Initiation of Oral Anticoagulation after Acute Ischaemic Stroke or Transient Ischaemic Attack: Timing and Complications of Overlapping Heparin or Conventional Treatment

Audebert, Heinrich J.; Schenk, Berit; Tietz, V.; Schenkel, Johannes; Heuschmann, Peter U.

doi:10.1159/000145324

Cited by 17 publications

(12 citation statements)

References 44 publications

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“…First, hematoma growth and rebleeding beyond the 24-h time window after the initial event are less frequent in sICH compared to other ICH populations, e.g. ICH related to oral anticoagulant treatment [18,25,26,27] – Lim et al [19] reported significant hematoma growth (>50%) in 0.9% of sICH patients between days 2 and 7. Consistent with that study and similar findings reported previously [18], 2 out of the 97 patients analyzed here (i.e.…”

Section: Discussionmentioning

confidence: 99%

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Kiphuth

Staykov²,

Köhrmann³

et al. 2008

Cerebrovasc Dis

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Background: Venous thromboembolism (VTE) is a common complication after stroke. Application of low molecular weight heparins (LMWH) has been proven to be beneficial for the prevention of VTE in ischemic stroke patients. However, there is no consensus whether and how to administer LMWH for prevention of thrombotic complications after acute spontaneous intracerebral hemorrhage (sICH), the main concern being possible hematoma growth. The objective of this study was to assess the safety of early subcutaneous LMWH in patients with sICH with respect to hemorrhage enlargement. Methods: A total of 97 patients with sICH were analyzed. LMWH (either enoxaparin-natrium or dalteparin-natrium) were initiated within 36 h after admission in all patients without clinical evidence of hemorrhage enlargement or an absence of evidence of hematoma growth on CT. Hematoma growth (significant when >33%, moderate when >20%) was assessed on follow-up CT between days 5 and 11. Results: None of the patients showed a significant hemorrhage growth. Between days 2 and 10, 2 patients experienced a moderate hematoma enlargement of 22.4 and 20.9%. None of the included patients developed a fatal lung embolism. Conclusions: Early application of subcutaneous LMWH for prevention of venous thromboembolism seems to be safe, and probably does not increase the risk of hematoma growth in patients with sICH.

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Section: Discussionmentioning

confidence: 99%

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Kiphuth

Staykov²,

Köhrmann³

et al. 2008

Cerebrovasc Dis

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“…614 The safety and efficacy of heparin, given as an interim therapy for those patients with atrial fibrillation who were beginning to receive oral anticoagulants, was evaluated in an observational study. 615 Heparin did not reduce the risk of thromboembolic events or increase the risk of bleeding complications, but the heparin bridging did prolong hospitalization. Besides an associated risk of bleeding, the administration of heparin to patients with acute ischemic stroke may be complicated by the development of heparininduced thrombocytopenia.…”

Section: Unfractionated Heparinmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,341

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…In many European hospitals, initial anticoagulatory treatment for these conditions is done with phenprocoumon and with bridging intravenous heparin until a therapeutic international normalized ratio (INR) has been reached [4]. This requires strict laboratory control of the very variable and clinically unpredictable individual treatment response.…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetic Testing for Guiding de novo Phenprocoumon Therapy in Stroke Patients

Arnold

Grond‐Ginsbach²,

Kloß³

et al. 2009

Cerebrovasc Dis

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Background: For many conditions causing transient ischemic attack or minor stroke, secondary prevention with early initiation of oral anticoagulation is indicated. The individual response to coumarins is known to vary widely and is not well predicted by clinical variables. Patients’ discharge from hospital care is often delayed only because the therapeutic target range has not been reached yet. A feasible tool to guide coumarin dosing and thereby safely shortening time in hospital is required. Methods: We established a polymerase chain reaction technique for rapid genotyping of the vitamin K epoxide reductase complex (VKORC1), which is the pharmaceutical target of the coumarins. C283 + 837C –> T (rs2359612) genotypes were determined in 49 patients who underwent de novo oral anticoagulation with phenprocoumon for cerebrovascular disease. Other variables potentially affecting phenprocoumon sensitivity were systematically evaluated. Results: Of 49 genotyped patients, 47 were treated in hospital until an international normalized ratio (INR) of 2–3 was reached. The time and the cumulative dose of phenprocoumon necessary to achieve the target INR both were strongly dependent on the individual C283 + 837C –> T genotype (Kruskal-Wallis test p = 0.0002, and p < 0.0001, respectively). Carriers of the TT genotype reached an INR of 2–3 after a mean time of 3.2 days (n = 5), CT carriers after 4.4 days (n = 27), and CC carriers after 6.5 days (n = 15). No other variable, including body weight, was significantly correlated with the treatment response. Conclusion: In patients with cerebrovascular disease, genotyping for VKORC1 alone can strongly predict the individual response to de novo phenprocoumon treatment. The size of the pharmacogenetic test’s potential effect on a more efficient use of hospital capacities remains to be shown by a controlled interventional study.

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Initiation of Oral Anticoagulation after Acute Ischaemic Stroke or Transient Ischaemic Attack: Timing and Complications of Overlapping Heparin or Conventional Treatment

Cited by 17 publications

References 44 publications

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Pharmacogenetic Testing for Guiding de novo Phenprocoumon Therapy in Stroke Patients

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