Cited by 307Acute Ischemic Stroke ManagementAtrial Fibrillation Management and OutcomesCardiovascular and Diving-Related Complications

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Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke: A Meta-Analysis of Randomized Controlled Trials

Paciaroni, Maurizio, Agnelli, Giancarlo, Micheli, Sara, Caso, Valeria·2007·Stroke

DOI 10.1161/01.str.0000254600.92975.1f

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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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Authors: Paciaroni, M., Agnelli, G., Micheli, S., & Caso, V.
Affiliations: University of Perugia (IT)
ORCID: Paciaroni, Maurizio
Agnelli, Giancarlo
Caso, Valeria
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-02
Volume: 38
Issue: 2
Pages: 423-430
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/01.str.0000254600.92975.1f
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 › Clinical Neurology › 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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Efficacy and Safety of Anticoagulant Treatment in Acute Cardioembolic Stroke: A Meta-Analysis of Randomized Controlled Trials

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