RECRUITING

Huanghua Municipal People's Hospital

Huanghua, , China

Site Status RECRUITING

First Affiliated Hospital of Henan Polytechnic University

Jiaozuo, , China

Site Status RECRUITING

Ningjin County People's Hospital

Ningjin, , China

Site Status RECRUITING

Ren Shou County People's Hospital

Renshou, , China

Site Status RECRUITING

Daliuta Experimental District People's Hospital of Shenmu City

Shenmu, , China

Site Status RECRUITING

Xiuyan Central Hospital

Xiuyan, , China

Site Status RECRUITING

The Affiliated Hospital of Xuzhou Medical University

Xuzhou, , China

Site Status RECRUITING

Countries

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China

Central Contacts

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Xunming Ji

Role: CONTACT

01083198962

Chuanjie Wu

Role: CONTACT

01083199439

Facility Contacts

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Chuanjie Wu

Role: primary

01083199439

Xunming Ji

Role: backup

01083198962

Fei Shi

Role: primary

Chong Li

Role: primary

Zhenyu Kong

Role: primary

Han Wang

Role: primary

Yufeng Jiang

Role: primary

Guoyu Wang

Role: primary

Guangping Li

Role: primary

Yu Feng

Role: primary

Other Identifiers

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TIMERS-1

Identifier Type: -

Identifier Source: org_study_id

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