Abstract P20: Bridging Therapy Increases Hemorrhagic Complications Without Improving Functional Outcomes in Atrial Fibrillation Associated Stroke

Abstract

* on behalf of the Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators Introduction: Intravenous thrombolysis complications are enriched in AF associated stroke, as these patients have worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications. These data suggest that AF patients may be at particularly high risk for complications of bridging therapy for large vessel occlusions treated with mechanical thrombectomy (MT). Here we determine whether clinical outcomes differ in AF associated stroke treated with MT and bridging therapy. Methods: We performed a retrospective cohort study of the Stroke and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4,169 patients who underwent MT for an anterior circulation stroke, 1,517 (36.4 %) of which had comorbid AF. Prospectively defined baseline characteristics and clinical outcomes were compared. Results: Hemorrhagic complications after MT were similar in patients with or without AF. In patients without AF, bridging therapy improved 90-day outcomes (aOR 1.32, 1.02-1.74, p<0.05) without increasing hemorrhagic complications. In patients with AF, bridging therapy independently predicted hemorrhagic complications in AF patients (aOR 2.08, 1.06-4.06, p<0.033) without improving functional outcomes. Conclusions: Bridging therapy in AF patients undergoing thrombectomy independently increased the odds of intracranial hemorrhage and did not improve functional outcomes. AF patients may represent a high-risk subgroup for thrombolytic complications. Randomized trials are warranted to determine whether patients with AF associated stroke may benefit by deferring bridging therapy at thrombectomy-capable centers.

Bridging intravenous thrombolysis in patients with atrial fibrillation

“…Recently, Akbik et al reported that patients with AF who underwent treatment with bridging IVT were significantly more associated with an increased risk of symptomatic intracranial hemorrhage (sICH) when compared with patients with non-AF undergoing bridging IVT ( 9 ). There was also no reported benefit in 90-day functional outcome in patients with AF who have received bridging IVT ( 9 ). Therefore, arguing that patients with AF would be a subgroup that might particularly benefit from withholding IVT before MT ( 9 ).…”

“…There was also no reported benefit in 90-day functional outcome in patients with AF who have received bridging IVT ( 9 ). Therefore, arguing that patients with AF would be a subgroup that might particularly benefit from withholding IVT before MT ( 9 ). However, the conducted analysis had not accounted for the use of anticoagulants and the type of anticoagulants that patients with AF were using, which are known to be important in the context of pursuing the bridging approach ( 10 , 11 ).…”