WARFARIN IN PATIENTS WITH CARDIOEMBOLIC STROKE
https://doi.org/10.20996/1819-6446-2012-8-4-581-586
Abstract
Analysis of the current literature data on the use of warfarin in patients with cardioembolic stroke is presented. Cardioembolic stroke pathology and particularities of this condition therapy
with antithrombotic medications are shown in details. Possibility to apply thrombolysis during warfarin treatment and the use of anticoagulants after cardioembolic stroke is discussed.
About the Authors
E. N. DankovtsevaRussian Federation
S. L. Arkhipov
Russian Federation
D. A. Zateyshchikov
Russian Federation
References
1. Doufekias E., Segal A.Z., Kizer J.R. Cardiogenic and aortogenic brain embolism. J Am Coll Cardiol 2008; 51:1049–1059.
2. Ferro J.M. Cardioembolic stroke: an update. Lancet Neurol 2003; 2:177–188.
3. Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011; 42:227–276.
4. de Jong G., Van Raak L., Kessels F ., Lodder J. Stroke subtype and mortality: a follow-up study in 998 patients with a first cerebral infarct. Journal of Clinical Epidemiology 2003; 56(3):262–268.
5. Murat Sumer M, Erturk O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurological Sciences 2002; 22(6):449–454.
6. Sprigg N., Gray L.J., Bath P .M.W. et al. Early recovery and functional outcome are related with causal stroke subtype: data from the Tinzaparin in acute ischemic stroke trial. Journal of Stroke and Cerebrovascular Diseases 2007; 16(4):180–184.
7. Winter Y ., Wolfram C., Schaeg M. et al. Evaluation of costs and outcome in cardioembolic stroke or TIA. Journal of Neurology 2009; 256(6) 954–963.
8. Cabral N.L., Goncalves A.R.R., Longo A.L. et al. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. Journal of Neurology , Neurosurgery and Psychiatry 2009; 80(7): 755–761.
9. Lavados P .M., Sacks C., Prina L. et al. Incidence, casefatality rate, and prognosis of ischaemic stroke subtypes in a predominantlyHispanic-Mestizo population in Iquique, Chile (PISCIS project): a community-based incidence study. The Lancet Neurology 2007; 6(2):140–148.
10. Stead L.G., Gilmore R.M., Bellolio M.F . et al. Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation. Stroke Research and T reatment 2011; 2011: 281496.
11. Kim Y .D., Park B., Cha M.J. et al. Stroke severity in concomitant cardiac sources of embolism in patients with atrial fibrillation. J Neurol Sci 2010; 298:23–27.
12. Marder V.J., Chute D.J., Starkman S. et al. Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke. Stroke 2006; 37:2086–2093.
13. Moulin T., Crepin-Leblond T., Chopard J.L. et al. Hemorrhagic infarcts. Eur Neurol 1994; 34:64–77.
14. Momjian-Mayor I., Baron J.C. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke 2005; 36:567–577.
15. Suslina Z. A., Piradov M. A., editors. Stroke: diagnosis, treatment, prevention. Guide for physicians. Moscow: MEDpress-inform; 2008. Russian (Суслина З. А., Пирадов М. А., редакторы. Инсульт: диагностика, лечение, профилактика. Руководство для врачей. М.: МЕДпресс-информ; 2008).
16. Mudd P .D., James M.A. Anticoagulation for atrial fibrillation: should warfarin be temporarily stopped or continued after acute cardioembolic stroke? Age and Ageing 2010; 39: 670–673
17. Alexandrov A.V., Black S.E., Ehrlich L.E. et al. Predictors of hemorrhagic transformation occurring spontaneously and on anticoagulants in patients with acute ischemic stroke. Stroke 1997; 28:1198–1202.
18. Hallevi H., Albright K.C., Martin-Schild S. et al. Anticoagulation after cardioembolic stroke. Arch Neurol 2008; 65:1169–1173.
19. Berger C., Fiorelli M., Steiner T. et al. Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic? Stroke 2001; 32:1330–1335.
20. Fujikawa T., Yamawaki S., Touhouda Y . Incidence of silent cerebral infarction in patients with major depression . Stroke 1993; 24(11):1631–1634.
21. Kobayashi S., Okada K., Koide H. et al. Subcortical silent brain infarction as a risk factor for clinical stroke. Stroke 1997; 28:1932–1939.
22. Fujikawa T. Asymptomatic cerebral infarction and depression — the concept of vascular depression. Seishin Shinkeigaku Zasshi 2004; 106(4):421–430.
23. Knecht S., Oelschlager C., Duning T. et al. Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J 2008; 29:2125–2132.
24. Vermeer S.E., Prins N.D., den Heijer T. et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003; 348:1215–1222.
25. Howard G., Safford M.M., Meschia J.F . Stroke symptoms in individuals reporting no prior stroke or transient ischemic attack are associated with a decrease in indices of mental and physical functioning. Stroke 2007; 38(9):2446–2452.
26. Chodosh E.H., Foulkes M.A., Kase C.S. et al. Silent stroke in the NINCDS Stroke Data Bank. Neurology 1988; 38:1674–679.
27. Kase C.S., Wolf P .A., Chodosh E.H. et al. Prevalence of silent stroke in patients presenting with initial stroke: the Framingham Study. Stroke 1989; 20:850–852.
28. EAFT Study Group. Silent brain infarction in nonrheumatic atrial fibrillation. European Atrial Fibrillation Trial. Neurology 1996; 46:159–165.
29. Howard G., Wagenknecht L.E., Cai J. et al. Cigarette smoking and other risk factors for silent cerebral infarction in the general population. Stroke 1998; 29:913–917.
30. Vermeer S.E., Koudstaal P .J., Oudkerk M. et al. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 2002; 33:21–25.
31. Das R.R., Seshadri S., Beiser A.S. et al. Prevalence and correlates of silent cerebral infarcts in the Framingham offspring study. Stroke 2008; 39:2929–2935.
32. Neumann T., Kuniss M., Conradi G. et al. MEDAFI-Trial (Micro-embolization during ablation of atrial fibrillation): comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy. Europace 2011; 13:37–44.
33. Lees K.R., Bluhmki E., von Kummer R. et al. ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375(9727):1695–1703.
34. Wardlaw J.M., Murray V., Berge E., Del Zoppo G.J. Thrombolysis for acute ischaemic stroke. Stroke 2010; 41:e445–e446.
35. Albers G.W., Bates V.E., Clark W.M. et al. Intravenous tissue-type plasminogen activator activator for treatment of acute stroke: the Standard T reatment with Alteplase to Reverse Stroke (STARS) study . JAMA 2000; 283(9): 1145–1150.
36. Hill M.D., Buchan A.M.; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005; 172(10):1307–1312.
37. Wahlgren N., Ahmed N., Davalos A. et al. SITS-MOST investigators. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS- MOST): an observational study. Lancet 2007; 369(9558): 275–282.
38. Jaillard A., Cornu C., Durieux A. et al. Hemorrhagic transformation in acute ischemic stroke. The MAST-E study. MAST-E Group. Stroke 1999; 30:1326–1332.
39. Del Zoppo G.J., Saver J.L., Jauch E.C., Adams H.P . Jr . Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke 2009; 40:2945–2948.
40. Lansberg M.G., O’Donnell M.J., Khatri P . et al. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141(2) (suppl):e601S–e636S.
41. Hacke W., Kaste M., Fieschi C. et al. The European Cooperative Acute Stroke Study (ECASS). Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 1995; 274(13): 1017–1025.
42. Hacke W., Kaste M., Fieschi C. et al. Second European-Australasian Acute Stroke Study Investigators . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352(9136):1245–1251.
43. Hacke W., Kaste M., Bluhmki E. et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13):1317–1329.
44. Clark W.M., Wissman S., Albers G.W. et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999; 282(21): 2019–2026.
45. Davis S.M., Donnan G.A., Parsons M.W. et al. EPITHET investigators . Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008; 7(4): 299–309.
46. Prabhakaran S., Rivolta J., Vieira J.R. et al. Symptomatic intracerebral hemorrhage among eligible war-farin-treated patients receiving intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2010; 67(5):559–563.
47. Meretoja A., Putaala J., Tatlisumak T. et al. Offlabel thrombolysis is not associated with poor outcome in patients with stroke. Stroke 2010; 41(7):1450–1458.
48. Kim Y .D., Lee J.H., Jung Y .H. et al. Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use. Journal of the Neurological Sciences 2010; 298:101–105.
49. Seet R.C., Zhang Y ., Moore S.A. et al. Subtherapeutic international normalized ratio in warfarin-treated patients increases the risk for symptomatic intracerebral hemorrhage after intravenous thrombolysis. Stroke 2011; 42(8):2333–2335.
50. Vergouwen M.D., Casaubon L.K., Swartz R.H. et al. Investigators of the Registry of the Canadian Stroke Network. Subtherapeutic warfarin is not associated with increased hemorrhage rates in ischemic strokes treated with tissue plasminogen activator . Stroke 2011; 42(4):1041–1045.
51. De Marchis G.M., Jung S., Colucci G. et al. Intracranial hemorrhage, outcome, and mortality after in- traarterial therapy for acute ischemic stroke in patients under oral anticoagulants. Stroke 2011; 42(11): 3061–3066.
52. Rizos T., Herweh C., Jenetzky E. et al. Point-of-care international normalized ratio testing accelerates thrombolysis in patients with acute ischemic stroke using oral anticoagulants. Stroke 2009; 40(11):3547–3551.
53. Dowlatshahi D., Hakim A., Fang J., Sharma M. Pre admission antithrombotics are associated with improved outcomes following ischaemic stroke: a cohort from the Registry of the Canadian Stroke Network. Int J Stroke 2009; 4(5):328–334.
54. Xian Y ., Liang L., Smith E.E. et al. Risks of Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Receiving Warfarin and Treated With Intravenous Tissue Plasminogen Activator . JAMA 2012; 307(204):2600–2608.
55. Adams J.R., del Zoppo G.J., Alberts M.J. et al. Guidelines for the early management of adults with is chemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 2007; 115:e478–e534.
56. The European Stroke Oraganisation (ESO) Executive Committee; ESO writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25(5):457–507.
57. Saxena R., Lewis S., Berge E. et al. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial. Stroke 2001; 32:2333–2337.
58. Sherman D.G. Heparin and heparinoids in stroke. Neurology 1998; 51: S56–S58.
59. Hart R.G., Palacio S., Pearce L.A. Atrial fibrillation, stroke, and acute antithrombotic therapy: analysis of randomized clinical trials. Stroke 2002; 33:2722–2727.
60. Moonis M., Fisher M. Considering the role of heparin and low-molecularweight heparins in acute is chemic stroke. Stroke 2002; 33:1927–1933.
61. Koennecke H.C. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology 2006; 66:165–171.
62. Chinese Acute Stroke Trial CAST. Randomised placebocontrolled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. Lancet 1997; 34: 1641–1649.
63. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both or neither among 19435 patients with acute ischaemic stroke. Lancet 1997; 349: 1569–1581.
64. Lee J.H., Park K.Y ., Shin J.H. et al. Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation. Eur Neurol 2010; 64(4):193–200.
65. EAFT (European Atrial Fibrillation Trial) Study Group . Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342(8882):1255–1262.
66. Whitlock R.P ., Sun J.C., Fremes S.E. et al. Antithrombotic and Thrombolytic Therapy for Valvular Disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141(2) (suppl):e576S–e600
67. Hohnloser S.H., Pajitnev D., Pogue J. et al. For the ACTIVE W Investigators. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy. An ACTIVE W Substudy. J Am Coll Cardiol 2007; 50:2156–61.
68. Shmitt L., Speckman J., Ansell J. Quality assessment of anticoagulation dose management: comparative evaluation of measures of Time-in-Therapeutic range. J.Thrombosis and thrombolysis, 2003, 15(3), p.213–216.
69. Ghate S.R., Biskupiak J.E., Ye X. et al. Hemorrhagic and Thrombotic Events Associated with Generic Substitution of Warfarin in Patients with Atrial Fibrillation: A Retrospective Analysis. The Annals of Phar- macotherapy 2011; 45:701–712.
70. Sandercock P .A.G., Counsell C., Gubitz G.J., Tseng M.C. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2008; (3):CD000029.
Review
For citations:
Dankovtseva E.N., Arkhipov S.L., Zateyshchikov D.A. WARFARIN IN PATIENTS WITH CARDIOEMBOLIC STROKE. Rational Pharmacotherapy in Cardiology. 2012;8(4):581-586. (In Russ.) https://doi.org/10.20996/1819-6446-2012-8-4-581-586