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Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke.
Lin, Longting; Blair, Christopher; Fu, James; Cordato, Dennis; Cappelen-Smith, Cecilia; Cheung, Andrew; Manning, Nathan W; Wenderoth, Jason; Chen, Chushuang; Bivard, Andrew; Butcher, Kenneth; Kleinig, Timothy J; Choi, Philip; Levi, Christopher R; Parsons, Mark.
Afiliação
  • Lin L; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Blair C; Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
  • Fu J; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Cordato D; Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
  • Cappelen-Smith C; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Cheung A; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Manning NW; Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
  • Wenderoth J; Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia.
  • Chen C; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Bivard A; Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
  • Butcher K; Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia.
  • Kleinig TJ; South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Choi P; Department of Interventional Neuroradiology, Liverpool Hospital, Sydney, New South Wales, Australia.
  • Levi CR; Institute of Neurological Sciences, Randwick Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia.
  • Parsons M; Advanced Endovascular Therapy, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
J Neurointerv Surg ; 15(e3): e433-e437, 2023 Dec 21.
Article em En | MEDLINE | ID: mdl-36944493
ABSTRACT

BACKGROUND:

Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports.

METHODS:

In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3).

RESULTS:

Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%).

CONCLUSIONS:

Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article