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Evidence summaries

Anticoagulant Treatment in Acute Cardioembolic Stroke

Early anticoagulation within 48 hours is not effective in acute cardioembolic stroke. Level of evidence: "A"

A systematic review 1 including 7 studies with a total of 4 624 subjects was abstracted in DARE. Studies comparing initial treatment (within 48 h) with anticoagulants (s.c. and i.v. unfractionated heparin, s.c. low molecular weight heparin, s.c. and i.v. heparinoids) with other treatments (placebo or aspirin) were included. Atrial fibrillation was diagnosed with 82% of the patients. There was no statistically significant difference between anticoagulant and other treatment in death or disability at final follow-up (at least 3 months) (73.5% vs 73.8%; OR 1.01, 95% CI 0.82 to 1.24) or all strokes (OR 1.18, 95% CI 0.74 to 1.88). Anticoagulants were associated with a non significant reduction in recurrent stroke within 7 to 14 days compared with other treatments (3.0% vs 4.9%; OR 0.68, 95% CI 0.44 to 1.06, NNT=53), but were associated with a significant increase in symptomatic intracranial bleeding (2.5% vs 0.7%; OR 2.89, 95% CI 1.19 to 7.01, NNH =55).

    References

    • Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke 2007 Feb;38(2):423-30. [PubMed] [DARE]

Primary/Secondary Keywords