Anticoagulation After Stroke in Patients With Atrial Fibrillation : To Bridge or Not With Low-Molecular-Weight Heparin?

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Altavilla , R , Caso , V , Bandini , F , Agnelli , G , Tsivgoulis , G , Yaghi , S , Furie , K L , Tadi , P , Becattini , C , Zedde , M , Abdul-Rahim , A H , Lees , K R , Alberti , A , Venti , M , Acciarresi , M , D'Amore , C , Mosconi , M G , Cimini , L A , Fusaro , J , Bovi , P , Carletti , M , Rigatelli , A , Cappellari , M , Putaala , J , Tomppo , L , Tatlisumak , T , Marcheselli , S , Pezzini , A , Poli , L , Padovani , A , Masotti , L , Vannucchi , V , Sohn , S-I , Lorenzini , G , Tassi , R , Guideri , F , Acampa , M , Martini , G , Ntaios , G , Athanasakis , G , Makaritsis , K , Karagkiozi , E , Vadikolias , K , Liantinioti , C , Chondrogianni , M , Mumoli , N , Consoli , D , Galati , F , Sacco , S , Carolei , A , Tiseo , C , Corea , F , Ageno , W , Bellesini , M , Silvestrelli , G , Ciccone , A , Lanari , A , Scoditti , U , Denti , L , Mancuso , M , Maccarrone , M , Ulivi , L , Orlandi , G , Giannini , N , Gialdini , G , Tassinari , T , De Lodovici , M L , Bono , G , Rueckert , C , Baldi , A , D'Anna , S , Toni , D , Letteri , F , Giuntini , M , Lotti , E M , Flomin , Y , Pieroni , A , Kargiotis , O , Karapanayiotides , T , Monaco , S , Baronello , M M , Csiba , L , Szabo , L , Chiti , A , Giorli , E , Del Sette , M , Imberti , D , Zabzuni , D , Doronin , B , Volodina , V , Michel , P , Vanacker , P , Barlinn , K , Pallesen , L-P , Barlinn , J , Deleu , D , Melikyan , G , Ibrahim , F , Akhtar , N , Gourbali , V & Paciaroni , M 2019 , ' Anticoagulation After Stroke in Patients With Atrial Fibrillation : To Bridge or Not With Low-Molecular-Weight Heparin? ' , Stroke , vol. 50 , no. 8 , pp. 2093-2100 . https://doi.org/10.1161/STROKEAHA.118.022856

Title: Anticoagulation After Stroke in Patients With Atrial Fibrillation : To Bridge or Not With Low-Molecular-Weight Heparin?
Author: Altavilla, Riccardo; Caso, Valeria; Bandini, Fabio; Agnelli, Giancarlo; Tsivgoulis, Georgios; Yaghi, Shadi; Furie, Karen L.; Tadi, Prasanna; Becattini, Cecilia; Zedde, Marialuisa; Abdul-Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Mosconi, Maria Giulia; Cimini, Ludovica Anna; Fusaro, Jessica; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Marcheselli, Simona; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Masotti, Luca; Vannucchi, Vieri; Sohn, Sung-Il; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Ntaios, George; Athanasakis, George; Makaritsis, Konstantinos; Karagkiozi, Efstathia; Vadikolias, Konstantinos; Liantinioti, Chrysoula; Chondrogianni, Maria; Mumoli, Nicola; Consoli, Domenico; Galati, Franco; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Corea, Francesco; Ageno, Walter; Bellesini, Marta; Silvestrelli, Giorgio; Ciccone, Alfonso; Lanari, Alessia; Scoditti, Umberto; Denti, Licia; Mancuso, Michelangelo; Maccarrone, Miriam; Ulivi, Leonardo; Orlandi, Giovanni; Giannini, Nicola; Gialdini, Gino; Tassinari, Tiziana; De Lodovici, Maria Luisa; Bono, Giorgio; Rueckert, Christina; Baldi, Antonio; D'Anna, Sebastiano; Toni, Danilo; Letteri, Federica; Giuntini, Martina; Lotti, Enrico Maria; Flomin, Yuriy; Pieroni, Alessio; Kargiotis, Odysseas; Karapanayiotides, Theodore; Monaco, Serena; Baronello, Mario Maimone; Csiba, Laszlo; Szabo, Lilla; Chiti, Alberto; Giorli, Elisa; Del Sette, Massimo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Michel, Patrik; Vanacker, Peter; Barlinn, Kristian; Pallesen, Lars-Peder; Barlinn, Jessica; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Gourbali, Vanessa; Paciaroni, Maurizio
Contributor: University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
Date: 2019-08
Language: eng
Number of pages: 8
Belongs to series: Stroke
ISSN: 0039-2499
URI: http://hdl.handle.net/10138/306347
Abstract: Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.
Subject: anticoagulants
atrial fibrillation
humans
incidence
secondary prevention
ACUTE ISCHEMIC-STROKE
HEMORRHAGIC TRANSFORMATION
ARTERIAL TERRITORIES
HUMAN BRAIN
LEUKOARAIOSIS
METAANALYSIS
OUTCOMES
RISK
3112 Neurosciences
3124 Neurology and psychiatry
3121 General medicine, internal medicine and other clinical medicine
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