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Warfarin Appears Safe After Cardioembolic Stroke

Many physicians reluctant to begin warfarin without 'bridging' with heparin or enoxaparin

THURSDAY, July 17 (HealthDay News) -- The initiation of warfarin for anticoagulation appears to be safe soon after cardioembolic stroke, according to research published online July 14 in the Archives of Neurology.

Hen Hallevi, M.D., of the University of Texas at Houston Medical School, and colleagues analyzed data from 204 patients who were diagnosed with cardioembolic stroke and weren't treated with tissue plasminogen activator. The researchers assessed patients by their treatment: no treatment, aspirin only, aspirin then warfarin, heparin bridging with heparin sodium followed by warfarin, or bridging with enoxaparin sodium combined with warfarin.

All cases of symptomatic hemorrhagic transformation were in the enoxaparin bridging group, comprising 10 percent of this group, the investigators found. Systemic bleeding developed in two patients and was associated with heparin bridging. Patients with anticoagulation were 2.4 times more likely to have a favorable outcome than those without anticoagulation, the researchers report.

"Our data may provide guidance as to the mode of starting long-term anticoagulation in patients with cardioembolic stroke. Warfarin treatment appears to be safe and can be started at any point during the hospital stay along with deep vein thrombosis prophylaxis. Bridging with a full dose of enoxaparin or heparin may carry a high risk of intracranial and systemic bleeding. However, it may be considered in special circumstances," the authors write.

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