Risk of stroke during long-term anticoagulant therapy in patients after myocardial infarction

Annals of Neurology
A J AzarJ W Deckers

Abstract

Myocardial infarction survivors have an increased risk of stroke, which is reduced with long-term anticoagulant therapy. However, an estimated 10-times increase in risk of bleeding during such treatment has been reported. We evaluated the risk of stroke in patients after a myocardial infarction and examined the relationship of the risk of intracranial hemorrhage or cerebral infarction and the intensity of anticoagulant therapy. The study population consisted of 3,404 post-myocardial infarction patients who took part in a randomized, double-blind, placebo-controlled trial. Patients were randomized to treatment with anticoagulants (international normalized ratio range, 2.8-4.8) or matching placebo. Mean follow-up was more than 3 years. The incidence of stroke analyzed on "intention-to-treat" was 0.7 per 100 patient-years in the anticoagulant patients against 1.2 in placebo, a hazard ratio of 0.60, with 95% confidence interval of 0.40 to 0.90. In the anticoagulation group, 15 patients had cerebral infarction and 17 an intracranial bleeding, 3 of which occurred after withdrawal of treatment. In the placebo group, the numbers were 43 and 2. Of the 14 intracranial bleeds during anticoagulation, 6 occurred at an international normaliz...Continue Reading

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Mar 1, 1996·Annals of Neurology·T Yanagihara, J P Whisnant
Sep 30, 2006·Journal of Thrombosis and Thrombolysis·A CantalapiedraL J García-Frade
Nov 30, 2000·Current Treatment Options in Neurology·S ChaturvediS R Levine
Aug 15, 2003·Southern Medical Journal·Roger E Kelley, Alireza Minagar
Feb 6, 2002·Current Cardiology Reports·Marco R Di Tullio, Shunichi Homma
Aug 9, 2011·Stroke Research and Treatment·M Àngels FontAdrià Arboix
Feb 28, 1998·Postgraduate Medicine·R E Kelley
Jul 5, 2007·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·David J Werring

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