Early Anticoagulation After Large Ischemic Stroke in the Initiation of Anticoagulation After Cardioembolic Stroke Study
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Background and Purpose Clinical trial data indicate that early anticoagulation is generally safe after an ischemic stroke, but there is a paucity of real-world data regarding the safety of early initiation in large strokes. We sought to determine the association between the time to the initiation of anticoagulation and the 90-day risk of recurrent ischemic and major hemorrhagic events. Methods We analyzed consecutive patients with an acute large ischemic stroke (volume ≥60 mL) who were included in the multicenter Initiation of Anticoagulation After Cardioembolic Stroke (IAC) study. We assessed recurrent ischemic events (transient ischemic attack, ischemic stroke, and systemic embolism), major hemorrhagic events (symptomatic intracranial hemorrhage [sICH] and major extracranial hemorrhage [ECH]), and the combined outcome within 90 days. Results This study included 155 patients (57.4% females) with a median NIHSS (National Institutes of Health Stroke Scale) score of 14. Only 11 (7.1%) events occurred, comprising 4 (2.6%) ischemic events, 2 (1.3%) sICHs, and 5 (3.2%) major ECHs. The median time to anticoagulation initiation did not differ significantly between subjects with and without recurrent ischemic events (13.5 days versus 9 days, p=0.221), major hemorrhagic events (4 days versus 10 days, p=0.334), or combined events (13 days versus 9.5 days, p=0.980). None of the patients who were started on anticoagulation within 7 days (n=71, 45.8%) experienced an ischemic event, and only one had an sICH, which occurred 20 days later. Two of the three recurrent strokes occurred prior to anticoagulation initiation in patients in whom this was done after 7 days. Conclusions Early anticoagulation after large ischemic stroke (volume ≥60 mL) in the IAC study was associated with a low risk of sICH and no recurrent ischemic strokes.
Abstract
Background and Purpose Clinical trial data indicate that early anticoagulation is generally safe after an ischemic stroke, but there is a paucity of real-world data regarding the safety of early initiation in large strokes. We sought to determine the association between the time to the initiation of anticoagulation and the 90-day risk of recurrent ischemic and major hemorrhagic events. Methods We analyzed consecutive patients with an acute large ischemic stroke (volume ≥60 mL) who were included in the multicenter Initiation of Anticoagulation After Cardioembolic Stroke (IAC) study. We assessed recurrent ischemic events (transient ischemic attack, ischemic stroke, and systemic embolism), major hemorrhagic events (symptomatic intracranial hemorrhage [sICH] and major extracranial hemorrhage [ECH]), and the combined outcome within 90 days. Results This study included 155 patients (57.4% females) with a median NIHSS (National Institutes of Health Stroke Scale) score of 14. Only 11 (7.1%) events occurred, comprising 4 (2.6%) ischemic events, 2 (1.3%) sICHs, and 5 (3.2%) major ECHs. The median time to anticoagulation initiation did not differ significantly between subjects with and without recurrent ischemic events (13.5 days versus 9 days, p=0.221), major hemorrhagic events (4 days versus 10 days, p=0.334), or combined events (13 days versus 9.5 days, p=0.980). None of the patients who were started on anticoagulation within 7 days (n=71, 45.8%) experienced an ischemic event, and only one had an sICH, which occurred 20 days later. Two of the three recurrent strokes occurred prior to anticoagulation initiation in patients in whom this was done after 7 days. Conclusions Early anticoagulation after large ischemic stroke (volume ≥60 mL) in the IAC study was associated with a low risk of sICH and no recurrent ischemic strokes.