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Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
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2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, 314-320 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: This study aims to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and hemorrhagic events in a cohort of Swedish patients with atrial fibrillation and intracerebral hemorrhage (ICH).

METHODS: Patients with atrial fibrillation and a first-ever ICH were identified in the Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was linked with other national registers to find information on treatment, comorbidity, and outcome. The optimal timing of treatment in patients with low and high thromboembolic risk was described through cumulative incidence functions separately for thrombotic and hemorrhagic events and for the combined end point vascular death or nonfatal stroke.

RESULTS: The study included 2619 ICH survivors with atrial fibrillation with 5759 person-years of follow-up. Anticoagulant treatment was associated with a reduced risk of vascular death and nonfatal stroke in high-risk patients with no significantly increased risk of severe hemorrhage. The benefit seemed to be greatest when treatment was started 7 to 8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within 3 years was 17.0% when anticoagulant treatment was initiated 8 weeks after ICH and 28.6% without any antithrombotic treatment (95% confidence interval for difference, 1.4%-21.8%). For high-risk men, the corresponding risks were 14.3% versus 23.6% (95% confidence interval for difference, 0.4%-18.2%).

CONCLUSIONS: This nationwide observational study suggests that anticoagulant treatment may be initiated 7 to 8 weeks after ICH in patients with atrial fibrillation to optimize the benefit from treatment and minimize risk.

Place, publisher, year, edition, pages
American Heart Association , 2017. Vol. 48, no 2, 314-320 p.
Keyword [en]
anticoagulants, atrial fibrillation, cerebral hemorrhage, ischemia, stroke
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-129335DOI: 10.1161/STROKEAHA.116.014643ISI: 000394510300024PubMedID: 27999135OAI: oai:DiVA.org:umu-129335DiVA: diva2:1059310
Note

Presented in part at the 2nd European Stroke Organisation Conference (ESOC 2016), Barcelona, Spain, May 10–12, 2016

Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-04-12Bibliographically approved

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Pennlert, JohannaOverholser, RosannaAsplund, KjellCarlberg, BoVan Rompaye, BartWiklund, Per-GunnarEriksson, Marie
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