Background: and Purpose We aimed to evaluate whether early versus late initiation of direct oral anticoagulant (DOAC) after acute ischemic stroke (AIS) yields different safety and efficacy outcomes in Asian versus non-Asian patients. Methods: We analyzed Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN) trial data from 2,013 AIS patients with atrial fibrillation (AF) randomized to early (≤48 hours for minor/moderate stroke, 6–7 days for major stroke) or late DOAC initiation (3–4 days for minor ischemic stroke, 6–7 days for moderate ischemic stroke, 12–14 days for major ischemic stroke). Patients were categorized by region as Asian (Japan and India) or non-Asian. The primary outcome was a composite of major extracranial bleeding, symptomatic uncerintracranial hemorrhage (SICH), recurrent ischemic stroke, systemic embolism (SE), or vascular death at 30 days (trial registration: ClinicalTrials.gov number, NCT03148457). Results: Among 1,975 patients, 245 were Asian (192 from Japan and 53 from India) and 1,730 were non-Asian. The primary outcome occurred in 6.5% of Asian patients (4.8% early vs. 8.3% late) and 3.1% of non-Asian patients (2.7% vs. 3.6%) (p<0.01). Higher rates of recurrent ischemic stroke (4.1% [2.4% vs. 5.8%] vs. 1.7% [1.3% vs. 2.1%], p=0.02) and SE (2.0% [0.8% vs. 3.3%] vs. 0.5% [0.4% vs. 0.6%], p=0.02) accounted for this difference. No significant differences were observed in major extracranial bleeding, SICH, recurrent ischemic stroke, SE, or vascular death. No significant interaction was observed between region and treatment allocation. Conclusions Although Asian patients had worse baseline profiles and outcomes, treatment effects did not differ by region, supporting the generalizability of early DOAC initiation in Asian AIS patients without region-specific timing modifications.

There is no evidence for effects of gait training in spinocerebellar degeneration (SCD) of SCD severity level IV. Here we report the effect of gait training in a 42-year-old man diagnosed with SCD severity level IV. At the beginning of physical therapy (day X), his Scale for Assessment and Rating of Ataxia (SARA) score was 20 and his Berg Balance Scale (BBS) score was 27. The patient required two people to assist him in walking because of his high risk of falling due to ataxia, which caused the lower limbs to step out in unexpected directions. His Functional Ambulation Categories (FAC) score was 0. Regular standing and balance function exercises failed to improve his condition, and he was switched to physical therapy focusing on gait training using a walker with a saddle (OG Giken Safety Walker GB-500), which improved his SARA score to 15 and BBS score to 35 at day X+24. He became able to walk with the assistance of one person, and with the use of handrails, his 10 m walking speed was 12 s and his continuous walking distance was 60 m. His FAC score also improved to 2, and he was transferred to another hospital to continue his rehabilitation. Even in this patient with SCD severity level IV, intensive gait training using a walker with saddle resulted in improved walking ability.