Study examines anti-clotting therapy following cardioembolic stroke

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."

(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 .