Anticoagulation After Stroke in Patients With Atrial Fibrillation
Authors: Altavilla Riccardo , Caso Valeria , 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 , Giulia Mosconi Maria , Anna Cimini Ludovica , Fusaro Jessica , Bovi Paolo , Carletti Monica , Rigatelli Alberto , Cappellari Manuel , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Marcheselli Simona , Pezzini Alessandro , Poli Loris , Padovani Alessandro , Masotti Luca , Vannucchi Vieri , Sohn Sung-Il , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Ntaios George , Athanasakis George , Makaritsis Konstantinos , Karagkiozi Efstathia , Vadikolias Konstantinos , Liantinioti Chrysoula , Chondrogianni Maria , Mumoli Nicola , Consoli Domenico , Galati Franco , Sacco Simona , Carolei Antonio , Tiseo Cindy , Corea Francesco , Ageno Walter , Bellesini Marta , Silvestrelli Giorgio , Ciccone Alfonso , Lanari Alessia , Scoditti Umberto , Denti Licia , Mancuso Michelangelo , Maccarrone Miriam , Ulivi Leonardo , Orlandi Giovanni , Giannini Nicola , Gialdini Gino , Tassinari Tiziana , De Lodovici Maria Luisa , Bono Giorgio , Rueckert Christina , Baldi Antonio , D’Anna Sebastiano , Toni Danilo , Letteri Federica , Giuntini Martina , Maria Lotti Enrico , Flomin Yuriy , Pieroni Alessio , Kargiotis Odysseas , Karapanayiotides Theodore , Monaco Serena , Maimone Baronello Mario , Csiba Laszló , Szabó Lilla , Chiti Alberto , Giorli Elisa , Del Sette Massimo , Imberti Davide , Zabzuni Dorjan , Doronin Boris , Volodina Vera , Michel Patrik , Vanacker Peter , Barlinn Kristian , Pallesen Lars-Peder , Barlinn Jessica , Deleu Dirk , Melikyan Gayane , Ibrahim Faisal , Akhtar Naveed , Gourbali Vanessa , Paciaroni Maurizio 
Published: June 2019

Background and Purpose—
Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed.

Methods—
We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke.

Results—

Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (
P
=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4–3.7;
P
<0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3–3.9;
P
=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2–4.9;
P
=0.01) end points separately.

Conclusions—
Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.