Study examines anti-clotting therapy following cardioembolic stroke

July 14, 2008

The common practice of administering heparin soon after cardioembolic stroke is associated with an increased risk for serious bleeding, according to an article posted online today that will appear in the September 2008 print issue of Archives of Neurology, one of the JAMA/Archives journals. However, it appears that anticoagulation with warfarin therapy may safely begin shortly after stroke.

Cardioembolic stroke, in which blood flow to the brain is interrupted by a clot or other substance originating within the heart, account for 20 percent of strokes involving reduced blood flow to an area of the brain (ischemic strokes), according to background information in the article. Current guidelines do not recommend giving anticoagulation (anti-clotting) therapy to patients shortly after cardioembolic stroke. However, most patients who have this type of stroke eventually need anticoagulation therapy, and there is no consensus regarding the best way to begin this treatment. Warfarin sodium, commonly prescribed for this purpose, takes several days to reach therapeutic levels and so is often combined (bridged) with other therapies.

Hen Hallevi, M.D., of the University of Texas Health Science Center at Houston, and colleagues retrospectively studied 204 patients who had been admitted with cardioembolic stroke between 2004 and 2006. Of these, eight received no anti-clotting therapy; 88 received aspirin only; 35 were given aspirin and warfarin; 44 received intravenous heparin and warfarin; and 29 were treated with a full dose of enoxaparin, a low-molecular-weight-heparin, followed by warfarin. All patients who did not receive full doses of heparin or enoxaparin took low doses of enoxaparin to prevent deep vein thrombosis (blood clots in the thigh or legs).

Recurrent strokes occurred in two patients (1 percent). The most common serious adverse event was a progressive stroke, in which the patient's neurological condition continues to deteriorate following the acute phase of the stroke, seen in 11 patients (5 percent). All except one of these cases occurred in the aspirin-only group. Patients receiving only aspirin therapy were 12.5 times as likely to experience stroke progression compared with patients who received other anticoagulation therapies, and patients with progressive strokes were 18 times more likely to have a poor outcome.

Hemorrhagic transformation, which involves bleeding into brain tissue affected by the ischemic stroke, was observed in 23 cases (11 percent) but only three (1 percent) were symptomatic. All three of these cases occurred in patients taking full-dose enoxaparin. Systemic bleeding occurred in two patients (1 percent), both taking heparin.

"Our data may provide guidance as to the mode of starting long-term anticoagulation therapy in patients with cardioembolic stroke," the authors write. "Warfarin treatment appears to be safe and can be started at any point during the hospital stay along with deep vein thrombosis prophylaxis. Bridging with a full dose of enoxaparin or heparin may carry a high risk of intracranial and systemic bleeding. However, it may be considered in special circumstances."
-end-
(Arch Neurol. 2008;65[9]:(doi:10.1001/archneur.65.9.noc70105). Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

The JAMA Network Journals

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.