Data_Sheet_1_Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data Fro.PDF (78.68 kB)
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Data_Sheet_1_Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry.PDF

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posted on 26.11.2020, 06:14 by María E. Ramos-Araque, Alba Chavarría-Miranda, Beatriz Gómez-Vicente, Elena López-Cancio Martínez, María Castañón Apilánez, Mar Castellanos, María López Fernández, Herbert Tejada Meza, Javier Marta Moreno, Javier Tejada García, Iria Beltrán Rodríguez, Patricia de la Riva, Noemi Díez, Susana Arias Rivas, María Santamaría Cadavid, Yolanda Bravo Anguiano, Mónica Bártulos Iglesias, Enrique Jesús Palacio Portilla, Marian Revilla García, Juan José Timiraos Fernández, Naroa Arenaza Basterrechea, José Luis Maciñeiras Montero, Pablo Vicente Alba, Francisco José Julián Villaverde, Ana Pinedo Brochado, Itxaso Azkune, Freijo M. Mar, Alain Luna, Juan F. Arenillas

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.

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