Document Detail

Anticoagulation after cardioembolic stroke: to bridge or not to bridge?
MedLine Citation:
PMID:  18625852     Owner:  NLM     Status:  MEDLINE    
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.
Hen Hallevi; Karen C Albright; Sheryl Martin-Schild; Andrew D Barreto; Sean I Savitz; Miguel A Escobar; Nicole R Gonzales; Elizabeth A Noser; Kachi Illoh; James C Grotta
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-07-14
Journal Detail:
Title:  Archives of neurology     Volume:  65     ISSN:  1538-3687     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-09     Completed Date:  2008-09-29     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1169-73     Citation Subset:  AIM; IM    
Department of Neurology, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.044, Houston, TX 77030, USA.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage*,  adverse effects
Atrial Fibrillation / chemically induced,  pathology
Embolism / complications,  drug therapy*,  pathology
Heart Diseases / complications,  drug therapy*,  pathology
Middle Aged
Prospective Studies
Retrospective Studies
Stroke / complications,  drug therapy*,  pathology
Time Factors
Grant Support
P50 NS044227-019002/NS/NINDS NIH HHS
Reg. No./Substance:
Comment In:
Arch Neurol. 2008 Sep;65(9):1157   [PMID:  18779416 ]

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