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

Paciaroni, M.; Caso, V.; Romoli, M.; Becattini, C.; Salerno, A.; Rapillo, C.; Simonnet, F.; Strambo, D.; Canavero, I.; Zedde, M.; Pascarella, R.; Sohn, S.I.; Sacco, S.; Ornello, R.; Barlinn, K.; Schoene, D.; Rahmig, J.; Mosconi, M.G.; Leone De Magistris, I.; Alberti, A.; Venti, M.; Silvestrelli, G.; Ciccone, A.; Padroni, M.; Laudisi, M.; Zini, A.; Gentile, L.; Kargiotis, O.; Tsivgoulis, G.; Tassi, R.; Guideri, F.; Acampa, M.; Masotti, L.; Grifoni, E.; Rocco, A.; Diomedi, M.; Karapanayiotides, T.; Engelter, S.T.; Polymeris, A.A.; Zietz, A.; Bandini, F.; Caliandro, P.; Reale, G.; Moci, M.; Zauli, A.; Cappellari, M.; Emiliani, A.; Gasparro, A.; Terruso, V.; Mannino, M.; Giorli, E.; Toni, D.; Andrighetti, M.; Falcou, A.; Palaiodimou, L.; Ntaios, G.; Sagris, D.; Karagkiozi, E.; Adamou, A.; Halvatsiotis, P.; Flomin, Y.; Scoditti, U.; Genovese, A.; Popovic, N.; Pantoni, L.; Mele, F.; Molitierno, N.; Lochner, P.; Pezzini, A.; Del Sette, M.; Sassos, D.; Giannopoulos, S.; Kosmidou, M.; Ntais, E.; Lotti, E.M.; Mastrangelo, V.; Chiti, A.; Naldi, A.; Vanacker, P.; Ferrante, M.; Volodina, V.; Mancuso, M.; Giannini, N.; Baldini, M.; Vadikolias, K.; Kitmeridou, S.; Saggese, C.E.; Tassinari, T.; Saia, V.; Michel, P.

doi:10.1177/23969873231186863

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

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Serval ID

serval:BIB_50B2BA258502

Type

Article: article from journal or magazin.

Collection

Publications

Institution

UNIL/CHUV

Title

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

Journal

European stroke journal

Author(s)

Paciaroni M., Caso V., Romoli M., Becattini C., Salerno A., Rapillo C., Simonnet F., Strambo D., Canavero I., Zedde M., Pascarella R., Sohn S.I., Sacco S., Ornello R., Barlinn K., Schoene D., Rahmig J., Mosconi M.G., Leone De Magistris I., Alberti A., Venti M., Silvestrelli G., Ciccone A., Padroni M., Laudisi M., Zini A., Gentile L., Kargiotis O., Tsivgoulis G., Tassi R., Guideri F., Acampa M., Masotti L., Grifoni E., Rocco A., Diomedi M., Karapanayiotides T., Engelter S.T., Polymeris A.A., Zietz A., Bandini F., Caliandro P., Reale G., Moci M., Zauli A., Cappellari M., Emiliani A., Gasparro A., Terruso V., Mannino M., Giorli E., Toni D., Andrighetti M., Falcou A., Palaiodimou L., Ntaios G., Sagris D., Karagkiozi E., Adamou A., Halvatsiotis P., Flomin Y., Scoditti U., Genovese A., Popovic N., Pantoni L., Mele F., Molitierno N., Lochner P., Pezzini A., Del Sette M., Sassos D., Giannopoulos S., Kosmidou M., Ntais E., Lotti E.M., Mastrangelo V., Chiti A., Naldi A., Vanacker P., Ferrante M., Volodina V., Mancuso M., Giannini N., Baldini M., Vadikolias K., Kitmeridou S., Saggese C.E., Tassinari T., Saia V., Michel P.

ISSN

2396-9881 (Electronic)

ISSN-L

2396-9873

Publication state

Published

Issued date

12/2023

Peer-reviewed

Oui

Volume

Number

Pages

1030-1040

Language

english

Notes

Publication types: Observational Study ; Multicenter Study ; Journal Article
Publication Status: ppublish

Abstract

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).
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.
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).
Acute ischemic stroke patients with MHV undergoing bridging therapy had a marginally higher risk of ischemic or hemorrhagic events, compared to nonbridging patients.

Keywords

Humans, Heparin/adverse effects, Ischemic Stroke/drug therapy, Retrospective Studies, Prospective Studies, Atrial Fibrillation/chemically induced, Anticoagulants/adverse effects, Hemorrhage/chemically induced, Heart Valves, Mechanical heart valve, acute stroke, oral anticoagulants, prevention

OAI-PMH

oai:serval.unil.ch:BIB_50B2BA258502

DOI

10.1177/23969873231186863

Pubmed

37452632

Web of science

001025973300001

Open Access

Yes

Create date

16/07/2023 23:19