@article{3106884,
    title = "Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation: Time to initiation of oral anticoagulant therapy and outcomes",
    author = "Paciaroni, M. 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 Mosconi, M.G. and Cimini, L.A. and Altavilla, R. and Volpi, G. 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 Colombo, G. 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 Caso, V.",
    journal = "Journal of the American Heart Association",
    year = "2018",
    volume = "7",
    number = "22",
    publisher = "American Heart Association Inc.",
    issn = "2047-9980",
    doi = "10.1161/JAHA.118.010133",
    keywords = "anticoagulant agent;  antivitamin K;  anticoagulant agent, aged;  Article;  atrial fibrillation;  brain embolism;  brain hemorrhage;  brain ischemia;  computer assisted tomography;  controlled study;  disease association;  drug efficacy;  early intervention;  female;  high risk patient;  human;  incidence;  major clinical study;  male;  mortality;  outcome assessment;  predictive value;  priority journal;  Rankin scale;  recurrent disease;  risk assessment;  risk factor;  time to treatment;  transient ischemic attack;  atrial fibrillation;  brain hemorrhage;  cerebrovascular accident;  clinical trial;  complication;  diagnostic imaging;  multicenter study;  neuroimaging;  oral drug administration;  prospective study;  time factor;  treatment outcome;  x-ray computed tomography, Administration, Oral;  Aged;  Anticoagulants;  Atrial Fibrillation;  Cerebral Hemorrhage;  Female;  Humans;  Incidence;  Male;  Neuroimaging;  Prospective Studies;  Risk Factors;  Stroke;  Time Factors;  Tomography, X-Ray Computed;  Treatment Outcome",
    abstract = "Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability. © 2018 The Authors."
}