@article{2988234,
    title = "Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: Effect of anticoagulation and its timing: The RAF study",
    author = "Paciaroni, M. and Agnelli, G. and Falocci, N. and Caso, V. and Becattini, C. and Marcheselli, S. and Rueckert, C. and Pezzini, A. and Poli, L. and Padovani, A. and Csiba, L. and Szabó, L. and Sohn, S.-I. and Tassinari, T. and Abdul-Rahim, A.H. and Michel, P. and Cordier, M. and Vanacker, P. and Remillard, S. and Alberti, A. and Venti, M. and Scoditti, U. and Denti, L. and Orlandi, G. and Chiti, A. and Gialdini, G. and Bovi, P. and Carletti, M. and Rigatelli, A. and Putaala, J. and Tatlisumak, T. and Masotti, L. and Lorenzini, G. and Tassi, R. and Guideri, F. and Martini, G. and Tsivgoulis, G. and Vadikolias, K. and Liantinioti, C. and Corea, F. and Del Sette, M. and Ageno, W. and De Lodovici, M.L. and Bono, G. and Baldi, A. and D'Anna, S. and Sacco, S. and Carolei, A. and Tiseo, C. and Acciarresi, M. and D'Amore, C. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Consoli, D. and Galati, F. and Pieroni, A. and Toni, D. and Monaco, S. and Baronello, M.M. and Barlinn, K. and Pallesen, L.-P. and Kepplinger, J. and Bodechtel, U. and Gerber, J. and Deleu, D. and Melikyan, G. and Ibrahim, F. and Akhtar, N. and Mosconi, M.G. and Bubba, V. and Silvestri, I. and Lees, K.R.",
    journal = "ISRN Stroke",
    year = "2015",
    volume = "46",
    number = "8",
    pages = "2175-2182",
    publisher = "Lippincott Williams and Wilkins",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.115.008891",
    keywords = "antivitamin K;  apixaban;  dabigatran;  low molecular weight heparin;  rivaroxaban;  anticoagulant agent, anticoagulant therapy;  Article;  Asia;  atrial fibrillation;  brain hemorrhage;  brain ischemia;  cardiovascular disease assessment;  cerebrovascular accident;  CHA2DS2 VASc score;  cohort analysis;  controlled clinical trial;  controlled study;  disability;  disease association;  disease severity;  drug efficacy;  drug safety;  embolism;  Europe;  human;  major clinical study;  mortality;  multicenter study;  National Institutes of Health Stroke Scale;  observational study;  priority journal;  prospective study;  Rankin scale;  recurrent disease;  risk assessment;  risk factor;  systemic embolism;  time to treatment;  treatment outcome;  aged;  atrial fibrillation;  brain ischemia;  Cerebral Hemorrhage;  clinical trial;  female;  follow up;  male;  middle aged;  recurrent disease;  Stroke;  time;  very elderly, Aged;  Aged, 80 and over;  Anticoagulants;  Atrial Fibrillation;  Brain Ischemia;  Cerebral Hemorrhage;  Cohort Studies;  Female;  Follow-Up Studies;  Humans;  Male;  Middle Aged;  Prospective Studies;  Recurrence;  Risk Factors;  Stroke;  Time Factors;  Treatment Outcome",
    abstract = "Background and Purpose - The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. Methods - The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Results - Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). Conclusions - Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants. © 2015 American Heart Association, Inc."
}