@article{2987673,
    title = "Anticoagulation after Stroke in Patients with Atrial Fibrillation: To Bridge or Not with Low-Molecular-Weight Heparin?",
    author = "Altavilla, R. and Caso, V. and Bandini, F. and Agnelli, G. and Tsivgoulis, G. and Yaghi, S. and Furie, K.L. and Tadi, P. and Becattini, C. and Zedde, M. and Abdul-Rahim, A.H. and Lees, K.R. and Alberti, A. and Venti, M. and Acciarresi, M. and D'Amore, C. and Giulia Mosconi, M. and Anna Cimini, L. and Fusaro, J. and Bovi, P. and Carletti, M. and Rigatelli, A. and Cappellari, M. and Putaala, J. and Tomppo, L. and Tatlisumak, T. and Marcheselli, S. and Pezzini, A. and Poli, L. and Padovani, A. and Masotti, L. and Vannucchi, V. and Sohn, S.-I. and Lorenzini, G. and Tassi, R. and Guideri, F. and Acampa, M. and Martini, G. and Ntaios, G. and Athanasakis, G. and Makaritsis, K. and Karagkiozi, E. and Vadikolias, K. and Liantinioti, C. and Chondrogianni, M. and Mumoli, N. and Consoli, D. and Galati, F. and Sacco, S. and Carolei, A. and Tiseo, C. and Corea, F. and Ageno, W. and Bellesini, M. and Silvestrelli, G. and Ciccone, A. and Lanari, A. and Scoditti, U. and Denti, L. and Mancuso, M. and MacCarrone, M. and Ulivi, L. and Orlandi, G. and Giannini, N. and Gialdini, G. and Tassinari, T. and De Lodovici, M.L. and Bono, G. and Rueckert, C. and Baldi, A. and D'Anna, S. and Toni, D. and Letteri, F. and Giuntini, M. and Lotti, E.M. and Flomin, Y. and Pieroni, A. and Kargiotis, O. and Karapanayiotides, T. and Monaco, S. and Baronello, M.M. and Csiba, L. and Szabó, L. and Chiti, A. and Giorli, E. and Del Sette, M. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Michel, P. and Vanacker, P. and Barlinn, K. and Pallesen, L.-P. and Barlinn, J. and Deleu, D. and Melikyan, G. and Ibrahim, F. and Akhtar, N. and Gourbali, V. and Paciaroni, M.",
    journal = "ISRN Stroke",
    year = "2019",
    volume = "50",
    number = "8",
    pages = "2093-2100",
    publisher = "Lippincott Williams and Wilkins",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.118.022856",
    keywords = "acetylsalicylic acid;  anticoagulant agent;  clopidogrel;  low molecular weight heparin;  warfarin;  anticoagulant agent;  low molecular weight heparin, age;  aged;  anticoagulant therapy;  Article;  atrial fibrillation;  brain embolism;  brain hemorrhage;  brain ischemia;  cerebrovascular accident;  cerebrovascular disease;  CHA2DS2-VASc score;  female;  follow up;  human;  leukoaraiosis;  major clinical study;  male;  National Institutes of Health Stroke Scale;  observational study;  outcome assessment;  priority journal;  prospective study;  transient ischemic attack;  treatment outcome;  atrial fibrillation;  brain hemorrhage;  cerebrovascular accident;  complication;  secondary prevention, Anticoagulants;  Atrial Fibrillation;  Cerebral Hemorrhage;  Heparin, Low-Molecular-Weight;  Humans;  Secondary Prevention;  Stroke",
    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<0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. 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. © 2019 American Heart Association, Inc."
}