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The Lead Episode 19: A Discussion of Early versus Later Anticoagulation for Stroke with Atrial Fibrillation
In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN number, NCT03148457.)
Learning Objectives
  • Define minor, moderate and strokes.
  • Effect of early as compared to later initiation of direct oral anticoagulants (DOAC) in persons with Atrial Fib who have had an acute ischemic stroke.
Article Authors and Podcast Contributors
Article Authors
U. Fischer, M. Koga, D. Strbian, M. Branca, S. Abend, S. Trelle, M. Paciaroni, G. Thomalla, P. Michel, K. Nedeltchev, L.H. Bonati, G. Ntaios, T. Gattringer, E.-C. Sandset, P. Kelly, R. Lemmens, P.N. Sylaja, D. Aguiar de Sousa, N.M. Bornstein, Z. Gdovinova, T. Yoshimoto, M. Tiainen, H. Thomas, M. Krishnan, G.C. Shim, C. Gumbinger, J. Vehoff, L. Zhang, K. Matsuzono, E. Kristoffersen, P. Desfontaines, P. Vanacker, A. Alonso, Y. Yakushiji, C. Kulyk, D. Hemelsoet, S. Poli, A. Paiva Nunes, N. Caracciolo, P. Slade, J. Demeestere, A. Salerno, M. Kneihsl, T. Kahles, D. Giudici, K. Tanaka, S. Räty, R. Hidalgo, D.J. Werring, M. Göldlin, M. Arnold, C. Ferrari, S. Beyeler, C. Fung, B.J. Weder, T. Tatlisumak, S. Fenzl, B. Rezny Kasprzak, A. Hakim, G. Salanti, C. Bassetti, J. Gralla, D.J. Seiffge, T. Horvath, and J. Dawson, for the ELAN Investigators*

Podcast Contributors
Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital

Niraj Sharma, MD, FHRS, of Northside Hospital
Kamala P. Tamirisa, of Texas Cardiac Arrhythmia
Disclosure Policy

ACE Disclosure Policy

The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.


Any individual who refuses to disclose financial relationships is disqualified from participating in HRS ACE-certified activities. Owners and employees of ACCME-defined ineligible companies may have no role in the planning or implementation of ACE activities without a special written exemption from the HRS Chief Learning Officer that will be granted only in specific circumstances that meet ACCME requirements.

ACCME Definition:

*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Examples of such organizations include:

  • Advertising, marketing, or communication firms whose clients are ineligible companies
  • Bio-medical startups that have begun a governmental regulatory approval process
  • Compounding pharmacies that manufacture proprietary compounds
  • Device manufacturers or distributors
  • Diagnostic labs that sell proprietary products
  • Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
  • Manufacturers of health-related wearable products
  • Pharmaceutical companies or distributors
  • Pharmacy benefit managers
  • Reagent manufacturers or sellers


All relevant financial relationships have been mitigated.

Host Disclosure(s):
D. Varghese: No relevant financial relationships with ineligible companies to disclose. 

Contributor Disclosure(s):

N. Sharma: No relevant financial relationships with ineligible companies to disclose.
K. Tamirisa: Honoraria/Speaking/Consulting Fee: Medscape, Abbott, Sanofi

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):
J. Glenn: No relevant financial relationships with ineligible companies to disclose. 
S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Availability: On-Demand
Cost: FREE
Credit Offered:
No Credit Offered
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