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Sheehan OC, Kyne L, Kelly LA, Hannon N, Marnane M, Merwick A, McCormack PM, Duggan J, Moore A, Moroney J, Daly L, Harris D, Horgan G, Williams EB, Kelly PJ. Population-Based Study of ABCD
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Score, Carotid Stenosis, and Atrial Fibrillation for Early Stroke Prediction After Transient Ischemic Attack. Stroke 2010; 41:844-50. [PMID: 20299667 DOI: 10.1161/strokeaha.109.571844] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orla C. Sheehan
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Lorraine Kyne
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Lisa A. Kelly
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Niamh Hannon
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Michael Marnane
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Aine Merwick
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Patricia M.E. McCormack
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Joseph Duggan
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Alan Moore
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Joan Moroney
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Leslie Daly
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Dawn Harris
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Gillian Horgan
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Emma B. Williams
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
| | - Peter J. Kelly
- From the Neurovascular Clinical Science Unit (O.C.S., L.K., L.A.K., N.H., M.M., A. Merwick, J.D., D.H., G.H., E.B.W., P.J.K.), Mater University Hospital/University College Dublin; Connolly Hospital (P.M.E.M.); Beaumont Hospital (A. Moore, J.M.); and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health and Population Science (L.D.), University College Dublin, Dublin, Ireland
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Sandercock PAG, Gibson LM, Liu M. Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack. Cochrane Database Syst Rev 2009; 2009:CD000248. [PMID: 19370555 PMCID: PMC7066483 DOI: 10.1002/14651858.cd000248.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND After a first ischaemic stroke, further vascular events due to thromboembolism are common and often fatal. Anticoagulants could potentially reduce the risk of such events, but any benefits could be offset by an increased risk of fatal or disabling haemorrhages. OBJECTIVES To assess the effect of prolonged anticoagulant therapy compared with placebo or open control following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register in May 2008. In June 2008 we searched three online trial registers, used Web of Science Cited Reference Search to identify new citations of previously included studies, contacted a pharmaceutical company, and also contacted authors for additional information on included trials. SELECTION CRITERIA Randomised and quasi-randomised trials comparing at least one month of anticoagulant therapy with control in people with previous, presumed non-cardioembolic, ischaemic stroke or transient ischaemic attack. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS Eleven trials involving 2487 participants were included. The quality of the nine trials which predated routine computerised tomography (CT) scanning and the use of the International Normalised Ratio to monitor anticoagulation was poor. There was no evidence of an effect of anticoagulant therapy on either the odds of death or dependency (two trials, odds ratio (OR) 0.83, 95% confidence interval (CI) 0.52 to 1.34) or of 'non-fatal stroke, myocardial infarction, or vascular death' (four trials, OR 0.96, 95% CI 0.68 to 1.37). Death from any cause (OR 0.95, 95% CI 0.73 to 1.24) and death from vascular causes (OR 0.86, 95% CI 0.66 to 1.13) were not significantly different between treatment and control. The inclusion of two recently completed trials did not alter these conclusions. There was no evidence of an effect of anticoagulant therapy on the risk of recurrent ischaemic stroke (OR 0.85, 95% CI 0.66 to 1.09). However, anticoagulants increased fatal intracranial haemorrhage (OR 2.54, 95% CI 1.19 to 5.45), and major extracranial haemorrhage (OR 3.43, 95% CI 1.94 to 6.08). This is equivalent to anticoagulant therapy causing about 11 additional fatal intracranial haemorrhages and 25 additional major extracranial haemorrhages per year for every 1000 patients given anticoagulant therapy. AUTHORS' CONCLUSIONS Compared with control, there was no evidence of benefit from long-term anticoagulant therapy in people with presumed non-cardioembolic ischaemic stroke or transient ischaemic attack, but there was a significant bleeding risk.
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Affiliation(s)
- Peter A G Sandercock
- Division of Clinical Neurosciences, University of Edinburgh, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
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