Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes

Medientyp: E-Artikel
Titel: Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes
Beteiligte: Paciaroni, Maurizio; Bandini, Fabio; Agnelli, Giancarlo; Tsivgoulis, Georgios; Yaghi, Shadi; Furie, Karen L.; Tadi, Prasanna; Becattini, Cecilia; Zedde, Marialuisa; Abdul‐Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Mosconi, Maria Giulia; Cimini, Ludovica Anna; Altavilla, Riccardo; Volpi, Giacomo; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2018
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.118.010133
ISSN: 2047-9980
Schlagwörter: Cardiology and Cardiovascular Medicine
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Beschreibung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation ( <jats:styled-content style="fixed-case">HT</jats:styled-content> ). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with <jats:styled-content style="fixed-case">HT</jats:styled-content> , (3) the association of <jats:styled-content style="fixed-case">HT</jats:styled-content> with ischemic recurrences, and (4) the association of <jats:styled-content style="fixed-case">HT</jats:styled-content> with clinical outcome at 90 days. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">HT</jats:styled-content> was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had <jats:styled-content style="fixed-case">HT</jats:styled-content> . Patients with and without <jats:styled-content style="fixed-case">HT</jats:styled-content> initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3–8.0) of the patients with <jats:styled-content style="fixed-case">HT</jats:styled-content> had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0–6.0) of those without <jats:styled-content style="fixed-case">HT</jats:styled-content> ; 53.1% of patients with <jats:styled-content style="fixed-case">HT</jats:styled-content> were deceased or disabled compared with 35.8% of those without <jats:styled-content style="fixed-case">HT</jats:styled-content> . On multivariable analysis, <jats:styled-content style="fixed-case">HT</jats:styled-content> was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24–2.35). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> In patients with <jats:styled-content style="fixed-case">HT</jats:styled-content> , anticoagulation was initiated about 12 days later than patients without <jats:styled-content style="fixed-case">HT</jats:styled-content> . This delay was not associated with increased detection of ischemic recurrence. <jats:styled-content style="fixed-case">HT</jats:styled-content> was associated with increased mortality or disability. </jats:p> </jats:sec>
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