@article{3103556,
    title = "Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes",
    author = "Paciaroni, M. and Agnelli, G. and Giustozzi, M. and Tsivgoulis, G. and Yaghi, S. and Grory, B.M. and Furie, K.L. and Tadi, P. and Zedde, M. and Abdul-Rahim, A.H. and Dawson, J. and Lees, K.R. and Alberti, A. and Venti, M. and Acciarresi, M. and D’Amore, C. and Mosconi, M.G. and Bogini, V. and Cappellari, M. and Rigatelli, A. and Bonetti, B. and Putaala, J. and Tomppo, L. and Tatlisumak, T. and Bandini, F. and Marcheselli, S. and Pezzini, A. and Poli, L. and Padovani, A. and Masotti, L. and Grifoni, E. 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 Palaiodimou, L. and Mumoli, N. and Porta, C. and Galati, F. and Sacco, S. and Tiseo, C. and Corea, F. and Ageno, W. and Bellesini, M. and Silvestrelli, G. and Ciccone, A. and Scoditti, U. and Denti, L. and Mancuso, M. and Caselli, M.C. and Maccarrone, M. and Ulivi, L. and Orlandi, G. and Giannini, N. and Tassinari, T. and Lodovici, M.L.D. and Rueckert, C. and Baldi, A. and Toni, D. and Gentile, L. 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 Mannino, M. and Baronello, M.M. and Csiba, L. and Szabó, L. and Chiti, A. and Giorli, E. and Sette, M.D. and Schirinzi, E. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Michel, P. and Eskandari, A. and Vanacker, P. and Barlinn, K. and Barlinn, J. and Deleu, D. and Gourbali, V. and Caso, V.",
    journal = "European Stroke Journal",
    year = "2020",
    volume = "5",
    number = "4",
    pages = "374-383",
    publisher = "SAGE Publications Ltd",
    issn = "2396-9873, 2396-9881",
    doi = "10.1177/2396987320937116",
    keywords = "alteplase;  anticoagulant agent;  apixaban;  dabigatran;  edoxaban;  rivaroxaban;  warfarin, adult;  aged;  anterior circulation brain ischemia;  anticoagulant therapy;  Article;  atrial fibrillation;  basilar artery;  blood transfusion;  body mass;  brain damage;  brain embolism;  brain hemorrhage;  brain ischemia;  brain size;  cardiovascular risk;  cardioversion;  cerebral revascularization;  CHA2DS2-VASc score;  clinical evaluation;  clinical outcome;  comparative study;  computer assisted tomography;  disease association;  disease severity;  experimental cerebral hemorrhage;  female;  follow up;  human;  major clinical study;  male;  mechanical thrombectomy;  middle aged;  National Institutes of Health Stroke Scale;  nuclear magnetic resonance imaging;  observational study;  posterior circulation brain ischemia;  priority journal;  Rankin scale;  recurrent disease;  risk factor;  thromboembolism;  transient ischemic attack;  treatment duration",
    abstract = "Introduction: The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing. Materials and Methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results: A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39–2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16–1.80). Discussion: our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events. Conclusions: Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT. © European Stroke Organisation 2020."
}