Published Online
on January 4, 2007

A more recent version of this article appeared on February 1, 2007

This Article Full Text (PDF) CME: Take the course for this article: Stroke: February 2007, Volume 38, Number 2 All Versions of this Article: 38/2/423    most recent 01.STR.0000254600.92975.1fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Paciaroni, M. Articles by Caso, V. Search for Related Content PubMed PubMed Citation Articles by Paciaroni, M. Articles by Caso, V. Related Collections Embolic stroke Emergency treatment of Stroke Anticoagulants Related Article

Submitted on April 24, 2006
Revised on August 28, 2006
Accepted on September 25, 2006

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

Maurizio Paciaroni MD^*; Giancarlo Agnelli MD; Sara Micheli MD; and Valeria Caso MD, PhD

From the Stroke Unit, Department of Internal Medicine, University of Perugia, Perugia, Italy.

^* To whom correspondence should be addressed. E-mail: mpaciaroni{at}libero.it.

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.

Key words: anticoagulants • cardioembolism • cerebral bleeding • stroke

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