American Heart Association

Monthly Archives: December 2020

Article Commentary: “Ischemic Stroke Occurs Less Frequently in Patients With COVID-19”

Ericka Samantha Teleg, MD

Bekelis K, Missios S, Ahmad J, Labropoulos N, Schirmer CM, Calnan DR, Skinner J, MacKenzie TA. Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study. Stroke. 2020;51:3570–3576.

COVID-19 has affected stroke systems all over the globe, including diagnosis, recognition, and even management in stroke centers and hospitals. Stroke times may have been compromised due to the evolving COVID-19 crisis. The strength of COVID-19 and stroke studies in general allows the stroke neurologist and other practitioners to navigate during the COVID-19 crises.

Bekelis et al. emphasize that despite the presence of multiple case series and observational studies regarding the stroke milieu in the time of COVID-19, there exists a decreased occurrence of ischemic stroke across the world during the COVID-19 pandemic. This statement emphasizes that despite the circumstances we face at this complicated time, we must urge patients not to delay stroke care, despite the risk of COVID-19 contraction. The title that includes “less frequently” has made this reader quite interested to understand what the authors mean.

By |December 3rd, 2020|clinical|0 Comments

Bridging and Anticoagulation After Acute Atrial Fibrillation-Related Ischemic Stroke

Kevin O’Connor, MD

Yaghi S, Mistry E, Liberman AL, Giles J, Asad SD, Liu A, Nagy M, Kaushal A, Azher I, Mac Grory B, et al. Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study. Stroke. 2020;51: 2724–2732.

The risk of recurrence is reduced with anticoagulation in patients with an ischemic stroke in the setting of atrial fibrillation, but whether bridging therapy with either heparin or low molecular weight heparin is needed and the choice of oral anticoagulant (warfarin versus direct oral anticoagulant [DOAC]) remains controversial.

This retrospective analysis of pooled data from the IAC (Initiation of Anticoagulation after Cardioembolic) stroke study examined the risk of recurrent ischemic events and delayed symptomatic intracranial hemorrhage (d-sICH) when employing bridging therapy (or not) and when starting warfarin or a DOAC within 90 days of a stroke. Of 2084 patients, 1289 were included in the analysis of benefits and harms of bridging therapy (bridging, n=203; no bridging, n=1086) and 1251 in the analysis of warfarin versus DOAC (warfarin n=389, DOAC n=862).