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Abstract Details

Anticoagulation with DOAC or Heparin Bridging in Acute Cardioembolic Stroke: Nationwide Retrospective Cohort Study Analysis in Japan
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
Heparin has been used as a “bridge” to parenteral anticoagulants in cardioembolic stroke, but its use is associated with an increased incidence of hemorrhagic events. Direct oral anticoagulants (DOAC) have recently been used more widely, but the efficacy and safety of heparin bridging with DOAC administration in acute phase of stroke remain to be elucidated.
To investigate whether bridging therapy with heparin in acute phase of cardioembolic stroke is more beneficial than single DOAC therapy.
We performed retrospective observational study utilizing a national administrative database in Japan from April 2011 to March 2018. Patients with cardioembolic stroke who received DOAC within 7 days of admission were dichotomized based on the anticoagulation within 2 days of admission – DOAC (non-bridging group) or heparin (bridging group). The primary outcome was an all-cause 90-day death and the secondary outcomes consisted of functional independence at discharge, major bleeding, and pneumonia. We balanced the data using the inverse probability of treatment weighting method. The balanced data was used for calculating adjusted hazard ratio (HR).
A total of 18125 patients was identified; 4453 patients in the non-bridging group and 13672 patients in the bridging group. In the Cox proportional hazard analysis, compared to the non-bridging group, heparin bridging was associated with lower functional independence (adjusted HR, 0.90; 95% confidence interval, 0.84-0.96) and higher rate of pneumonia (adjusted HR, 1.29; 95% confidence interval, 1.05-1.57), while in-hospital mortality (adjusted HR, 0.83; 95% confidence interval, 0.65-1.06) and the major bleeding (adjusted HR, 1.42; 95% confidence interval, 0.96-2.11) were not significantly different between the heparin bridging group and the non-bridging group.
The present retrospective study using a nationwide inpatient database indicate that heparin bridging in cardioembolic stroke might not be an effective or safe strategy compared to anticoagulation only with DOAC.
Takahisa Mikami, MD (Massachusetts General Hospital)
Dr. Mikami has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file