Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation
Por:
Korompoki E., Filippidis F.T., Nielsen P.B., Del Giudice A., Lip G.Y.H., Kuramatsu J.B., Huttner H.B., Fang J., Schulman S., Martí-Fàbregas J., Gathier C.S., Viswanathan A., Biffi A., Poli D., Weimar C., Malzahn U., Heuschmann P., Veltkamp R.
Publicada:
1 ene 2017
Resumen:
Objective: To perform a systematic review and meta-analysis of studies reporting recurrent intracranial hemorrhage (ICH) and ischemic stroke (IS) in ICH survivors with atrial fibrillation (AF) during long-term follow-up. Methods: A comprehensive literature search including MEDLINE, EMBASE, Cochrane library, clinical trials registry was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We considered studies capturing outcome events (ICH recurrence and IS) for =3 months and treatment exposure to vitamin K antagonists (VKAs), antiplatelet agents (APAs), or no antithrombotic medication (no-ATM). Corresponding authors provided aggregate data for IS and ICH recurrence rate between 6 weeks after the event and 1 year of follow-up for each treatment exposure. Meta-analyses of pooled rate ratios (RRs) were conducted with the inverse variance method. Results: Seventeen articles met inclusion criteria. Seven observational studies enrolling 2,452 patients were included in the meta-analysis. Pooled RR estimates for IS were lower for VKAs compared to APAs (RR = 0.45, 95% confidence interval [CI] 0.27-0.74, p = 0.002) and no-ATM (RR = 0.47, 95% CI 0.29-0.77, p = 0.002). Pooled RR estimates for ICH recurrence were not significantly increased across treatment groups (VKA vs APA: RR = 1.34, 95% CI 0.79-2.30, p = 0.28; VKA vs no-ATM: RR = 0.93, 95% CI 0.45-1.90, p = 0.84). Conclusions: In observational studies, anticoagulation with VKA is associated with a lower rate of IS than APA or no-ATM without increasing ICH recurrence significantly. A randomized controlled trial is needed to determine the net clinical benefit of anticoagulation in ICH survivors with AF. © 2017 American Academy of Neurology.
Filiaciones:
Korompoki E.:
Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, United Kingdom
Filippidis F.T.:
Department of Primary Care and Public Health, Imperial College, London, United Kingdom
Nielsen P.B.:
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Denmark
Del Giudice A.:
Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, United Kingdom
Lip G.Y.H.:
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Denmark
Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
Kuramatsu J.B.:
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
Huttner H.B.:
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
Fang J.:
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
Schulman S.:
Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
Martí-Fàbregas J.:
Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
Gathier C.S.:
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Netherlands
Viswanathan A.:
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
Biffi A.:
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
Poli D.:
Thrombosis Center, Careggi Hospital, Florence, Italy
Weimar C.:
Department of Neurology, University Hospital of Duisburg-Essen, Essen, Germany
Malzahn U.:
Clinical Trial Center Würzburg, University Hospital Würzburg, Germany
Heuschmann P.:
Clinical Trial Center Würzburg, University Hospital Würzburg, Germany
Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University Würzburg, Germany
Veltkamp R.:
Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, United Kingdom
All Open Access; Green
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