| Literature DB >> 31221054 |
Riccardo Altavilla1, Valeria Caso1, Fabio Bandini2, Giancarlo Agnelli1, Georgios Tsivgoulis3,4, Shadi Yaghi5, Karen L Furie5, Prasanna Tadi5, Cecilia Becattini1, Marialuisa Zedde5, Azmil H Abdul-Rahim6, Kennedy R Lees6, Andrea Alberti1, Michele Venti1, Monica Acciarresi1, Cataldo D'Amore1, Maria Giulia Mosconi1, Ludovica Anna Cimini1, Jessica Fusaro1, Paolo Bovi7, Monica Carletti7, Alberto Rigatelli7, Manuel Cappellari7, Jukka Putaala8, Liisa Tomppo8, Turgut Tatlisumak8,9,10, Simona Marcheselli11, Alessandro Pezzini12, Loris Poli12, Alessandro Padovani12, Luca Masotti13, Vieri Vannucchi13, Sung-Il Sohn14, Gianni Lorenzini15, Rossana Tassi16, Francesca Guideri16, Maurizio Acampa16, Giuseppe Martini16, George Ntaios17, George Athanasakis17, Konstantinos Makaritsis17, Efstathia Karagkiozi17, Konstantinos Vadikolias18, Chrysoula Liantinioti4, Maria Chondrogianni4, Nicola Mumoli19, Domenico Consoli20, Franco Galati20, Simona Sacco21, Antonio Carolei21, Cindy Tiseo21, Francesco Corea22, Walter Ageno23, Marta Bellesini23, Giorgio Silvestrelli24, Alfonso Ciccone24, Alessia Lanari24, Umberto Scoditti25, Licia Denti26, Michelangelo Mancuso27, Miriam Maccarrone27, Leonardo Ulivi27, Giovanni Orlandi27,28, Nicola Giannini27, Gino Gialdini27, Tiziana Tassinari29, Maria Luisa De Lodovici30, Giorgio Bono30, Christina Rueckert31, Antonio Baldi32, Sebastiano D'Anna32, Danilo Toni33, Federica Letteri33, Martina Giuntini28, Enrico Maria Lotti34, Yuriy Flomin35, Alessio Pieroni33, Odysseas Kargiotis36, Theodore Karapanayiotides37, Serena Monaco38, Mario Maimone Baronello38, Laszló Csiba39, Lilla Szabó39, Alberto Chiti27,40, Elisa Giorli40, Massimo Del Sette40,41, Davide Imberti42, Dorjan Zabzuni42, Boris Doronin43, Vera Volodina43, Patrik Michel44, Peter Vanacker45, Kristian Barlinn46, Lars-Peder Pallesen46, Jessica Barlinn46, Dirk Deleu47, Gayane Melikyan47, Faisal Ibrahim47, Naveed Akhtar47, Vanessa Gourbali48, Maurizio Paciaroni1.
Abstract
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.Entities:
Keywords: anticoagulants; atrial fibrillation; humans; incidence; secondary prevention
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Year: 2019 PMID： 31221054 DOI： 10.1161/STROKEAHA.118.022856
Source DB: PubMed Journal: Stroke ISSN： 0039-2499 Impact factor: 7.914