Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke: A Meta-Analysis of Randomized Controlled Trials
Abstract
BACKGROUND AND PURPOSE: The role of anticoagulant treatment for acute cardioembolic stroke is uncertain. We performed an updated meta-analysis of all randomized trials to obtain the best estimates of the efficacy and safety of anticoagulants for the initial treatment of acute cardioembolic stroke. METHODS: Using electronic and manual searches of the literature, we identified randomized trials comparing anticoagulants (unfractionated heparin or low-molecular-weight heparin or heparinoids), started within 48 hours, with other treatments (aspirin or placebo) in patients with acute ischemic cardioembolic stroke. Two reviewers independently selected studies and extracted data on study design, quality, and clinical outcomes, including death or disability, all strokes, recurrent ischemic stroke, and cerebral symptomatic bleeding. Odds ratios for individual outcomes were calculated for each trial and data from all the trials were pooled using the Mantel-Haenszel method. RESULTS: Seven trials, involving 4624 patients with acute cardioembolic stroke, met the criteria for inclusion. Compared with other treatments, anticoagulants were associated with a nonsignificant reduction in recurrent ischemic stroke within 7 to 14 days (3.0% versus 4.9%, odds ratio 0.68, 95% CI: 0.44 to 1.06, P=0.09, number needed to treat=53), a significant increase in symptomatic intracranial bleeding (2.5% versus 0.7%, odds ratio 2.89; 95% CI: 1.19 to 7.01, P=0.02, number needed to harm=55), and a similar rate of death or disability at final follow up (73.5% versus 73.8%, odds ratio 1.01; 95% CI: 0.82 to 1.24, P=0.9). CONCLUSIONS: Our findings indicate that in patients with acute cardioembolic stroke, early anticoagulation is associated with a nonsignificant reduction in recurrence of ischemic stroke, no substantial reduction in death and disability, and an increased intracranial bleeding.
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Parenteral anticoagulants seem to be associated with a non-significant reduction in recurrent ischaemic stroke when administered 7 to 14 days after acute stroke (OR 0.68; 95% CI 0.44-1.06), with a significant increase in symptomatic intracranial bleeding (OR 2.89; 95% CI 1.19-7.01), and a similar rate of death or disability at final follow-up.
“Parenteral anticoagulants seem to be associated with a non-significant reduction in recurrent ischaemic stroke when administered 7 to 14 days after the acute stroke (odds ratio [OR] 0.68; 95% CI 0.44-1.06),with a significant increase in symptomatic intracranial bleeding (OR 2.89; 95% CI 1.19-7.01),and a similar rate of death or disability at final follow-up.477”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [477]
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- Authors
- Paciaroni, M., Agnelli, G., Micheli, S., & Caso, V.
- Affiliations
- University of Perugia (IT)
- Venue
- Stroke
- Published
- 2007-02
- Volume
- 38
- Issue
- 2
- Pages
- 423-430
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2138775201
- Cited by
- 307
- References
- 48
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 7 · 2023: 17 · 2022: 23 · 2021: 26 · 2020: 17 · 2019: 19 · 2018: 12 · 2017: 16 · 2016: 20 · 2015: 15 · 2014: 22 · 2013: 19 · 2012: 14
- FWCI
- 12.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- cardioembolic stroke, anticoagulation, heparin, low molecular weight heparin, heparinoids, aspirin, recurrent ischemic stroke, intracranial hemorrhage, stroke mortality and disability
- MeSH terms
- Anticoagulants, Embolism, Humans, Randomized Controlled Trials as Topic, Myocardial Ischemia, Stroke
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