title: Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation: A Prospective Magnetic Resonance Imaging Study.
abstract: Early anticoagulation after cardioembolic stroke remains controversial because of the potential for hemorrhagic transformation (HT). We tested the safety and feasibility of initiating rivaroxaban ≤14 days after cardioembolic stroke/transient ischemic attack.
  
  
  
  A prospective, open-label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of transient ischemic attack or ischemic stroke (National Institute of Health Stroke Scale <9). All patients underwent magnetic resonance imaging <24 hours of rivaroxaban initiation and day 7. The primary end point was symptomatic HT at day 7.
  
  
  
  Sixty patients (mean±SD age 71±19 years, 82% stroke/18% transient ischemic attack) were enrolled. Median (interquartile range) time from onset to rivaroxaban was 3 (5) days. At treatment initiation, median National Institute of Health Stroke Scale was 2 (4), and median diffusion-weighted imaging volume was 7.9 (13.7) mL. At baseline, HT was present in 25 (42%) patients (hemorrhagic infarct [HI]1=19, HI2=6). On follow-up magnetic resonance imaging, no patients developed symptomatic HT. New asymptomatic HI1 developed in 3 patients, and asymptomatic progression from HI1 to HI2 occurred in 5 patients; otherwise, HT remained unchanged at day 7.
  
  
  
  These data support the safety of rivaroxaban initiation ≤14 days of mild-moderate cardioembolic stroke/transient ischemic attack. Magnetic resonance imaging evidence of petechial HT, which is common, does not appear to increase the risk of symptomatic HT.
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Gioia
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kate
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Leka
authors.initials: L
authors.lastname: Sivakumar
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Dulara
authors.initials: D
authors.lastname: Hussain
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Hayrapet
authors.initials: H
authors.lastname: Kalashyan
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Buck
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Miguel
authors.initials: M
authors.lastname: Bussiere
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Emery
authors.affiliation: From the Division of Neurology, University of Montreal, Montreal, Canada (L.C.G.); and Division of Neurology (M.K., L.S., D.H., H.K., B.B., M.B., T.J., A.S., K.B.), and Department of Diagnostic Imaging (D.E.), University of Alberta, Alberta, Canada. ken.butcher@ualberta.ca.
authors.forename: Ken
authors.initials: K
authors.lastname: Butcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000209:etiology; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011446:Prospective Studies; D012008:Recurrence; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
keywords: atrial fibrillation; cerebrovascular disease; magnetic resonance imaging; stroke; transient ischemic attack