title: Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The role of anticoagulant treatment for acute cardioembolic stroke is uncertain. We performed an updated meta-analysis of all randomized trials to obtain the best estimates of the efficacy and safety of anticoagulants for the initial treatment of acute cardioembolic stroke.
  
  
  METHODS
  Using electronic and manual searches of the literature, we identified randomized trials comparing anticoagulants (unfractionated heparin or low-molecular-weight heparin or heparinoids), started within 48 hours, with other treatments (aspirin or placebo) in patients with acute ischemic cardioembolic stroke. Two reviewers independently selected studies and extracted data on study design, quality, and clinical outcomes, including death or disability, all strokes, recurrent ischemic stroke, and cerebral symptomatic bleeding. Odds ratios for individual outcomes were calculated for each trial and data from all the trials were pooled using the Mantel-Haenszel method.
  
  
  RESULTS
  Seven trials, involving 4624 patients with acute cardioembolic stroke, met the criteria for inclusion. Compared with other treatments, anticoagulants were associated with a nonsignificant reduction in recurrent ischemic stroke within 7 to 14 days (3.0% versus 4.9%, odds ratio 0.68, 95% CI: 0.44 to 1.06, P=0.09, number needed to treat=53), a significant increase in symptomatic intracranial bleeding (2.5% versus 0.7%, odds ratio 2.89; 95% CI: 1.19 to 7.01, P=0.02, number needed to harm=55), and a similar rate of death or disability at final follow up (73.5% versus 73.8%, odds ratio 1.01; 95% CI: 0.82 to 1.24, P=0.9).
  
  
  CONCLUSIONS
  Our findings indicate that in patients with acute cardioembolic stroke, early anticoagulation is associated with a nonsignificant reduction in recurrence of ischemic stroke, no substantial reduction in death and disability, and an increased intracranial bleeding.
authors.affiliation: Stroke Unit, Department of Internal Medicine, University of Perugia, Perugia, Italy. mpaciaroni@libero.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Sara
authors.initials: S
authors.lastname: Micheli
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D004617:Embolism / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants