Deans' stroke musings: Risk of Hemorrhagic Transformation with Early Use of Direct Oral Anticoagulants after Acute Ischemic Stroke: A Pooled Analysis of Prospective Studies and Randomized Trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 20, 2023

Risk of Hemorrhagic Transformation with Early Use of Direct Oral Anticoagulants after Acute Ischemic Stroke: A Pooled Analysis of Prospective Studies and Randomized Trials

WHOM specifically is going to take the obvious next step and come up with a protocol that prevents hemorrhagic transformation? As is, this is useless, no protocol created. With NO LEADERSHIP IN STROKE nothing will occur. Another useless research prediction.

Risk of Hemorrhagic Transformation with Early Use of Direct Oral Anticoagulants after Acute Ischemic Stroke: A Pooled Analysis of Prospective Studies and Randomized Trials

Anas Alrohimi https://orcid.org/0000-0001-7601-6920, David Z. Rose https://orcid.org/0000-0002-9449-6494, and Kenneth Butcher ken.butcher@unsw.edu.auView all authors and affiliations

Express Articles

https://doi.org/10.1177/17474930231164891

Abstract

Introduction:

Precise risk of hemorrhagic transformation (HT) in acute ischemic stroke (AIS) remains unknown, leading to delays in anticoagulation initiation for secondary stroke prevention. We sought to assess the rate of HT associated with direct oral anticoagulant (DOAC) initiation within and beyond 48 hours post-AIS.

Methods:

A pooled analysis of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted with 6 studies (4 prospective open label treatment, blinded outcome studies and 2 randomized trials; NCT02295826 and NCT02283294). The primary endpoint was incident radiographic HT on follow-up imaging (day 7–30). Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, study-period mortality, and follow-up modified Rankin Scale score. The results were reported as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI).

Results:

We evaluated 509 patients; median infarct volume was 1.5 (0.1–7.8) ml, and median National Institutes of Health Stroke Scale was 2 (0–3). Incident radiographic HT was seen on follow-up scan in 34 (6.8%) patients. DOAC initiation within 48 hours from index event was not associated with incident HT (adjusted OR 0.67, [0.30 – 1.50] P=0.32). No patients developed symptomatic HT. Conversely, 31 (6.1%) patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating a DOAC within 48 hours of onset was associated with similar recurrent ischemic event rates compared to those in which treatment was delayed (HR 0.42, [0.17 – 1.008] P=0.052). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR=6.8, [2.84 – 16.24], p<0.001).

Conclusions:

In this pooled analysis, initiation of DOAC within 48 hours post-stroke was not associated with increased incident risk of HT, and none developed symptomatic HT. The analysis was underpowered to determine the effect of early DOAC use upon recurrent ischemic events.