Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes
| Autor: | J Mocco, Frank C. Tong, Marios Psychogios, Travis M. Dumont, Feras Akbik, Stroke Thrombectomy, Peter Kan, Roberto Crosa, Adam S Arthur, Jan Liman, C. Michael Cawley, Wuwei Feng, Fadi Nahab, Ansaar T Rai, Pascal Jabbour, Jonathan A Grossberg, W. Christopher Fox, Ilko Maier, Saleh G. Keyrouz, Benjamin Gory, Reade De Leacy, Laurie Dimisko, Brian M. Howard, Owen Samuels, Alejandro M Spiotta, Stacey Q Wolfe, Nitin Goyal, Kyle M Fargen, Ali Alawieh, Robert M. Starke |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Mechanical Thrombolysis medicine.medical_treatment 030204 cardiovascular system & hematology Brain Ischemia Cohort Studies 03 medical and health sciences 0302 clinical medicine Hematoma Fibrinolytic Agents Internal medicine Atrial Fibrillation Medicine Humans In patient Thrombolytic Therapy Prospective Studies Stroke Thrombectomy business.industry Atrial fibrillation General Medicine Thrombolysis medicine.disease 3. Good health Treatment Outcome Hemorrhagic complication Propensity score matching Cardiology Surgery Neurology (clinical) business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Journal of neurointerventional surgery. 14(10) |
| ISSN: | 1759-8486 |
| Popis: | BackgroundAtrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT.MethodsThis international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared.Results6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis.ConclusionIn this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers. |
| Databáze: | OpenAIRE |
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