Recanalization Therapies in Acute Ischemic Stroke Patients. Issue 13 (29th September 2015)

• Record Type: Journal Article
• Authors: Seiffge, David J.; Hooff, Robbert-JanVan; Nolte, Christian H.; Béjot, Yannick; Turc, Guillaume; Ikenberg, Benno; Berge, Eivind; Persike, Malte; Dequatre-Ponchelle, Nelly; Strbian, Daniel; Pfeilschifter, Waltraud; Zini, Andrea; Tveiten, Arnstein; Næss, Halvor; Michel, Patrik; Sztajzel, Roman; Luft, Andreas; Gensicke, Henrik; Traenka, Christopher; Hert, Lisa; Scheitz, Jan F.; De Marchis, Gian Marco; Bonati, Leo H.; Peters, Nils; Charidimou, Andreas; Werring, David J.; Palm, Frederick; Reinhard, Matthias; Niesen, Wolf-Dirk; Nagao, Takehiko; Pezzini, Alessandro; Caso, Valeria; Nederkoorn, Paul J.; Kägi, Georg; von Hessling, Alexander; Padjen, Visnja; Cordonnier, Charlotte; Erdur, Hebun; Lyrer, Philippe A.; Brouns, Raf; Steiner, Thorsten; Tatlisumak, Turgut; Engelter, Stefan T.;
• Is Part Of: Circulation. Volume 132:Issue 13(2015)
• Publication Date: 2015-09-29
• Subjects: Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.115.015484
• Languages: English
• ISSNs: 0009-7322

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>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).</p> </sec> <sec> <title>Methods and Results—</title> <p>This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICH<sub>any</sub>), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICH<sub>ECASS-II</sub>) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICH<sub>NINDS</sub>); 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<sub>any</sub> was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICH<sub>ECASS-II</sub> and sICH<sub>NINDS</sub> 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.</p> </sec> <sec> <title>Conclusions—</title> <p>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.</p> </sec> </abstract>