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Recanalization Therapies in Acute Ischemic Stroke Patients Impact of Prior Treatment With Novel Oral Anticoagulants on Bleeding Complications and Outcome A Pilot Study

Journal article
Authors D. J. Seiffge
R. J. Hooff
C. H. Nolte
Y. Bejot
G. Turc
B. Ikenberg
E. Berge
M. Persike
N. Dequatre-Ponchelle
D. Strbian
W. Pfeilschifter
A. Zini
A. Tveiten
H. Naess
P. Michel
R. Sztajzel
A. Luft
H. Gensicke
C. Traenka
L. Hert
J. F. Scheitz
G. M. De Marchis
L. H. Bonati
N. Peters
A. Charidimou
D. J. Werring
M. Reinhard
W. D. Niesen
T. Nagao
A. Pezzini
V. Caso
P. J. Nederkoorn
G. Kagi
A. von Hessling
V. Padjen
C. Cordonnier
H. Erdur
P. A. Lyrer
R. Brouns
T. Steiner
Turgut Tatlisumak
S. T. Engelter
Published in Circulation
Volume 132
Issue 13
Pages 1261-1269
ISSN 0009-7322
Publication year 2015
Published at Institute of Neuroscience and Physiology
Pages 1261-1269
Language en
Links dx.doi.org/10.1161/circulationaha.1...
Keywords anticoagulants, endovascular procedures, intra-arterial treatment, intracranial hemorrhages, tissue-plasminogen activator, intravenous thrombolysis, intracerebral, hemorrhage, intracranial hemorrhage, atrial-fibrillation, endovascular, thrombectomy, propensity score, iv thrombolysis, dabigatran, management, Cardiovascular System & Cardiology
Subject categories Neurosciences

Abstract

Background-We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results-This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICH any), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICH ECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICH NINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8-22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1-1.6). ICH any was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICH ECASS-II and sICH NINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions-IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.

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