Anticoagulation After Cardioembolic StrokeTo Bridge or Not to Bridge?Hen Hallevi, MD; Karen C. Albright, DO, MPH; Sheryl Martin-Schild, MD, PhD; Andrew D. Barreto, MD; Sean I. Savitz, MD; Miguel A. Escobar, MD; Nicole R. Gonzales, MD; Elizabeth A. Noser, MD; Kachi Illoh, MD; James C. Grotta, MDArch Neurol. 2008;65(9):1169-1173. Published online July 14, 2008 (doi:10.1001/archneur.65.9.noc70105).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 distributionan 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.Author Affiliations: Department of Neurology, University of Texas at Houston Medical School (Drs Hallevi, Martin-Schild, Barreto, Savitz, Gonzales, Noser, Illoh, and Grotta) and Department of Hematology (Dr Escobar), University of Texas Health Science Center at Houston; and Department of Neuroscience, University of California, San Diego (Dr Albright). Muito incenso tambem esta sendo queimado para o senador Arns, que largou o PT, cheio de indignacao.Meio tarde, nao e mesmo ? Um velho e recorrente cacoete da publicidade continua em vigor em nossa midia, com anuncios exibindo a formula "precos a partir de R$.....", o que sabemos ser falso na maioria das vezes.Nao vamos nunca encontrar aquele modelo de carro, nem aquela passagem aerea, nem aquela cabine no navio nem aquele imovel pelos precos anunciados. O certo seria a indicacao completa, precos de X reais a tantos reais, seria menos enganador.Parece o boquirroto vendendo o pre-sal como a porta da felicidade. Fagundes, o genio"Nao tenho Twitter,Orkut.My Space, Facebook, nada disso. "Sou analfabyte".Nem email eu tenho.Nao uso computador,tenho tantos livros para ler.Nao vou perder tempo naquela maquininha" Se fosse fotografo seria lambe lambe. E vive saudoso dos aeroplanos da Panair. Dilma Roussef, hoje:"Nao vejo porque o Brasil nao tenha [maturidade] para eleger uma presidenta. Pode ter metalurgico, negro e pode ter uma presidenta. O Brasil esta maduro politicamente para perceber que sua multiplicidade pode ser representada de varias formas", disse Dilma em um hotel de Sao Paulo onde se reuniu com a presidente