OBJECTIVE: Guidelines recommend initiating anticoagulation within 4 to 14 days after cardioembolic stroke. Data supporting this did not account for key factors potentially affecting the decision to initiate anticoagulation, such as infarct size, hemorrhagic transformation, or high-risk features on echocardiography. METHODS: We pooled data from stroke registries of 8 comprehensive stroke centers across the United States. We included consecutive patients admitted with ischemic stroke and atrial fibrillation. The primary predictor was timing of initiating anticoagulation (0-3 days, 4-14 days, or >14 days), and outcomes were recurrent stroke/transient ischemic attack/systemic embolism, symptomatic intracerebral hemorrhage (sICH), and major extracranial hemorrhage (ECH) within 90 days. RESULTS: Among 2,084 patients, 1,289 met the inclusion criteria. The combined endpoint occurred in 10.1% (n = 130) subjects (87 ischemic events, 20 sICH, and 29 ECH). Overall, there was no significant difference in the composite endpoint between the 3 groups (0-3 days: 10.3%, 64/617; 4-14 days: 9.7%, 52/535; >14 days: 10.2%, 14/137; p = 0.933). In adjusted models, patients started on anticoagulation between 4 and 14 days did not have a lower rate of sICH (vs 0-3 days; odds ratio [OR] = 1.49, 95% confidence interval [CI] = 0.50-4.43), nor did they have a lower rate of recurrent ischemic events (vs >14 days; OR = 0.76, 95% CI = 0.36-1.62, p = 0.482). INTERPRETATION: In this multicenter real-world cohort, the recommended (4-14 days) time frame to start oral anticoagulation was not associated with reduced ischemic and hemorrhagic outcomes. Randomized trials are required to determine the optimal timing of anticoagulation initiation. ANN NEUROL 2020;88:807-816.
OBJECTIVE: Guidelines recommend initiating anticoagulation within 4 to 14 days after cardioembolic stroke. Data supporting this did not account for key factors potentially affecting the decision to initiate anticoagulation, such as infarct size, hemorrhagic transformation, or high-risk features on echocardiography. METHODS: We pooled data from stroke registries of 8 comprehensive stroke centers across the United States. We included consecutive patients admitted with ischemic stroke and atrial fibrillation. The primary predictor was timing of initiating anticoagulation (0-3 days, 4-14 days, or >14 days), and outcomes were recurrent stroke/transient ischemic attack/systemic embolism, symptomatic intracerebral hemorrhage (sICH), and major extracranial hemorrhage (ECH) within 90 days. RESULTS: Among 2,084 patients, 1,289 met the inclusion criteria. The combined endpoint occurred in 10.1% (n = 130) subjects (87 ischemic events, 20 sICH, and 29 ECH). Overall, there was no significant difference in the composite endpoint between the 3 groups (0-3 days: 10.3%, 64/617; 4-14 days: 9.7%, 52/535; >14 days: 10.2%, 14/137; p = 0.933). In adjusted models, patients started on anticoagulation between 4 and 14 days did not have a lower rate of sICH (vs 0-3 days; odds ratio [OR] = 1.49, 95% confidence interval [CI] = 0.50-4.43), nor did they have a lower rate of recurrent ischemic events (vs >14 days; OR = 0.76, 95% CI = 0.36-1.62, p = 0.482). INTERPRETATION: In this multicenter real-world cohort, the recommended (4-14 days) time frame to start oral anticoagulation was not associated with reduced ischemic and hemorrhagic outcomes. Randomized trials are required to determine the optimal timing of anticoagulation initiation. ANN NEUROL 2020;88:807-816.
Authors: Shadi Yaghi; Nils Henninger; James A Giles; Christopher Leon Guerrero; Eva Mistry; Ava L Liberman; 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; Karen L Furie; Salah G Keyrouz; Amre Nouh; Adam de Havenon; Muhib Khan; Eric E Smith; M Edip Gurol Journal: J Neurol Neurosurg Psychiatry Date: 2021-04-26 Impact factor: 13.654
Authors: Gerrit M Grosse; Christian Weimar; Nils Kuklik; Anika Hüsing; Andreas Stang; Marcus Brinkmann; Christoph C Eschenfelder; Hans-Christoph Diener Journal: Eur Stroke J Date: 2021-11-17
Authors: Lina Palaiodimou; Maria-Ioanna Stefanou; Aristeidis H Katsanos; Maurizio Paciaroni; Simona Sacco; Gian Marco De Marchis; Ashkan Shoamanesh; Konark Malhotra; Diana Aguiar de Sousa; Vaia Lambadiari; Maria Kantzanou; Sofia Vassilopoulou; Konstantinos Toutouzas; Dimitrios K Filippou; David J Seiffge; Georgios Tsivgoulis Journal: J Clin Med Date: 2022-08-25 Impact factor: 4.964
Authors: Shadi Yaghi; Eva Mistry; Adam de Havenon; Christopher R Leon Guerrero; Amre Nouh; Ava L Liberman; James Giles; Angela Liu; Muhammad Nagy; Ashutosh Kaushal; Idrees Azher; Brian Mac Grory; Hiba Fakhri; Kiersten Brown Espaillat; Syed Daniyal Asad; Hemanth Pasupuleti; Heather Martin; Jose Tan; Manivannan Veerasamy; Charles Esenwa; Natalie Cheng; Khadean Moncrieffe; Iman Moeini-Naghani; Mithilesh Siddu; Erica Scher; Tushar Trivedi; Teddy Wu; Muhib Khan; Salah Keyrouz; Karen Furie; Nils Henninger Journal: J Am Heart Assoc Date: 2021-07-29 Impact factor: 5.501