Details

Autor(en) / Beteiligte

• Korompoki, Eleni
• Filippidis, Filippos T
• Nielsen, Peter B
• Del Giudice, Angela
• Lip, Gregory Y H
• Kuramatsu, Joji B
• Huttner, Hagen B
• Fang, Jiming
• Schulman, Sam
• Martí-Fàbregas, Joan
• Gathier, Celine S
• Viswanathan, Anand
• Biffi, Alessandro
• Poli, Daniela
• Weimar, Christian
• Malzahn, Uwe
• Heuschmann, Peter
• Veltkamp, Roland

Titel

Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation

Ist Teil von

• Neurology, 2017-08, Vol.89 (7), p.687

Ort / Verlag

United States

Erscheinungsjahr

2017

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. 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. 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, = 0.002) and no-ATM (RR = 0.47, 95% CI 0.29-0.77, = 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, = 0.28; VKA vs no-ATM: RR = 0.93, 95% CI 0.45-1.90, = 0.84). 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.