TY - JOUR
T1 - Anticoagulation Type and Early Recurrence in Cardioembolic Stroke
T2 - The IAC Study
AU - Yaghi, Shadi
AU - Mistry, Eva
AU - Liberman, Ava L.
AU - Giles, James
AU - Asad, Syed Daniyal
AU - Liu, Angela
AU - Nagy, Muhammad
AU - Kaushal, Ashutosh
AU - Azher, Idrees
AU - Mac Grory, Brian
AU - Fakhri, Hiba
AU - Brown Espaillat, Kiersten
AU - Pasupuleti, Hemanth
AU - Martin, Heather
AU - Tan, Jose
AU - Veerasamy, Manivannan
AU - Esenwa, Charles
AU - Cheng, Natalie
AU - Moncrieffe, Khadean
AU - Moeini-Naghani, Iman
AU - Siddu, Mithilesh
AU - Scher, Erica
AU - Trivedi, Tushar
AU - Lord, Aaron
AU - Furie, Karen
AU - Keyrouz, Salah
AU - Nouh, Amre
AU - Leon Guerrero, Christopher R.
AU - De Havenon, Adam
AU - Khan, Muhib
AU - Henninger, Nils
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
AB - 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.
KW - anticoagulant
KW - atrial fibrillation
KW - hemorrhage
KW - heparin
KW - warfarin
UR - http://www.scopus.com/inward/record.url?scp=85090076253&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090076253&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.028867
DO - 10.1161/STROKEAHA.120.028867
M3 - Article
C2 - 32757753
AN - SCOPUS:85090076253
SN - 0039-2499
VL - 51
SP - 2724
EP - 2732
JO - Stroke
JF - Stroke
IS - 9
ER -