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1. The OPTIMAS trial evaluated the timing of direct oral anticoagulant (DOAC) initiation after acute ischemic stroke (IS) in patients with atrial fibrillation (AF), stratified by chronic kidney disease (CKD) status.
2. Early DOAC initiation (within 4 days) compared to delayed initiation (days 7-14) showed no difference in recurrent ischemic stroke, intracranial hemorrhage, systemic embolism, or mortality in both CKD and non-CKD groups.
3. CKD does not modify the effect of early versus delayed anticoagulation initiation, supporting early treatment for stroke prevention in patients with AF regardless of kidney function.
4. These findings address safety concerns and may inform clinical guidelines to optimize anticoagulation timing in this high-risk population.
