Why the study?
The best therapeutic strategy for patients with mechanical heart valves having acute ischemic stroke during treatment with vitamin K antagonists remains unclear.
Does full dose heparin bridging therapy reduce the composite of stroke, systemic embolism, and bleeding in acute ischemic stroke patients with mechanical heart valves compared to restarting VKA without heparin?
Population
603 acute ischemic stroke patients with mechanical heart valves during treatment with VKAs
Comparison
Full dose heparin along with VKA vs restarting VKA without heparin
Design
Multicenter observational cohort study with propensity score matching
Follow-up
90 days
Authors
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Bridging may raise event risk vs nonbridging in MHV stroke; leaves optimal strategy open pending randomized trials.
Does full dose heparin bridging therapy reduce the composite of stroke, systemic embolism, and bleeding in acute ischemic stroke patients with mechanical heart valves compared to restarting VKA without heparin?
Bridging therapy with heparin in acute ischemic stroke patients with mechanical heart valves does not improve outcomes and may marginally increase the risk of ischemic or hemorrhagic events compared to restarting VKA alone.
Paciaroni et al. (2023) studied this question.