Anticoagulation After Stroke in Patients With Atrial Fibrillation

Riccardo Altavilla, Valeria Caso, Fabio Bandini, Giancarlo Agnelli, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H. Abdul-Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Jessica Fusaro, Paolo BoviMonica Carletti, Alberto Rigatelli, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Luca Masotti, Vieri Vannucchi, Sung Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Gino Gialdini, Tiziana Tassinari, Maria Luisa De Lodovici, Giorgio Bono, Christina Rueckert, Antonio Baldi, Sebastiano D'Anna, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Maurizio Paciaroni

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P<0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.

Original languageEnglish
Pages (from-to)2093-2100
Number of pages8
JournalStroke
Volume50
Issue number8
DOIs
Publication statusPublished - Aug 1 2019

Fingerprint

Atrial Fibrillation
Stroke
Low Molecular Weight Heparin
Odds Ratio
Hemorrhage
Anticoagulants
Therapeutics
Leukoaraiosis
Intracranial Embolism
Transient Ischemic Attack
Observational Studies
Recurrence
Incidence

Keywords

  • anticoagulants
  • atrial fibrillation
  • humans
  • incidence
  • secondary prevention

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Altavilla, R., Caso, V., Bandini, F., Agnelli, G., Tsivgoulis, G., Yaghi, S., ... Paciaroni, M. (2019). Anticoagulation After Stroke in Patients With Atrial Fibrillation. Stroke, 50(8), 2093-2100. https://doi.org/10.1161/STROKEAHA.118.022856

Anticoagulation After Stroke in Patients With Atrial Fibrillation. / Altavilla, Riccardo; Caso, Valeria; Bandini, Fabio; Agnelli, Giancarlo; Tsivgoulis, Georgios; Yaghi, Shadi; Furie, Karen L.; Tadi, Prasanna; Becattini, Cecilia; Zedde, Marialuisa; Abdul-Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Giulia Mosconi, Maria; Anna Cimini, Ludovica; Fusaro, Jessica; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Marcheselli, Simona; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Masotti, Luca; Vannucchi, Vieri; Sohn, Sung Il; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Ntaios, George; Athanasakis, George; Makaritsis, Konstantinos; Karagkiozi, Efstathia; Vadikolias, Konstantinos; Liantinioti, Chrysoula; Chondrogianni, Maria; Mumoli, Nicola; Consoli, Domenico; Galati, Franco; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Corea, Francesco; Ageno, Walter; Bellesini, Marta; Silvestrelli, Giorgio; Ciccone, Alfonso; Lanari, Alessia; Scoditti, Umberto; Denti, Licia; Mancuso, Michelangelo; Maccarrone, Miriam; Ulivi, Leonardo; Orlandi, Giovanni; Giannini, Nicola; Gialdini, Gino; Tassinari, Tiziana; De Lodovici, Maria Luisa; Bono, Giorgio; Rueckert, Christina; Baldi, Antonio; D'Anna, Sebastiano; Toni, Danilo; Letteri, Federica; Giuntini, Martina; Maria Lotti, Enrico; Flomin, Yuriy; Pieroni, Alessio; Kargiotis, Odysseas; Karapanayiotides, Theodore; Monaco, Serena; Maimone Baronello, Mario; Csiba, Laszló; Szabó, Lilla; Chiti, Alberto; Giorli, Elisa; Del Sette, Massimo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Michel, Patrik; Vanacker, Peter; Barlinn, Kristian; Pallesen, Lars Peder; Barlinn, Jessica; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Gourbali, Vanessa; Paciaroni, Maurizio.

In: Stroke, Vol. 50, No. 8, 01.08.2019, p. 2093-2100.

Research output: Contribution to journalArticle

Altavilla, R, Caso, V, Bandini, F, Agnelli, G, Tsivgoulis, G, Yaghi, S, Furie, KL, Tadi, P, Becattini, C, Zedde, M, Abdul-Rahim, AH, Lees, KR, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Giulia Mosconi, M, Anna Cimini, L, Fusaro, J, Bovi, P, Carletti, M, Rigatelli, A, Cappellari, M, Putaala, J, Tomppo, L, Tatlisumak, T, Marcheselli, S, Pezzini, A, Poli, L, Padovani, A, Masotti, L, Vannucchi, V, Sohn, SI, Lorenzini, G, Tassi, R, Guideri, F, Acampa, M, Martini, G, Ntaios, G, Athanasakis, G, Makaritsis, K, Karagkiozi, E, Vadikolias, K, Liantinioti, C, Chondrogianni, M, Mumoli, N, Consoli, D, Galati, F, Sacco, S, Carolei, A, Tiseo, C, Corea, F, Ageno, W, Bellesini, M, Silvestrelli, G, Ciccone, A, Lanari, A, Scoditti, U, Denti, L, Mancuso, M, Maccarrone, M, Ulivi, L, Orlandi, G, Giannini, N, Gialdini, G, Tassinari, T, De Lodovici, ML, Bono, G, Rueckert, C, Baldi, A, D'Anna, S, Toni, D, Letteri, F, Giuntini, M, Maria Lotti, E, Flomin, Y, Pieroni, A, Kargiotis, O, Karapanayiotides, T, Monaco, S, Maimone Baronello, M, Csiba, L, Szabó, L, Chiti, A, Giorli, E, Del Sette, M, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Michel, P, Vanacker, P, Barlinn, K, Pallesen, LP, Barlinn, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Gourbali, V & Paciaroni, M 2019, 'Anticoagulation After Stroke in Patients With Atrial Fibrillation', Stroke, vol. 50, no. 8, pp. 2093-2100. https://doi.org/10.1161/STROKEAHA.118.022856
Altavilla R, Caso V, Bandini F, Agnelli G, Tsivgoulis G, Yaghi S et al. Anticoagulation After Stroke in Patients With Atrial Fibrillation. Stroke. 2019 Aug 1;50(8):2093-2100. https://doi.org/10.1161/STROKEAHA.118.022856
Altavilla, Riccardo ; Caso, Valeria ; Bandini, Fabio ; Agnelli, Giancarlo ; Tsivgoulis, Georgios ; Yaghi, Shadi ; Furie, Karen L. ; Tadi, Prasanna ; Becattini, Cecilia ; Zedde, Marialuisa ; Abdul-Rahim, Azmil H. ; Lees, Kennedy R. ; Alberti, Andrea ; Venti, Michele ; Acciarresi, Monica ; D'Amore, Cataldo ; Giulia Mosconi, Maria ; Anna Cimini, Ludovica ; Fusaro, Jessica ; Bovi, Paolo ; Carletti, Monica ; Rigatelli, Alberto ; Cappellari, Manuel ; Putaala, Jukka ; Tomppo, Liisa ; Tatlisumak, Turgut ; Marcheselli, Simona ; Pezzini, Alessandro ; Poli, Loris ; Padovani, Alessandro ; Masotti, Luca ; Vannucchi, Vieri ; Sohn, Sung Il ; Lorenzini, Gianni ; Tassi, Rossana ; Guideri, Francesca ; Acampa, Maurizio ; Martini, Giuseppe ; Ntaios, George ; Athanasakis, George ; Makaritsis, Konstantinos ; Karagkiozi, Efstathia ; Vadikolias, Konstantinos ; Liantinioti, Chrysoula ; Chondrogianni, Maria ; Mumoli, Nicola ; Consoli, Domenico ; Galati, Franco ; Sacco, Simona ; Carolei, Antonio ; Tiseo, Cindy ; Corea, Francesco ; Ageno, Walter ; Bellesini, Marta ; Silvestrelli, Giorgio ; Ciccone, Alfonso ; Lanari, Alessia ; Scoditti, Umberto ; Denti, Licia ; Mancuso, Michelangelo ; Maccarrone, Miriam ; Ulivi, Leonardo ; Orlandi, Giovanni ; Giannini, Nicola ; Gialdini, Gino ; Tassinari, Tiziana ; De Lodovici, Maria Luisa ; Bono, Giorgio ; Rueckert, Christina ; Baldi, Antonio ; D'Anna, Sebastiano ; Toni, Danilo ; Letteri, Federica ; Giuntini, Martina ; Maria Lotti, Enrico ; Flomin, Yuriy ; Pieroni, Alessio ; Kargiotis, Odysseas ; Karapanayiotides, Theodore ; Monaco, Serena ; Maimone Baronello, Mario ; Csiba, Laszló ; Szabó, Lilla ; Chiti, Alberto ; Giorli, Elisa ; Del Sette, Massimo ; Imberti, Davide ; Zabzuni, Dorjan ; Doronin, Boris ; Volodina, Vera ; Michel, Patrik ; Vanacker, Peter ; Barlinn, Kristian ; Pallesen, Lars Peder ; Barlinn, Jessica ; Deleu, Dirk ; Melikyan, Gayane ; Ibrahim, Faisal ; Akhtar, Naveed ; Gourbali, Vanessa ; Paciaroni, Maurizio. / Anticoagulation After Stroke in Patients With Atrial Fibrillation. In: Stroke. 2019 ; Vol. 50, No. 8. pp. 2093-2100.
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abstract = "Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20{\%}) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3{\%}) reached the combined outcome versus 72 (5.0{\%}) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95{\%} CI, 1.4-3.7; P<0.0001), as well as ischemic (odds ratio, 2.2; 95{\%} CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95{\%} CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.",
keywords = "anticoagulants, atrial fibrillation, humans, incidence, secondary prevention",
author = "Riccardo Altavilla and Valeria Caso and Fabio Bandini and Giancarlo Agnelli and Georgios Tsivgoulis and Shadi Yaghi and Furie, {Karen L.} and Prasanna Tadi and Cecilia Becattini and Marialuisa Zedde and Abdul-Rahim, {Azmil H.} and Lees, {Kennedy R.} and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D'Amore and {Giulia Mosconi}, Maria and {Anna Cimini}, Ludovica and Jessica Fusaro and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Manuel Cappellari and Jukka Putaala and Liisa Tomppo and Turgut Tatlisumak and Simona Marcheselli and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Luca Masotti and Vieri Vannucchi and Sohn, {Sung Il} and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and George Ntaios and George Athanasakis and Konstantinos Makaritsis and Efstathia Karagkiozi and Konstantinos Vadikolias and Chrysoula Liantinioti and Maria Chondrogianni and Nicola Mumoli and Domenico Consoli and Franco Galati and Simona Sacco and Antonio Carolei and Cindy Tiseo and Francesco Corea and Walter Ageno and Marta Bellesini and Giorgio Silvestrelli and Alfonso Ciccone and Alessia Lanari and Umberto Scoditti and Licia Denti and Michelangelo Mancuso and Miriam Maccarrone and Leonardo Ulivi and Giovanni Orlandi and Nicola Giannini and Gino Gialdini and Tiziana Tassinari and {De Lodovici}, {Maria Luisa} and Giorgio Bono and Christina Rueckert and Antonio Baldi and Sebastiano D'Anna and Danilo Toni and Federica Letteri and Martina Giuntini and {Maria Lotti}, Enrico and Yuriy Flomin and Alessio Pieroni and Odysseas Kargiotis and Theodore Karapanayiotides and Serena Monaco and {Maimone Baronello}, Mario and Laszl{\'o} Csiba and Lilla Szab{\'o} and Alberto Chiti and Elisa Giorli and {Del Sette}, Massimo and Davide Imberti and Dorjan Zabzuni and Boris Doronin and Vera Volodina and Patrik Michel and Peter Vanacker and Kristian Barlinn and Pallesen, {Lars Peder} and Jessica Barlinn and Dirk Deleu and Gayane Melikyan and Faisal Ibrahim and Naveed Akhtar and Vanessa Gourbali and Maurizio Paciaroni",
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TY - JOUR

T1 - Anticoagulation After Stroke in Patients With Atrial Fibrillation

AU - Altavilla, Riccardo

AU - Caso, Valeria

AU - Bandini, Fabio

AU - Agnelli, Giancarlo

AU - Tsivgoulis, Georgios

AU - Yaghi, Shadi

AU - Furie, Karen L.

AU - Tadi, Prasanna

AU - Becattini, Cecilia

AU - Zedde, Marialuisa

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy R.

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D'Amore, Cataldo

AU - Giulia Mosconi, Maria

AU - Anna Cimini, Ludovica

AU - Fusaro, Jessica

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Cappellari, Manuel

AU - Putaala, Jukka

AU - Tomppo, Liisa

AU - Tatlisumak, Turgut

AU - Marcheselli, Simona

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Masotti, Luca

AU - Vannucchi, Vieri

AU - Sohn, Sung Il

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Ntaios, George

AU - Athanasakis, George

AU - Makaritsis, Konstantinos

AU - Karagkiozi, Efstathia

AU - Vadikolias, Konstantinos

AU - Liantinioti, Chrysoula

AU - Chondrogianni, Maria

AU - Mumoli, Nicola

AU - Consoli, Domenico

AU - Galati, Franco

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Corea, Francesco

AU - Ageno, Walter

AU - Bellesini, Marta

AU - Silvestrelli, Giorgio

AU - Ciccone, Alfonso

AU - Lanari, Alessia

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Mancuso, Michelangelo

AU - Maccarrone, Miriam

AU - Ulivi, Leonardo

AU - Orlandi, Giovanni

AU - Giannini, Nicola

AU - Gialdini, Gino

AU - Tassinari, Tiziana

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Rueckert, Christina

AU - Baldi, Antonio

AU - D'Anna, Sebastiano

AU - Toni, Danilo

AU - Letteri, Federica

AU - Giuntini, Martina

AU - Maria Lotti, Enrico

AU - Flomin, Yuriy

AU - Pieroni, Alessio

AU - Kargiotis, Odysseas

AU - Karapanayiotides, Theodore

AU - Monaco, Serena

AU - Maimone Baronello, Mario

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Chiti, Alberto

AU - Giorli, Elisa

AU - Del Sette, Massimo

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Michel, Patrik

AU - Vanacker, Peter

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Barlinn, Jessica

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Gourbali, Vanessa

AU - Paciaroni, Maurizio

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P<0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.

AB - Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P<0.0001), as well as ischemic (odds ratio, 2.2; 95% CI, 1.3-3.9; P=0.005) and hemorrhagic (odds ratio, 2.4; 95% CI, 1.2-4.9; P=0.01) end points separately. Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.

KW - anticoagulants

KW - atrial fibrillation

KW - humans

KW - incidence

KW - secondary prevention

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U2 - 10.1161/STROKEAHA.118.022856

DO - 10.1161/STROKEAHA.118.022856

M3 - Article

C2 - 31221054

AN - SCOPUS:85070183947

VL - 50

SP - 2093

EP - 2100

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -