Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

Zapata-Wainberg, Gustavo; Ximénez-Carrillo, Álvaro; Trillo, S.; Fuentes, Blanca; Culebras, Antonio; Aguirre, Clara; Leciñana, María Alonso de; Vera, Rocío; Bárcena, Eduardo; Fernández-Prieto, Andrés; Méndez-Cendón, J.C.; Caniego, José Luis; Díez‐Tejedor, Exuperio; Masjuán, Jaime; Vivancos, José

doi:10.1136/neurintsurg-2017-013504

Cited by 32 publications

(38 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In accordance with other authors [12,13,24], rates of recanalization were similar between anticoagulated and non-anticoagulated patients. Furthermore, after 3 months of follow-up, no significant differences were observed in rates of mortality or independent outcome (mRS score ≤2) in anticoagulated patients compared to non-anticoagulated patients.…”

Section: Discussionsupporting

confidence: 76%

“…Furthermore, after 3 months of follow-up, no significant differences were observed in rates of mortality or independent outcome (mRS score ≤2) in anticoagulated patients compared to non-anticoagulated patients. Benavente et al [24] reported a trend towards improved survival rates among anticoagulated patients following mechanical thrombectomy, while studies on mixed thrombectomy and thrombolysis cohorts have reported either a trend towards higher mortality rates [13] or no differences [12].…”

Section: Discussionmentioning

confidence: 99%

“…However, studies of mechanical thrombectomy in therapeutically anticoagulated patients report mainly on cohorts that receive intravenous or intra-arterial tPA concomitantly with endovascular thrombectomy [11][12][13][14][15][16][17][18]. Therefore, the safety of thrombectomy in anticoagulated patients ineligible for thrombolysis is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the safety of thrombectomy in anticoagulated patients ineligible for thrombolysis is largely unknown. This knowledge is of significant clinical importance, given that more than 1 in 5 patients presenting with acute ischaemic stroke who are candidates for endovascular therapy may be anticoagulated in clinical practice [12].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

et al. 2018

View full text Add to dashboard Cite

Background/Aim: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis. Methods: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic stroke patients undergoing mechanical thrombectomy from January 2008 to June 2017. Patients receiving any dose of intravenous or intra-arterial thrombolysis were excluded. Patients taking oral anticoagulants (VKAs or DOACs) were compared with non-anticoagulated patients. Outcomes compared between groups included the rate of intracerebral haemorrhage (ICH) on follow-up imaging (ICHany), symptomatic ICH, functional independence at 90 days (modified Rankin scale score, 0–2), mortality, and post-treatment recanalization (Thrombolysis in Cerebral Infarction score ≥2b). Results: In all, 102 patients undergoing mechanical thrombectomy without prior thrombolysis were included in the study. Sixty-six (64.7%) patients were not anticoagulated, 23 (22.5%) patients were taking VKAs, and 13 (12.7%) patients were taking DOACs. There were no significant differences in the rate of ICHany (11.1 vs. 13.6%, p = 0.93) or sICH (2.8 vs. 1.5%, p = 0.14) in anticoagulated patients compared to non-anticoagulated patients. No cases of sICH were observed among patients taking DOACs. After 90 days of follow-up, the rates of functional independence (50.0 vs. 43.1%) and mortality (27.8 vs. 25.8%) were also similar between the anticoagulation and the non-anticoagulation groups. Conclusion: Mechanical thrombectomy appears to be safe and effective in anticoagulated patients ineligible for thrombolysis, with observed haemorrhage rates similar to those of patients not on anticoagulant therapy. However, further multicentre prospective studies are needed, due to the rising number of patients on warfarin and DOACs worldwide.

show abstract

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The mean INR value of patients on warfarin was 1.81 (median 1.78) in the present study. Other authors reported mean values of 2.0 (Rebello et al 5 ) and 1.91 (Zapata-Wainberg et al 9 ) and, the median values of 1.79 (De Marchis et al 3 ) and 2.1 (Kurowski et al 7 ). The present group of 26 patients on OAC is too small to determine a possible dependency of SICH on a particular INR value; however, as found repeatedly in patients on warfarin with INR 1.7, treated with IVT, the INR value did not differ between patients with and without SICH, 29e31 and Benavente et al 6 reported no difference in the occurrence of SICH also in patients with INR <1.7/!1.7 treated with MT.…”

Section: Discussionmentioning

confidence: 92%

Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke

et al. 2019

View full text Add to dashboard Cite

To assess the safety and efficacy of mechanical thrombectomy (MT) with stentretrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC. MATERIALS AND METHODS: The present retrospective study comprised 285 consecutive patients (115 males; mean age 74AE13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score !2b), post-treatment imaging findings. The 90-day clinical outcome was assessed using modified Rankin scale (good outcome defined as 0e2). RESULTS: The following statistically insignificant differences were found in 26 patients on OAC versus 259 patients without OAC: occurrence of symptomatic intracerebral haemorrhage 7.7% versus 8.1%, achievement of successful recanalisation 69.2% versus 82.6%, good 90-day clinical outcome 34.6% versus 56.8%, 90-day mortality 26.9% versus 20.8% (p>0.05 in all cases). Age and neurological deficit at the time of treatment were identified as independent negative predictors of good 90-day clinical outcome (odds ratio [OR]¼0.90, 95% confidence interval [CI]: 0.88e0.94 and OR¼0.83, 95% CI: 0.77e0.90, respectively) and as independent positive predictors of mortality (OR¼1.12, 95% CI: 1.06e1.18 and, OR¼1.17, 95% CI: 1.07e1.27, respectively; p<0.05 in all cases).

show abstract

Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke

Grory

Holmes

Matsouaka

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.ObjectiveTo determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.Design, Setting, and ParticipantsRetrospective, observational cohort study based on the American Heart Association’s Get With the Guidelines–Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.ExposureVKA use within the 7 days prior to hospital arrival.Main Outcome and MeasuresThe primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion therapy, in-hospital mortality, and in-hospital mortality or discharge to hospice.ResultsOf 32 715 patients (median age, 72 years; 50.7% female), 3087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29 628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211/3087 patients [6.8%] taking a VKA compared with 1904/29 628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, −0.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n = 1585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, −0.79% to 3.04%]). Of 5 prespecified secondary end points, none showed a significant difference across VKA-exposed vs VKA-unexposed groups.Conclusions and RelevanceAmong patients with acute ischemic stroke selected to receive EVT, VKA use within the preceding 7 days was not associated with a significantly increased risk of sICH overall. However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants.

show abstract

Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

Abstract: Mechanical thrombectomy is feasible in anticoagulated patients with acute ischemic stroke. The outcomes and safety profile are similar to those of patients with no prior anticoagulation therapy.

Cited by 32 publications

References 35 publications

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke

Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke

Contact Info

Product

Resources

About