Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry.

Autor:	Ramos-Araque ME; Department of Neurology, Institute of Biomedical Research of Salamanca, Hospital Universitario de Salamanca, Salamanca, Spain.; Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Chavarría-Miranda A; Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Gómez-Vicente B; Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., López-Cancio Martínez E; Department of Neurology, Stroke Unit, Hospital Universitario Central de Asturias, Oviedo, Spain., Castañón Apilánez M; Department of Neurology, Stroke Unit, Hospital Universitario Central de Asturias, Oviedo, Spain., Castellanos M; A Coruña Biomedical Research Institute/A Coruña University Hospital, A Coruña, Spain., López Fernández M; A Coruña Biomedical Research Institute/A Coruña University Hospital, A Coruña, Spain., Tejada Meza H; Department of Neurology, Stroke Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain.; Department of Radiology, Neurointerventionism Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain., Marta Moreno J; Department of Neurology, Stroke Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain.; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain., Tejada García J; Department of Neurology, Complejo Asistencial Universitario de León, León, Spain., Beltrán Rodríguez I; Department of Neurology, Complejo Asistencial Universitario de León, León, Spain., de la Riva P; Department of Neurology, Donostia University Hospital, San Sebastián, Spain., Díez N; Department of Neurology, Donostia University Hospital, San Sebastián, Spain., Arias Rivas S; Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain., Santamaría Cadavid M; Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain., Bravo Anguiano Y; Department of Neurology, Hospital Universitario de Burgos, Burgos, Spain., Bártulos Iglesias M; Department of Neurology, Hospital Universitario de Burgos, Burgos, Spain., Palacio Portilla EJ; Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Revilla García M; Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Timiraos Fernández JJ; Department of Neurology, Stroke Unit, Hospital Universitario de Araba, Vitoria, Spain., Arenaza Basterrechea N; Department of Neurology, Stroke Unit, Hospital Universitario de Araba, Vitoria, Spain., Maciñeiras Montero JL; Department of Neurology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain., Vicente Alba P; Department of Neurology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain., Julián Villaverde FJ; Department of Neurology, Hospital San Pedro, La Rioja, Spain., Pinedo Brochado A; Department of Neurology, Hospital Galdakao-Usansolo, Bizkaia, Spain., Azkune I; Department of Neurology, Hospital Galdakao-Usansolo, Bizkaia, Spain., Mar FM; Neurovascular Group, Neurology Department, Biocruces Research Health Institute, Cruces Hospital, Barakaldo, Spain., Luna A; Neurovascular Group, Neurology Department, Biocruces Research Health Institute, Cruces Hospital, Barakaldo, Spain., Arenillas JF; Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.; Clinical Neurosciences Research Group, Department of Medicine, University of Valladolid, Valladolid, Spain.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2020 Nov 26; Vol. 11, pp. 594251. Date of Electronic Publication: 2020 Nov 26 (Print Publication: 2020).
DOI:	10.3389/fneur.2020.594251
Abstrakt:	Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01-3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months. Competing Interests: JA reports having received speaker or consultant honoraria by: BI, Bayer, Daiichy Sankyo, Pfizer, Amgen, Medtronic. MC has received speaker honoraria from Pfizer-BristolMyers Squibb, Daichii-Sankyo, and Boehringer-Ingelheim, and for providing consultancy on advisory board meetings from Amgen and Allergan. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2020 Ramos-Araque, Chavarría-Miranda, Gómez-Vicente, López-Cancio Martínez, Castañón Apilánez, Castellanos, López Fernández, Tejada Meza, Marta Moreno, Tejada García, Beltrán Rodríguez, de la Riva, Díez, Arias Rivas, Santamaría Cadavid, Bravo Anguiano, Bártulos Iglesias, Palacio Portilla, Revilla García, Timiraos Fernández, Arenaza Basterrechea, Maciñeiras Montero, Vicente Alba, Julián Villaverde, Pinedo Brochado, Azkune, Mar, Luna and Arenillas.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu