Anticoagulants for acute ischaemic stroke

Sandercock, Peter; Counsell, Carl; Kane, Edward J.

doi:10.1002/14651858.cd000024.pub4

Cited by 81 publications

(57 citation statements)

References 61 publications

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“…Sixty-four percent of patients received rivaroxaban 20 mg daily and the remainder 15 mg daily. Patients with TIA (n=11) had a shorter interval between onset and rivaroxaban initiation (1 [1][2][3] days) than patients with ischemic stroke (n=49; 4 [2][3][4][5][6] days; P=0.27). At the time of treatment initiation, the median NIHSS was 2 (0-4) and median DWI lesion volume was 7.9 (1.5-14.7) mL (range 0-174.6 mL).…”

Section: Resultsmentioning

confidence: 99%

“…On baseline susceptibility-weighted sequences, HT was present in 25 (42%) patients (HI1, n=19; H12, n=6; PH 1/2, n=0; Figure Median time to rivaroxaban initiation was longer in patients with baseline HT (6 [3-7] days) than those without (2 [1][2][3][4] days; P<0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Although anticoagulation in acute stroke patients is associated with reduced early stroke recurrence rates, these benefits are offset by a comparable increase in the rate of symptomatic hemorrhagic transformation (HT). 1 Rivaroxaban is a non-vitamin K antagonist oral anticoagulant (NOAC) 2 used to prevent ischemic stroke in atrial fibrillation patients. All safety data related to rivaroxaban come from trials that excluded patients ≤14 days after stroke and 3 days after TIA.…”

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confidence: 99%

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Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation

Gioia

Kate

Sivakumar

et al. 2016

Stroke

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Background and Purpose-Early anticoagulation after cardioembolic stroke remains controversial because of the potential for hemorrhagic transformation (HT). We tested the safety and feasibility of initiating rivaroxaban ≤14 days after cardioembolic stroke/transient ischemic attack. Methods-A prospective, open-label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of transient ischemic attack or ischemic stroke (National Institute of Health Stroke Scale <9). All patients underwent magnetic resonance imaging <24 hours of rivaroxaban initiation and day 7. The primary end point was symptomatic HT at day 7. Results-Sixty patients (mean±SD age 71±19 years, 82% stroke/18% transient ischemic attack) were enrolled. Median (interquartile range) time from onset to rivaroxaban was 3 (5) days. At treatment initiation, median National Institute of Health Stroke Scale was 2 (4), and median diffusion-weighted imaging volume was 7.9 (13.7) mL. At baseline, HT was present in 25 (42%) patients (hemorrhagic infarct [HI]1=19, HI2=6). On follow-up magnetic resonance imaging, no patients developed symptomatic HT. New asymptomatic HI1 developed in 3 patients, and asymptomatic progression from HI1 to HI2 occurred in 5 patients; otherwise, HT remained unchanged at day 7. Conclusions-These data support the safety of rivaroxaban initiation ≤14 days of mild-moderate cardioembolic stroke/ transient ischemic attack. Magnetic resonance imaging evidence of petechial HT, which is common, does not appear to increase the risk of symptomatic HT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation

Gioia

Kate

Sivakumar

et al. 2016

Stroke

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“…Patients with acute ischemic stroke of arterial origin do not benefit from anticoagulation because the reductions in early recurrent ischemic events and venous thromboembolism are offset by increased bleeding complications (9, 50, 51). However, long-term treatment with anticoagulant drugs benefits patients with ischemic stroke of cardiac origin by reducing the risk of recurrent stroke (9, 51).…”

Section: Discussionmentioning

confidence: 99%

Protective and detrimental effects of neuroectodermal cell–derived tissue factor in mouse models of stroke

et al. 2016

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Within the CNS, a dysregulated hemostatic response contributes to both hemorrhagic and ischemic strokes. Tissue factor (TF), the primary initiator of the extrinsic coagulation cascade, plays an essential role in hemostasis and also contributes to thrombosis. Using both genetic and pharmacologic approaches, we characterized the contribution of neuroectodermal (NE) cell TF to the pathophysiology of stroke. We used mice with various levels of TF expression and found that astrocyte TF activity reduced to ~5% of WT levels was still sufficient to maintain hemostasis after hemorrhagic stroke but was also low enough to attenuate inflammation, reduce damage to the blood-brain barrier, and improve outcomes following ischemic stroke. Pharmacologic inhibition of TF during the reperfusion phase of ischemic stroke attenuated neuronal damage, improved behavioral deficit, and prevented mortality of mice. Our data demonstrate that NE cell TF limits bleeding complications associated with the transition from ischemic to hemorrhagic stroke and also contributes to the reperfusion injury after ischemic stroke. The high level of TF expression in the CNS is likely the result of selective pressure to limit intracerebral hemorrhage (ICH) after traumatic brain injury but, in the modern era, poses the additional risk of increased ischemia-reperfusion injury after ischemic stroke.

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“…6 However, patients from the 3 studies on argatroban accounted for only 1.3% (303 patients) of all patients included in the meta-analysis. [3][4][5] Thus, it is still uncertain whether argatroban is beneficial in patients with acute ischemic stroke.…”

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Outcomes of Argatroban Treatment in Patients With Atherothrombotic Stroke

Wada

Yasunaga

Horiguchi

et al. 2016

Stroke

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Background and Purpose-Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke. Methods-This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset. Patients were divided into 2 groups: those receiving argatroban on admission (argatroban group), and those who did not receive argatroban during hospitalization (control group). To balance the baseline characteristics and concomitant treatments during hospitalization between the 2 groups, one-to-one propensity-score matching analyses were performed. The main outcomes were the modified Rankin Scale score at discharge and the occurrence of hemorrhagic complications during hospitalization. An ordinal logistic regression analysis evaluated the association between argatroban use and modified Rankin Scale at discharge. Results-After propensity-score matching, 2289 pairs of patients were analyzed. There were no significant differences in modified Rankin Scale at discharge between the argatroban and the control groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.88-1.16). The occurrence of hemorrhagic complications did not differ significantly between the argatroban and the control groups (3.5% versus 3.8%; P=0.58). Conclusions-The present study suggested that argatroban was safe, but had no added benefit in early outcomes after acute atherothrombotic stroke. The aim of the present study was to investigate whether argatroban was effective and safe in patients with acute ischemic stroke, using a database of Japanese inpatients. Methods Study Design and SettingThis was a retrospective observational cohort study using data from a nationwide administrative claims and discharge abstract database in Japan, the Diagnosis Procedure Combination database. The Diagnosis Procedure Combination database has been described in detail previously. 9 In brief, >1000 hospitals, including all 82 academic hospitals in Japan, contribute to the Diagnosis Procedure Combination database. The annual number of cases added to the database is ≈7 000 000 and encompasses ≈50% of all hospital admissions in Japan.The Diagnosis Procedure Combination database contains the following information for each patient: patient demographics, a unique hospital identifier, diagnoses, outcomes, drugs used, procedures performed, healthcare costs, and several disease-specific data. Diagnoses include the main diagnosis on admission, preexisting comorbidities, and postadmission complications, which are recorded separately with International Classification of Diseases-10th revision codes and text data in Japanese. Drugs and procedures ar...

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Anticoagulants for acute ischaemic stroke

Cited by 81 publications

References 61 publications

Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation

Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation

Protective and detrimental effects of neuroectodermal cell–derived tissue factor in mouse models of stroke

Outcomes of Argatroban Treatment in Patients With Atherothrombotic Stroke

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