| Autor: |
Yaghi, Shadi, Trivedi, Tushar, Henninger, Nils, Giles, James, Liu, Angela, Nagy, Muhammad, Kaushal, Ashutosh, Azher, Idrees, Mac Grory, Brian, Fakhri, Hiba, Brown Espaillat, Kiersten, Asad, Syed Daniyal, Pasupuleti, Hemanth, Martin, Heather, Tan, Jose, Veerasamy, Manivannan, Liberman, Ava L., Esenwa, Charles, Cheng, Natalie, Moncrieffe, Khadean |
| Předmět: |
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| Zdroj: |
Annals of Neurology; Oct2020, Vol. 88 Issue 4, p807-816, 10p |
| Abstrakt: |
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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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