Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study.

Autor:	Yaghi S; Department of Neurology, New York Langone Health (S.Y., E.S., T.T., A.L.)., Mistry E; Department of Neurology, Vanderbilt University, Nashville, TN (E.M., H.F., K.B.E.)., Liberman AL; Department of Neurology, Montefiore Medical Center, NY (A.L.L., C.E., N.C., K.M.)., Giles J; Department of Neurology, Washington University, Saint Louis, MO (J.G., A.L., S.K.)., Asad SD; Department of Neurology, Hartford Hospital, CT (S.D.A., A.N.)., Liu A; Department of Neurology, Washington University, Saint Louis, MO (J.G., A.L., S.K.)., Nagy M; Department of Neurology, University of Massachusetts, Worcester (M.N., N.H.)., Kaushal A; Department of Neurology, Brown University, Providence, RI (A.K., I.A., B.M.G., K.F.)., Azher I; Department of Neurology, Brown University, Providence, RI (A.K., I.A., B.M.G., K.F.)., Mac Grory B; Department of Neurology, Brown University, Providence, RI (A.K., I.A., B.M.G., K.F.)., Fakhri H; Department of Neurology, Vanderbilt University, Nashville, TN (E.M., H.F., K.B.E.)., Brown Espaillat K; Department of Neurology, Vanderbilt University, Nashville, TN (E.M., H.F., K.B.E.)., Pasupuleti H; Department of Neurology, Spectrum Health, Grand Rapids, MI (H.P., H.M., J.T., M.V., M.K.)., Martin H; Department of Neurology, Spectrum Health, Grand Rapids, MI (H.P., H.M., J.T., M.V., M.K.)., Tan J; Department of Neurology, Spectrum Health, Grand Rapids, MI (H.P., H.M., J.T., M.V., M.K.)., Veerasamy M; Department of Neurology, Spectrum Health, Grand Rapids, MI (H.P., H.M., J.T., M.V., M.K.)., Esenwa C; Department of Neurology, Montefiore Medical Center, NY (A.L.L., C.E., N.C., K.M.)., Cheng N; Department of Neurology, Montefiore Medical Center, NY (A.L.L., C.E., N.C., K.M.)., Moncrieffe K; Department of Neurology, Montefiore Medical Center, NY (A.L.L., C.E., N.C., K.M.)., Moeini-Naghani I; Department of Neurology, George Washington University, DC (I.M.-N., M.S., C.R.L.G.)., Siddu M; Department of Neurology, George Washington University, DC (I.M.-N., M.S., C.R.L.G.)., Scher E; Department of Neurology, New York Langone Health (S.Y., E.S., T.T., A.L.)., Trivedi T; Department of Neurology, New York Langone Health (S.Y., E.S., T.T., A.L.)., Lord A; Department of Neurology, New York Langone Health (S.Y., E.S., T.T., A.L.)., Furie K; Department of Neurology, Brown University, Providence, RI (A.K., I.A., B.M.G., K.F.)., Keyrouz S; Department of Neurology, Washington University, Saint Louis, MO (J.G., A.L., S.K.)., Nouh A; Department of Neurology, Hartford Hospital, CT (S.D.A., A.N.)., Leon Guerrero CR; Department of Neurology, George Washington University, DC (I.M.-N., M.S., C.R.L.G.)., de Havenon A; Department of Neurology, University of Utah (A.d.H.)., Khan M; Department of Neurology, Spectrum Health, Grand Rapids, MI (H.P., H.M., J.T., M.V., M.K.)., Henninger N; Department of Neurology, University of Massachusetts, Worcester (M.N., N.H.).; Department of Psychiatry, University of Massachusetts, Worcester (N.H.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2020 Sep; Vol. 51 (9), pp. 2724-2732. Date of Electronic Publication: 2020 Aug 06.
DOI:	10.1161/STROKEAHA.120.028867
Abstrakt:	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.
Databáze:	MEDLINE
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