BACKGROUND: Most patients with cardioembolic stroke require long-term anticoagulation. Still, uncertainty exists regarding the best mode of starting long-term anticoagulation. Design, Setting, and Patients We conducted a retrospective review of all patients with cardioembolic stroke admitted to our center from April 1, 2004, to June 30, 2006, and not treated with tissue plasminogen activator. Patients were grouped by treatment: no treatment, aspirin only, aspirin followed by warfarin sodium, intravenous heparin sodium in the acute phase followed by warfarin (heparin bridging), and full-dose enoxaparin sodium combined with warfarin (enoxaparin bridging). Outcome measures and adverse events were collected prospectively. Laboratory values were captured from the records. MAIN OUTCOME MEASURES: Symptomatic hemorrhagic transformation, stroke progression, and discharge modified Rankin Scale score. RESULTS: Two hundred four patients were analyzed. Recurrent stroke occurred in 2 patients (1%). Progressive stroke was the most frequent serious adverse event, seen in 11 patients (5%). Hemorrhagic transformation occurred in a bimodal distribution-an early benign hemorrhagic transformation and a late symptomatic hemorrhagic transformation. All of the symptomatic hemorrhagic transformation cases were in the enoxaparin bridging group (10%) (P = .003). Systemic bleeding occurred in 2 patients (1%) and was associated with heparin bridging (P = .04). CONCLUSIONS: Anticoagulation of patients with cardioembolic stroke can be safely started with warfarin shortly after stroke. Heparin bridging and enoxaparin bridging increase the risk for serious bleeding.
BACKGROUND: Most patients with cardioembolic stroke require long-term anticoagulation. Still, uncertainty exists regarding the best mode of starting long-term anticoagulation. Design, Setting, and Patients We conducted a retrospective review of all patients with cardioembolic stroke admitted to our center from April 1, 2004, to June 30, 2006, and not treated with tissue plasminogen activator. Patients were grouped by treatment: no treatment, aspirin only, aspirin followed by warfarin sodium, intravenous heparin sodium in the acute phase followed by warfarin (heparin bridging), and full-dose enoxaparin sodium combined with warfarin (enoxaparin bridging). Outcome measures and adverse events were collected prospectively. Laboratory values were captured from the records. MAIN OUTCOME MEASURES: Symptomatic hemorrhagic transformation, stroke progression, and discharge modified Rankin Scale score. RESULTS: Two hundred four patients were analyzed. Recurrent stroke occurred in 2 patients (1%). Progressive stroke was the most frequent serious adverse event, seen in 11 patients (5%). Hemorrhagic transformation occurred in a bimodal distribution-an early benign hemorrhagic transformation and a late symptomatic hemorrhagic transformation. All of the symptomatic hemorrhagic transformation cases were in the enoxaparin bridging group (10%) (P = .003). Systemic bleeding occurred in 2 patients (1%) and was associated with heparin bridging (P = .04). CONCLUSIONS: Anticoagulation of patients with cardioembolic stroke can be safely started with warfarin shortly after stroke. Heparin bridging and enoxaparin bridging increase the risk for serious bleeding.
Authors: M Fiorelli; S Bastianello; R von Kummer; G J del Zoppo; V Larrue; E Lesaffre; A P Ringleb; S Lorenzano; C Manelfe; L Bozzao Journal: Stroke Date: 1999-11 Impact factor: 7.914
Authors: G M de Courten-Myers; M Kleinholz; P Holm; G DeVoe; G Schmitt; K R Wagner; R E Myers Journal: Ann Emerg Med Date: 1992-02 Impact factor: 5.721
Authors: Shadi Yaghi; Eva Mistry; Ava L Liberman; James Giles; Syed Daniyal Asad; Angela Liu; Muhammad Nagy; Ashutosh Kaushal; Idrees Azher; Brian Mac Grory; Hiba Fakhri; Kiersten Brown Espaillat; Hemanth Pasupuleti; Heather Martin; Jose Tan; Manivannan Veerasamy; Charles Esenwa; Natalie Cheng; Khadean Moncrieffe; Iman Moeini-Naghani; Mithilesh Siddu; Erica Scher; Tushar Trivedi; Aaron Lord; Karen Furie; Salah Keyrouz; Amre Nouh; Christopher R Leon Guerrero; Adam de Havenon; Muhib Khan; Nils Henninger Journal: Stroke Date: 2020-08-06 Impact factor: 7.914
Authors: Karen Smoyer-Tomic; Kimberly Siu; David R Walker; Barbara H Johnson; David M Smith; Stephen Sander; Alpesh Amin Journal: Am J Cardiovasc Drugs Date: 2012-12-01 Impact factor: 3.571