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

Journal Article (Multicenter Study;Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Yaghi, S; Mistry, E; Liberman, AL; Giles, J; Asad, SD; Liu, A; Nagy, M; Kaushal, A; Azher, I; Mac Grory, B; Fakhri, H; Brown Espaillat, K; Pasupuleti, H; Martin, H; Tan, J; Veerasamy, M; Esenwa, C; Cheng, N; Moncrieffe, K; Moeini-Naghani, I; Siddu, M; Scher, E; Trivedi, T; Lord, A; Furie, K; Keyrouz, S; Nouh, A; Leon Guerrero, CR; de Havenon, A; Khan, M; Henninger, N

Published Date

  • September 2020

Published In

Volume / Issue

  • 51 / 9

Start / End Page

  • 2724 - 2732

PubMed ID

  • 32757753

Pubmed Central ID

  • PMC7484360

Electronic International Standard Serial Number (EISSN)

  • 1524-4628

International Standard Serial Number (ISSN)

  • 0039-2499

Digital Object Identifier (DOI)

  • 10.1161/strokeaha.120.028867

Language

  • eng