TY - JOUR
TI - Anticoagulation after Stroke in Patients with Atrial Fibrillation: To Bridge or Not with Low-Molecular-Weight Heparin?
AU - Altavilla, R.
AU - Caso, V.
AU - Bandini, F.
AU - Agnelli, G.
AU - Tsivgoulis, G.
AU - Yaghi, S.
AU - Furie, K.L.
AU - Tadi, P.
AU - Becattini, C.
AU - Zedde, M.
AU - Abdul-Rahim, A.H.
AU - Lees, K.R.
AU - Alberti, A.
AU - Venti, M.
AU - Acciarresi, M.
AU - D'Amore, C.
AU - Giulia Mosconi, M.
AU - Anna Cimini, L.
AU - Fusaro, J.
AU - Bovi, P.
AU - Carletti, M.
AU - Rigatelli, A.
AU - Cappellari, M.
AU - Putaala, J.
AU - Tomppo, L.
AU - Tatlisumak, T.
AU - Marcheselli, S.
AU - Pezzini, A.
AU - Poli, L.
AU - Padovani, A.
AU - Masotti, L.
AU - Vannucchi, V.
AU - Sohn, S.-I.
AU - Lorenzini, G.
AU - Tassi, R.
AU - Guideri, F.
AU - Acampa, M.
AU - Martini, G.
AU - Ntaios, G.
AU - Athanasakis, G.
AU - Makaritsis, K.
AU - Karagkiozi, E.
AU - Vadikolias, K.
AU - Liantinioti, C.
AU - Chondrogianni, M.
AU - Mumoli, N.
AU - Consoli, D.
AU - Galati, F.
AU - Sacco, S.
AU - Carolei, A.
AU - Tiseo, C.
AU - Corea, F.
AU - Ageno, W.
AU - Bellesini, M.
AU - Silvestrelli, G.
AU - Ciccone, A.
AU - Lanari, A.
AU - Scoditti, U.
AU - Denti, L.
AU - Mancuso, M.
AU - MacCarrone, M.
AU - Ulivi, L.
AU - Orlandi, G.
AU - Giannini, N.
AU - Gialdini, G.
AU - Tassinari, T.
AU - De Lodovici, M.L.
AU - Bono, G.
AU - Rueckert, C.
AU - Baldi, A.
AU - D'Anna, S.
AU - Toni, D.
AU - Letteri, F.
AU - Giuntini, M.
AU - Lotti, E.M.
AU - Flomin, Y.
AU - Pieroni, A.
AU - Kargiotis, O.
AU - Karapanayiotides, T.
AU - Monaco, S.
AU - Baronello, M.M.
AU - Csiba, L.
AU - Szabó, L.
AU - Chiti, A.
AU - Giorli, E.
AU - Del Sette, M.
AU - Imberti, D.
AU - Zabzuni, D.
AU - Doronin, B.
AU - Volodina, V.
AU - Michel, P.
AU - Vanacker, P.
AU - Barlinn, K.
AU - Pallesen, L.-P.
AU - Barlinn, J.
AU - Deleu, D.
AU - Melikyan, G.
AU - Ibrahim, F.
AU - Akhtar, N.
AU - Gourbali, V.
AU - Paciaroni, M.
JO - ISRN Stroke
PY - 2019
VL - 50
TODO - 8
SP - 2093-2100
PB - Lippincott Williams and Wilkins
SN - 2090-9454
TODO - 10.1161/STROKEAHA.118.022856
TODO - 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
TODO - 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.
ER -