Cerebrovascular Diseases
Original Paper
Initiation of Oral Anticoagulation after Acute Ischaemic Stroke or Transient Ischaemic Attack: Timing and Complications of Overlapping Heparin or Conventional TreatmentAudebert H.J.a · Schenk B.b · Tietz V.b · Schenkel J.b · Heuschmann P.U.caStroke Unit, Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; bDepartment of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, Munich, Germany; cDivision of Health and Social Care Research, King’s College, London, UK
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Article / Publication Details
Received: November 05, 2007
Accepted: January 29, 2008
Published online: July 15, 2008
Issue release date: August 2008
Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 2
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
Background: Oral anticoagulation is highly effective for secondary prevention of cardioembolic strokes in patients with atrial fibrillation (AF). There are no studies investigating timing and complications of different strategies for initiation of oral anticoagulation after acute stroke or transient ischaemic attack (TIA). Methods: Patients of ten community hospitals participating in the prospective evaluation of medical effects of the Telemedical Project for Integrative Stroke Care (TEMPiS) were included. This observational evaluation was restricted to ischaemic stroke or TIA patients with AF who were started on Phenprocoumon treatment during in-hospital stay. Antithrombotic co-medication was dichotomized in heparin bridging (weight or partial thromboplastin time-adjusted heparin) or conventional treatment (antiplatelets and/or low-dose heparin or nil). Besides treatment-relevant extracranial bleeding, major complications were documented according to the European Atrial Fibrillation Trial definitions including vascular death, ischaemic or haemorrhagic stroke, systemic embolism, and myocardial infarction. Results: Between July 2003 and March 2005, 4,082 ischaemic stroke or TIA patients were admitted. AF was recorded in 961 patients (23.5%), of whom 376 (39.1%) received oral anticoagulation. In 229 of these patients oral anticoagulation was started in hospital, 150 (65.5%) with heparin bridging and 79 (34.5%) with conventional treatment. Patients with heparin bridging were younger, and had a longer in-hospital stay after adjustment for potential confounders (p = 0.01). Major complications were infrequent in both groups (2.0 vs. 2.5%; p = 1.0) as well as extracranial bleeding (3.3 vs. 1.2%; p = 0.43). Conclusions: Initiation of oral anticoagulation after acute ischaemic stroke yielded low complication rates independent of antithrombotic co-medication. Heparin bridging was associated with a longer stay in acute care hospitals.
© 2008 S. Karger AG, Basel
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Article / Publication Details
Received: November 05, 2007
Accepted: January 29, 2008
Published online: July 15, 2008
Issue release date: August 2008
Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 2
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
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