Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Taking Warfarin with Subtherapeutic INR

Mowla, Ashkan; Memon, Aurangzeb; Razavi, Seyed Mostafa; Lail, Navdeep S.; Vaughn, Caila B.; Mohammadi, Pegah; Sawyer, Robert N.; Shirani, Peyman

doi:10.1016/j.jstrokecerebrovasdis.2021.105678

Cited by 12 publications

(5 citation statements)

References 39 publications

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“…Of note, a valid comparison of functional outcomes between dMT and BT groups could be made only if all patients in both groups met the criteria for IV tPA administration. Obviously, including IV tPA-ineligible patients, such as patients taking anti-coagulants or with other contraindications [ 60 , 61 , 62 , 63 , 64 , 65 , 66 ] in the dMT group might result in poorer outcomes and affect the final comparisons [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Kolahchi

Rahimian

Momtazmanesh

et al. 2023

Life

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Background: The current guideline recommends using an intravenous tissue-type plasminogen activator (IV tPA) prior to mechanical thrombectomy (MT) in eligible acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). Some recent studies found no significant differences in the long-term functional outcomes between bridging therapy (BT, i.e., IV tPA prior to MT) and direct MT (dMT). Methods: We conducted a systematic review and meta-analysis to compare the safety and functional outcomes between BT and dMT in AIS patients with ELVO who were eligible for IV tPA administration. Based on the ELVO location, patients were categorized as the anterior group (occlusion of the anterior circulation), or the combined group (occlusion of the anterior and/or posterior circulation). A subgroup analysis was performed based on the study type, i.e., RCT and non-RCT. Results: Thirteen studies (3985 patients) matched the eligibility criteria. Comparing the BT and dMT groups, no significant differences in terms of mortality and good functional outcome were observed at 90 days. Symptomatic intracranial hemorrhagic (sICH) events were more frequent in BT patients in the combined group (OR = 0.73, p = 0.02); this result remained significant only in the non-RCT subgroup (OR = 0.67, p = 0.03). The RCT subgroup had a significantly higher rate of successful revascularization in BT patients (OR = 0.73, p = 0.02). Conclusions: Our meta-analysis uncovered no significant differences in functional outcome and mortality rate at 90 days between dMT and BT in patients with AIS who had ELVO. Although BT performed better in terms of successful recanalization rate, there is a risk of increased sICH rate in this group.

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Section: Discussionmentioning

confidence: 99%

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Kolahchi

Rahimian

Momtazmanesh

et al. 2023

Life

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“…Patients with substantial thrombocytopenia (<100 × 10 9 /L) have been generally excluded from AIS treatment with intravenous tissue-type plasminogen activator (IV tPA) clinical studies since it has been considered a relative contraindication [ 91 ]. IV tPA is the sole FDA-approved pharmacological therapy for AIS and its safety and efficacy have been studied in various settings [ [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] ]. Previous studies reported that the risk of symptomatic intracerebral hemorrhage (sICH) might be higher in AIS patients with severe thrombocytopenia who were treated with IV tPA, compared to those without thrombocytopenia [ 105 , 106 ].…”

Section: Resultsmentioning

confidence: 99%

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

Kolahchi

Khanmirzaei

Mowla

2022

Journal of the Neurological Sciences

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“…Sixth, the window for treatment with OEA in our trial was within 12 hours following the onset of stroke symptoms; earlier treatment may have different efficacy. Finally, IV thrombolytics are the only Oxidative Medicine and Cellular Longevity FDA-approved pharmacological treatment for acute ischemic stroke [50][51][52][53][54][55][56][57][58][59][60] and roughly half of our patients received this treatment given they were eligible. Thus, this treatment might have influenced our results.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Oleoylethanolamide (OEA) Add-On Treatment on Inflammatory, Oxidative Stress, Lipid, and Biochemical Parameters in the Acute Ischemic Stroke Patients: Randomized Double-Blind Placebo-Controlled Study

Sabahi

Ahmadi

Kazemi

et al. 2022

Oxidative Medicine and Cellular Longevity

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Background and Objective. There is a growing body of evidence for the efficacy of oleoylethanolamide (OEA) in patients with inflammatory disorders. The present randomized double-blind placebo-controlled study is aimed at evaluating the efficacy of OEA add-on treatment in patients with acute ischemic stroke (AIS). Methods. Sixty patients with a mean age of 68.60 ± 2.10 comprising 29 females (48.33%), who were admitted to an academic tertiary care facility within the first 12 hours poststroke symptoms onset or last known well (LKW), in case symptom onset time is not clear, were included in this study. AIS was confirmed based on a noncontrast head CT scan and also neurological symptoms. Patients were randomly and blindly assigned to OEA of 300 mg/day ( n = 20 ) or 600 mg/day ( n = 20 ) or placebo ( n = 20 ) in addition to the standard AIS treatment for three days. A blood sample was drawn at 12 hours from symptoms onset or LKW as the baseline followed by the second blood sample at 72 hours post symptoms onset or LKW. Blood samples were assessed for inflammatory and biochemical parameters, oxidative stress (OS) biomarkers, and lipid profile. Results. Compared to the baseline, there is a significant reduction in the urea, creatinine, triglyceride, high-density lipoprotein, cholesterol, alanine transaminase, total antioxidant capacity, malondialdehyde (MDA), total thiol groups (TTG), interleukin-6 (IL-6), and C-reactive protein levels on the follow-up blood testing in the OEA (300 mg/day) group. In patients receiving OEA (600 mg/day) treatment, there was only a significant reduction in the MDA level comparing baseline with follow-up blood testing. Also, the between-group analysis revealed a statistically significant difference between patients receiving OEA (300 mg/day) and placebo in terms of IL-6 and TTG level reduction when comparing them between baseline and follow-up blood testing. Conclusion. OEA in moderate dosage, 300 mg/day, add-on to the standard stroke treatment improves short-term inflammatory, OS, lipid, and biochemical parameters in patients with AIS. This effect might lead to a better long-term neurological prognosis.

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Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Taking Warfarin with Subtherapeutic INR

Cited by 12 publications

References 39 publications

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

The Effect of Oleoylethanolamide (OEA) Add-On Treatment on Inflammatory, Oxidative Stress, Lipid, and Biochemical Parameters in the Acute Ischemic Stroke Patients: Randomized Double-Blind Placebo-Controlled Study

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