Miriam Stoppard shares research from University College London that could bring peace of mind to patients with heart rhythm disturbance atrial fibrillation

Recently a girlfriend of mine had a stroke. She was discovered to have atrial fibrillation but wasn’t given an anticoagulant.

As a result she developed a clot, as people with AF will, hence the stroke. She was lucky. The clot was removed from her brain with no lasting damage.

She’s exactly the sort of patient that University College London researchers have been studying. They have concluded it’s safe and effective to give blood-thinning treatments (anticoagulants) to AF stroke patients within four days of them having a stroke, rather than waiting for up to 14 days as previously recommended.

I have atrial fibrillation. It’s a heart rhythm disturbance that affects many people as they get older. It results in an irregular heartbeat which can lead to a clot forming inside the heart. This clot may travel to the brain, blocking its blood supply and causing a stroke.

More than 1.6 million people in the UK have AF – and they’re five times more likely to have a stroke than people without it.

However, anticoagulants come with the rare but dangerous side effect of bleeding into the brain.

Chief investigator, Professor David Werring (UCL Queen Square Institute of Neurology), explains: “There are concerns that starting anticoagulants too early might increase the risk of bleeding into the area of the brain damaged by the stroke – especially in people with more severe strokes. However, starting them too late might leave the patient at risk of stroke due to further clots from the heart.”

To tackle this dilemma, the researchers investigated the impact of early compared to delayed anticoagulant treatment.

The team analysed 3,621 AF patients who had had a stroke between 2019 and 2024, across 100 UK hospitals. Half of the participants began anticoagulant treatment within four days of their stroke (early), and the other half started treatment seven-14 days after having a stroke (delayed).

Patients were followed up after 90 days. Early treatment was found to be effective and didn’t increase the risk of a bleed into the brain.

The researchers hope their findings will enable patients to get treatment earlier and prevent them from missing out.

Prof Werring believes it isn’t necessary to wait before starting anticoagulants regardless of stroke severity. “This should lead to a rapid change in clinical practice, particularly for people with more severe strokes.”

Professor Nick Freemantle, senior investigator, also pointed out: “The benefits are that patients are quickly given the definitive and effective long-term stroke prevention treatment instead of waiting, which could lead to the treatments not being started at all – especially if patients are discharged from hospital.”

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