![]() There is no consensus on the best way to initiate AC after CES. 3, 4 Nevertheless, most patients with CES ultimately need AC. 2 Current guidelines do not support the routine anticoagulation (AC) of patients with CES in the acute phase. 1 In addition, cardioembolic stroke (CES) carries increased risk of hemorrhagic transformation (HT). The infarct is typically larger than that in atherothrombotic stroke and the outcome is poorer. Published online J(doi:10.1001/archneur.65.9.noc70105).Ĭardioembolism accounts for 20% of ischemic strokes. Heparin bridging and enoxaparin bridging increase the risk for serious bleeding. ![]() Systemic bleeding occurred in 2 patients (1%) and was associated with heparin bridging ( P = .04).Ĭonclusions Anticoagulation of patients with cardioembolic stroke can be safely started with warfarin shortly after stroke. All of the symptomatic hemorrhagic transformation cases were in the enoxaparin bridging group (10%) ( P = .003). Hemorrhagic transformation occurred in a bimodal distribution-an early benign hemorrhagic transformation and a late symptomatic hemorrhagic transformation. Progressive stroke was the most frequent serious adverse event, seen in 11 patients (5%). Recurrent stroke occurred in 2 patients (1%). Results Two hundred four patients were analyzed. Main Outcome Measures Symptomatic hemorrhagic transformation, stroke progression, and discharge modified Rankin Scale score. Laboratory values were captured from the records. Outcome measures and adverse events were collected prospectively. 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). Still, uncertainty exists regarding the best mode of starting long-term anticoagulation.ĭesign, 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. Shared Decision Making and Communicationīackground Most patients with cardioembolic stroke require long-term anticoagulation.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment. ![]() Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Hemorrhage Intervention Stroke Thrombectomy. In patients with stroke treated with MT, mildly elevated INR is associated with worse clinical outcomes after recanalization and may worsen the mortality risk of hemorrhagic transformations. This effect size was larger than in patients without ICH (OR 3.38, p<0.001). Elevated INR was not associated with a higher likelihood of ICH, and there were no differences in rates of HI1, HI2, PH1, or PH2 hemorrhagic transformations however, elevated INR was associated with significantly higher odds of 90-day mortality in patients with ICH (OR 6.22, p=0.024). After multivariable adjustments, mildly elevated INR was associated with lower odds of excellent outcomes (mRS 0-1, OR 0.24, p=0.009), lower odds of functional independence (mRS 0-2, OR 0.38, p=0.038), and higher odds of 90-day mortality (OR 3.45, p=0.018). Patients were divided into two groups: normal INR (0.8-1.1) and mildly elevated INR (1.2-1.7).Ī total of 489 patients were included for analysis, of which 349 had normal INR and 140 had mildly elevated INR. Outcome measures included modified Thrombolysis in Cerebral Infarction (mTICI) score, modified Rankin Scale (mRS) score at 90 days, and intracerebral hemorrhage (ICH). Demographic information, past medical history, INR, National Institutes of Health Stroke Scale score, use of tissue plasminogen activator, and last known normal to arteriotomy time were recorded. In this retrospective cohort study, consecutive patients with stroke treated with MT were identified from 2015 to 2020 at a Comprehensive Stroke Center. This study investigates the impact of mild INR elevations on clinical outcomes following MT. Elevated International Normalized Ratio (INR) is a marker of coagulopathy, but its impact on outcomes following mechanical thrombectomy (MT) in patients with stroke is unclear.
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