Mechanical Thrombectomy in Patients with Acute Ischemic Stroke on Anticoagulation Therapy

Černík, David; Šaňák, Daniel; Divišová, Petra; Köcher, Martin; Cihlář, Filip; Zapletalová, Jana; Veverka, Tomáš; Prcúchová, Andrea; Ospalík, Dušan; Černá, Marie; Janoušová, Petra; Král, Michal; Dorňák, Tomáš; Prasil, Vojtech; Franc, David; Kaňovský, Petr

doi:10.1007/s00270-018-1902-7

Cited by 22 publications

(19 citation statements)

References 20 publications

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“…We found that therapeutic anticoagulation in AF patients at the time of stroke did not adversely influence outcome. This finding is similar to several studies, including thrombolysis-ineligible patients [23][24][25][26][27] .…”

Section: Discussionsupporting

confidence: 92%

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Fu¹,

Cappelen‐Smith²,

Edwards³

et al. 2021

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Aim: Patients with atrial fibrillation (AF) are over-represented in endovascular thrombectomy (EVT) populations, due to a high prevalence of large vessel occlusions (LVO) and contraindication to intravenous thrombolysis. This study aimed to: (1) compare 90-day functional outcomes [modified Rankin Score (mRS) 0-2] and mortality in AF vs. non-AF patients receiving EVT; (2) compare 90-day functional outcomes and mortality in AF patients on therapeutic vs. non-therapeutic anticoagulation receiving EVT; and (3) identify factors influencing outcomes in AF patients receiving EVT.Methods: A retrospective analysis of 394 consecutive patients who received EVT for anterior cerebral circulation LVO at an Australian comprehensive stroke center was performed. The main outcome measures [90-day dichotomized mRS (0-2 good; 3-6 poor functional outcome) and mortality] were compared between AF and non-AF patients, as well as between therapeutic and non-therapeutic anticoagulation cohorts.Results: In total, 171 (49%) EVT patients had AF. Patients with AF were older, had higher NIHSS, and had lower rates of thrombolysis administration. AF patients showed improved 90-day mRS on multivariate analysis [aOR 1.988 (1.167-3.387)], with similar symptomatic intracranial hemorrhage (sICH) [aOR 0.364 (0.064-2.086)] and mortality ]. There was no difference in 90-day mRS ], successful reperfusion rates )], or mortality [aOR 1.077 (0.429-2.705)] between AF patients on therapeutic vs. non-therapeutic anticoagulation. In patients with AF, advancing age and higher NIHSS were independent predictors of worse 90-day functional outcome (OR = 1.045, P = 0.020; OR = 1.086, P = 0.001) and mortality (OR = 1.138, P < 0.001; OR = 1.107, P = 0.002). On multivariate analysis, thrombolysis administration improved mortality (OR = 0.215, P = 0.016) but not functional outcomes. Conclusion:Patients with AF showed improved 90-day functional outcome, with similar mortality and sICH, after EVT. Therapeutic anticoagulation did not adversely influence EVT outcomes.

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Section: Discussionsupporting

confidence: 92%

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Fu¹,

Cappelen‐Smith²,

Edwards³

et al. 2021

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“…This statistically insignificant difference may be caused by several factors: the present cohort with OAC was older (75 versus 71.1 years), with more comorbidities (more frequent occurrence of arterial hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease, atrial fibrillation, and history of previous stroke/TIA) and, none of them suffered from tandem pathology. Less frequent achievement of good clinical outcome in patients with OAC versus those without OAC was also reported by other authors, e.g., 30% versus 40% (Rebello et al 5 ), 47% versus 55% (Benavente et al 6 ), and 36% versus 49% ( Cerník et al 8 ). The mean INR value of patients on warfarin was 1.81 (median 1.78) in the present study.…”

Section: Discussionsupporting

confidence: 72%

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

et al. 2019

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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).

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“…In this cohort of 234 patients who underwent thrombectomy for acute ischemic stroke, over half were on antithrombotics pre-admission, consistent with prior reported rates of anticoagulation and antiplatelet use pre-admission in this population [11][12][13][14][15][16][17]. Pre-admission antithrombotic use was associated with worse 3-month mRS scores even when controlling for initial NIHSS score, post-procedure ASPECTS score, and age at admission, but did not affect any other measure of radiographic or functional outcome.…”

Section: Discussionsupporting

confidence: 82%

“…Of patients who undergo thrombectomy for acute ischemic stroke, 20-34% are on antiplatelets and 13-23% are on anticoagulation pre-admission [11][12][13][14][15][16][17]. Antithrombotics can alter clot composition, allowing for easier lysis, which could improve recanalization [7,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…[13] In studies on the impact of preadmission anticoagulation use in patients who underwent thrombectomy for acute ischemic stroke, some investigators found no increased risk of ICH and no difference in 3-month mRS scores or mortality [15,16]. However, Černík et al found that pre-admission anticoagulation use was associated with worse 3-month mRS score despite faster recanalization time [17]. In a systematic review and meta-analysis, Liu et al reported anticoagulation use preadmission was associated was lower likelihood of good functional outcome at 3-months after thrombectomy for acute ischemic stroke [22].…”

Section: Introductionmentioning

confidence: 99%

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Pre-admission antithrombotic use is associated with 3-month mRS score after thrombectomy for acute ischemic stroke

Krieger

Melmed

Torres

et al. 2022

J Thromb Thrombolysis

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In patients who undergo thrombectomy for acute ischemic stroke, the relationship between pre-admission antithrombotic (anticoagulation or antiplatelet) use and both radiographic and functional outcome is not well understood. We sought to explore the relationship between pre-admission antithrombotic use in patients who underwent thrombectomy for acute ischemic stroke at two medical centers in New York City between December 2018 and November 2020. Analyses were performed using analysis of variance and Pearson's chi-squared tests. Of 234 patients in the analysis cohort, 65 (28%) were on anticoagulation, 64 (27%) were on antiplatelet, and 105 (45%) with no antithrombotic use pre-admission. 3-month Modified Rankin Scale (mRS) score of 3-6 was associated with pre-admission antithrombotic use (71% anticoagulation vs. 77% antiplatelet vs. 56% no antithrombotic, p = 0.04). There was no relationship between pre-admission antithrombotic use and Thrombolysis in Cerebral Iinfarction (TICI) score, post-procedure Alberta Stroke Program Early CT Score (ASPECTS) score, rate of hemorrhagic conversion, length of hospital admission, discharge NIH Stroke Scale (NIHSS), discharge mRS score, or mortality. When initial NIHSS score, post-procedure ASPECTS score, and age at admission were included in multivariate analysis, pre-admission antithrombotic use was still significantly associated with a 3-month mRS score of 3-6 (OR 2.36, 95% CI 1.03-5.54, p = 0.04). In this cohort of patients with acute ischemic stroke who underwent thrombectomy, pre-admission antithrombotic use was associated with 3-month mRS score, but no other measures of radiographic or functional outcome. Further research is needed on the relationship between use of specific anticoagulation or antiplatelet agents and outcome after acute ischemic stroke, but moreover, improve stroke prevention.

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Mechanical Thrombectomy in Patients with Acute Ischemic Stroke on Anticoagulation Therapy

Abstract: MT seems to be safe also in patients on AT. Poor outcome may be related to higher admission NIHSS, higher rate of SICH and presence of atrial fibrillation.

Cited by 22 publications

References 20 publications

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation

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

Pre-admission antithrombotic use is associated with 3-month mRS score after thrombectomy for acute ischemic stroke

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