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Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation.
Meinel, Thomas R; Branca, Mattia; De Marchis, Gian Marco; Nedeltchev, Krassen; Kahles, Timo; Bonati, Leo; Arnold, Marcel; Heldner, Mirjam R; Jung, Simon; Carrera, Emmanuel; Dirren, Elisabeth; Michel, Patrik; Strambo, Davide; Cereda, Carlo W; Bianco, Giovanni; Kägi, Georg; Vehoff, Jochen; Katan, Mira; Bolognese, Manuel; Backhaus, Roland; Salmen, Stephan; Albert, Sylvan; Medlin, Friedrich; Berger, Christian; Schelosky, Ludwig; Renaud, Susanne; Niederhauser, Julien; Bonvin, Christophe; Schaerer, Michael; Mono, Marie-Luise; Rodic, Biljana; Tarnutzer, Alexander A; Mordasini, Pasquale; Gralla, Jan; Kaesmacher, Johannes; Engelter, Stefan; Fischer, Urs; Seiffge, David J.
Afiliación
  • Meinel TR; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Branca M; Clinicial Trials Unit Bern, University of Bern, Bern, Switzerland.
  • De Marchis GM; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Nedeltchev K; Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
  • Kahles T; Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
  • Bonati L; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Arnold M; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Heldner MR; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Jung S; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Carrera E; Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
  • Dirren E; Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
  • Michel P; Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Strambo D; Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Cereda CW; Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.
  • Bianco G; Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.
  • Kägi G; Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • Vehoff J; Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • Katan M; Department of Neurology, University Hospital Zurich, Basel, Switzerland.
  • Bolognese M; Neurocenter, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
  • Backhaus R; Hirslanden Hospital Zurich, Glattpark, Switzerland.
  • Salmen S; Spitalzentrum Biel, Biel, Switzerland.
  • Albert S; Cantonal Hospital Graubuenden, Chur, Switzerland.
  • Medlin F; Stroke Unit, Cantonal Hospital Fribourg, Fribourg, Switzerland.
  • Berger C; Spital Sarganserland Grabs, Grabs, Switzerland.
  • Schelosky L; Neurology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
  • Renaud S; Neurology, Cantonal Hospital Neuchatel, Neuchâtel, Switzerland.
  • Niederhauser J; Stroke Unit, Groupement hospitalier de l'ouest lémanique, Nyon, Switzerland.
  • Bonvin C; Hôpital du Valais, Sion, Switzerland.
  • Schaerer M; Bürgerspital Solothurn, Solothurn, Switzerland.
  • Mono ML; Stadtspital Waid und Triemli, Zurich, Switzerland.
  • Rodic B; Cantonal Hospital Winterthur, Winterthur, Switzerland.
  • Tarnutzer AA; Cantonal hospital of Baden, Baden, Switzerland.
  • Mordasini P; Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Gralla J; Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Kaesmacher J; Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
  • Engelter S; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Fischer U; Neurology and Neurorehabilitation, University Department of Geriatic Medicine Felix Platter, University of Basel, Basel, Switzerland.
  • Seiffge DJ; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Ann Neurol ; 89(1): 42-53, 2021 01.
Article en En | MEDLINE | ID: mdl-32996627
OBJECTIVE: The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes. METHODS: This was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months. RESULTS: Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15], p < 0.001; quantile regression: ß -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51). INTERPRETATION: Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42-53.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Isquemia Encefálica / Accidente Cerebrovascular Isquémico / Anticoagulantes Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Neurol Año: 2021 Tipo del documento: Article País de afiliación: Suiza
Texto completo
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Isquemia Encefálica / Accidente Cerebrovascular Isquémico / Anticoagulantes Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Neurol Año: 2021 Tipo del documento: Article País de afiliación: Suiza