The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to AF is unknown. This study was done to investigate the safety of early initiation of DOACs, VKAs or no anticoagulation.

This study included consecutive patients with recent ischaemic stroke and AF. The primary outcome was the rate of major bleeding in patients on different treatment schemes, i.e. DOACs, VKAs and not anticoagulated.

We included 959 consecutive patients with AF and ischaemic stroke followed up for an average of 16.1 days after the index event. A total of 559 out of 959 patients were anticoagulated with either VKAs or DOACs. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding and in particular of intracranial bleeding compared with no anticoagulation. In contrast to VKAs, treatment with DOACs reduced the rate of major bleeding compared with no anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups.

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This study concluded that starting DOACs within a mean of one week after stroke appeared to be safe. Randomized controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.