Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study-Reference-Cited by-同舟云学术

Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study

Published:2023-07-15 Issue:4 Volume:8 Page:1030-1040
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Paciaroni Maurizio¹^ORCID,Caso Valeria¹,Romoli Michele²^ORCID,Becattini Cecilia¹,Salerno Alexander³^ORCID,Rapillo Costanza³⁴,Simonnet Fanny³,Strambo Davide³,Canavero Isabella⁵⁶,Zedde Marialuisa⁷^ORCID,Pascarella Rosario⁸,Sohn Sung-Il⁹,Sacco Simona¹⁰^ORCID,Ornello Raffaele¹⁰,Barlinn Kristian¹¹,Schoene Daniela¹¹,Rahmig Jan¹¹,Mosconi Maria Giulia¹^ORCID,Leone De Magistris Ilaria¹,Alberti Andrea¹,Venti Michele¹,Silvestrelli Giorgio¹²,Ciccone Alfonso¹²,Padroni Marina¹³,Laudisi Michele¹³,Zini Andrea¹⁴,Gentile Luana¹⁴^ORCID,Kargiotis Odysseas¹⁵^ORCID,Tsivgoulis Georgios¹⁶^ORCID,Tassi Rossana¹⁷^ORCID,Guideri Francesca¹⁷,Acampa Maurizio¹⁷^ORCID,Masotti Luca¹⁸,Grifoni Elisa¹⁸^ORCID,Rocco Alessandro¹⁹^ORCID,Diomedi Marina¹⁹,Karapanayiotides Theodore²⁰,Engelter Stefan T²¹²²,Polymeris Alexandros A²¹^ORCID,Zietz Annaelle²¹^ORCID,Bandini Fabio²³,Caliandro Pietro²⁴^ORCID,Reale Giuseppe²⁴,Moci Marco²⁴^ORCID,Zauli Aurelia²⁵,Cappellari Manuel²⁶,Emiliani Andrea²⁶,Gasparro Antonio²⁷,Terruso Valeria²⁷,Mannino Marina²⁷^ORCID,Giorli Elisa²⁸,Toni Danilo²⁹,Andrighetti Marco²⁹^ORCID,Falcou Anne³⁰,Palaiodimou Lina¹⁶^ORCID,Ntaios George³¹^ORCID,Sagris Dimitrios³¹,Karagkiozi Efstathia³¹,Adamou Anastasia³¹^ORCID,Halvatsiotis Panagiotis³²,Flomin Yuriy³³^ORCID,Scoditti Umberto³⁴,Genovese Antonio³⁴^ORCID,Popovic Nemanja³⁵,Pantoni Leonardo³⁶^ORCID,Mele Francesco³⁶,Molitierno Nicola³⁶^ORCID,Lochner Piergiorgio³⁷,Pezzini Alessandro³⁸^ORCID,Del Sette Massimo³⁹,Sassos Davide³⁹,Giannopoulos Sotirios⁴⁰^ORCID,Kosmidou Maria⁴⁰,Ntais Evangelos⁴⁰^ORCID,Lotti Enrico Maria⁴¹,Mastrangelo Vincenzo⁴¹,Chiti Alberto⁴²,Naldi Andrea⁴³^ORCID,Vanacker Peter⁴⁴⁴⁵⁴⁶,Ferrante Mario⁴⁷,Volodina Vera⁴⁸,Mancuso Michelangelo⁴⁹,Giannini Nicola⁴⁹,Baldini Marco⁴⁹,Vadikolias Kostantinos⁵⁰,Kitmeridou Sofia⁵⁰,Saggese Carlo Emanuele⁵¹,Tassinari Tiziana⁵²,Saia Valentina⁵²^ORCID,Michel Patrik²

Affiliation:

1. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy

2. Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy

3. Stroke Center, Neurology Service,Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

4. Stroke Unit, Careggi University Hospital, Florence, Italy

5. Emergency Neurology, IRCCS Casimiro Mondino Foundation, Pavia, Italy

6. Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy

7. Neurology Unit, AUSL - IRCCS of Reggio Emilia, Reggio Emilia, Italy

8. SSD Neuroradiologia, AUSL – IRCCS of Reggio Emila, Reggio Emilia, Italy

9. Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea

10. Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

11. Department of Neurology, Dresden University Stroke Center, Dresden, Germany

12. S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy

13. Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy

14. IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy

15. Stroke Unit, Metropolitan Hospital, Piraeus, Greece

16. Second Department of Neurology, “Attikon” Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece

17. Stroke Unit, AOU Senese, Siena, Italy

18. Internal Medicine, San Giuseppe Hospital, Empoli, Italy

19. Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy

20. 2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece

21. Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland

22. Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland

23. Department of Neurology, ASL 3 Genovese, Genova, Italy

24. Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

25. Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy

26. Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

27. Neurologia, Ospedali Riuniti, Palermo, Italy

28. Stroke Unit, Department of Neurology, Sant’Andrea Hospital, La Spezia, Italy

29. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

30. Stroke Unit – Emergency Department, Policlinico Umberto I, Rome, Italy

31. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

32. Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital “Attikon,” National and Kapodistrian University of Athens, Greece

33. Stroke and Neurorehabilitation Unit MC ‘Universal Clinic “Oberig” Kyiv, Kyiv, Ukraine

34. Stroke Unit, Emergency Department, University of Parma, Parma, Italy

35. Clinic of Neurology, University Clinical Center of Vòsvodina, University of Novi Sad, Novi Sad, Serbia

36. Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy

37. Department of Neurology, Saarland University, Medical Center, Homburg, Germany

38. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy

39. IRCCS Ospedale Policlinico San Martino, Genova, Italy

40. Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece

41. Neurology Unit, “Infermi” Hospital, AUSL Romagna, Rimini, Italy

42. Neurologia, Ospedale Apuano, Massa Carrara, Italy

43. Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy

44. NeuroVascular Center and Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium

45. Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

46. Groeninge Hospital, Kortrijk, Belgium

47. Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

48. Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital # 1, Novosibirsk (Russia) at the Novosibirsk State Medical University, Novosibirsk, Russia

49. Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy

50. Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece

51. Unità di Terapia Neurovascolare, Ospedale “Fabrizio Spaziani,” Frosinone, Italy

52. Department of Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (Savona), Italy

Abstract

Introduction: The best therapeutic strategy for patients with mechanical heart valves (MHVs) having acute ischemic stroke during treatment with vitamin K antagonists (VKAs) remain unclear. Being so, we compared the outcomes for: (i) full dose heparin along with VKA (bridging therapy group) and (ii) restarting VKA without heparin (nonbridging group). Patients and methods: For this multicenter observational cohort study, data on consecutive acute ischemic stroke patients with MHV was retrospectively collected from prospective registries. Propensity score matching (PSM) was adopted to adjust for any treatment allocation confounders. The primary outcome was the composite of stroke, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding at 90 days. Results: Overall, 255 out of 603 patients (41.3%) received bridging therapy: 36 (14.1%) had combined outcome, compared with 28 (8.0%) in the nonbridging group (adjusted OR 1.83; 95% CI 1.05–3.18; p = 0.03). Within the bridging group, 13 patients (5.1%) compared to 12 (3.4%) in the nonbridging group had an ischemic outcome (adjusted OR 1.71; 95% CI 0.84–3.47; p = 0.2); major bleedings were recorded in 23 (9.0%) in the bridging group and 16 (4.6%) in the nonbridging group (adjusted OR 1.88; 95% CI 0.95–3.73; p = 0.07). After PSM, 36 (14.2%) of the 254 bridging patients had combined outcome, compared with 23 (9.1%) of 254 patients in the nonbridging group (OR 1.66; 95% CI 0.95–2.85; p = 0.07). Conclusion: Acute ischemic stroke patients with MHV undergoing bridging therapy had a marginally higher risk of ischemic or hemorrhagic events, compared to nonbridging patients.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/23969873231186863

Reference19 articles.

1. Anticoagulation After Stroke in Patients With Atrial Fibrillation

2. Anticoagulation Type and Early Recurrence in Cardioembolic Stroke

3. Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke

4. Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome