Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study.
Aged
Aged, 80 and over
Anticoagulants
/ therapeutic use
Atrial Fibrillation
/ complications
Brain Ischemia
/ drug therapy
Embolism
/ complications
Female
Heart Diseases
/ complications
Heparin, Low-Molecular-Weight
/ therapeutic use
Humans
Incidence
Intracranial Hemorrhages
/ epidemiology
Male
Middle Aged
Neuroimaging
Recurrence
Registries
Retrospective Studies
Risk Assessment
Stroke
/ drug therapy
Treatment Outcome
United States
/ epidemiology
Warfarin
/ therapeutic use
anticoagulant
atrial fibrillation
hemorrhage
heparin
warfarin
Journal
Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
8
8
2020
medline:
31
10
2020
entrez:
8
8
2020
Statut:
ppublish
Résumé
In patients with acute ischemic stroke and atrial fibrillation, treatment with low molecular weight heparin increases early hemorrhagic risk without reducing early recurrence, and there is limited data comparing warfarin to direct oral anticoagulant (DOAC) therapy. We aim to compare the effects of the treatments above on the risk of 90-day recurrent ischemic events and delayed symptomatic intracranial hemorrhage. We included consecutive patients with acute ischemic stroke and atrial fibrillation from the IAC (Initiation of Anticoagulation after Cardioembolic) stroke study pooling data from stroke registries of 8 comprehensive stroke centers across the United States. We compared recurrent ischemic events and delayed symptomatic intracranial hemorrhage between each of the following groups in separate Cox-regression analyses: (1) DOAC versus warfarin and (2) bridging with heparin/low molecular weight heparin versus no bridging, adjusting for pertinent confounders to test these associations. We identified 1289 patients who met the bridging versus no bridging analysis inclusion criteria and 1251 patients who met the DOAC versus warfarin analysis inclusion criteria. In adjusted Cox-regression models, bridging (versus no bridging) treatment was associated with a high risk of delayed symptomatic intracranial hemorrhage (hazard ratio, 2.74 [95% CI, 1.01-7.42]) but a similar rate of recurrent ischemic events (hazard ratio, 1.23 [95% CI, 0.63-2.40]). Furthermore, DOAC (versus warfarin) treatment was associated with a lower risk of recurrent ischemic events (hazard ratio, 0.51 [95% CI, 0.29-0.87]) but not delayed symptomatic intracranial hemorrhage (hazard ratio, 0.57 [95% CI, 0.22-1.48]). Our study suggests that patients with ischemic stroke and atrial fibrillation would benefit from the initiation of a DOAC without bridging therapy. Due to our study limitations, these findings should be interpreted with caution pending confirmation from large prospective studies.
Sections du résumé
BACKGROUND AND PURPOSE
In patients with acute ischemic stroke and atrial fibrillation, treatment with low molecular weight heparin increases early hemorrhagic risk without reducing early recurrence, and there is limited data comparing warfarin to direct oral anticoagulant (DOAC) therapy. We aim to compare the effects of the treatments above on the risk of 90-day recurrent ischemic events and delayed symptomatic intracranial hemorrhage.
METHODS
We included consecutive patients with acute ischemic stroke and atrial fibrillation from the IAC (Initiation of Anticoagulation after Cardioembolic) stroke study pooling data from stroke registries of 8 comprehensive stroke centers across the United States. We compared recurrent ischemic events and delayed symptomatic intracranial hemorrhage between each of the following groups in separate Cox-regression analyses: (1) DOAC versus warfarin and (2) bridging with heparin/low molecular weight heparin versus no bridging, adjusting for pertinent confounders to test these associations.
RESULTS
We identified 1289 patients who met the bridging versus no bridging analysis inclusion criteria and 1251 patients who met the DOAC versus warfarin analysis inclusion criteria. In adjusted Cox-regression models, bridging (versus no bridging) treatment was associated with a high risk of delayed symptomatic intracranial hemorrhage (hazard ratio, 2.74 [95% CI, 1.01-7.42]) but a similar rate of recurrent ischemic events (hazard ratio, 1.23 [95% CI, 0.63-2.40]). Furthermore, DOAC (versus warfarin) treatment was associated with a lower risk of recurrent ischemic events (hazard ratio, 0.51 [95% CI, 0.29-0.87]) but not delayed symptomatic intracranial hemorrhage (hazard ratio, 0.57 [95% CI, 0.22-1.48]).
CONCLUSIONS
Our study suggests that patients with ischemic stroke and atrial fibrillation would benefit from the initiation of a DOAC without bridging therapy. Due to our study limitations, these findings should be interpreted with caution pending confirmation from large prospective studies.
Identifiants
pubmed: 32757753
doi: 10.1161/STROKEAHA.120.028867
pmc: PMC7484360
mid: NIHMS1613377
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Warfarin
5Q7ZVV76EI
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2724-2732Subventions
Organisme : NINDS NIH HHS
ID : R44 NS076272
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS107643
Pays : United States
Organisme : NINDS NIH HHS
ID : K08 NS091499
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS113858
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS105924
Pays : United States
Commentaires et corrections
Type : CommentIn
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