INTRODUCTION: Endovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials. OBJECTIVE: To analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values. METHODS: Retrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy. Patients with anticoagulation other than vitamin K antagonists were excluded. The primary safety endpoint was defined as symptomatic intracranial hemorrhage (sICH; ECASS II definition). The efficacy endpoint was the modified Rankin scale (mRS) score after 3 months, dichotomized into favorable outcome (mRS 0-2) and unfavorable outcome (mRS 3-6). RESULTS: 435 patients were included. 90% were treated with stent retriever. 27 (6.2%) patients with an INR of 1.2-1.7 and 21 (4.8%) with an INR >1.7. 33 (7.6%) had sICH and 149 patients (34.3%) had a favorable outcome. Patients with an elevated INR did not have an increased risk for sICH or unfavorable outcome in multivariable analysis. The additional use of IV thrombolysis in patients with an INR of 1.2-1.7 did not increase the risk of sICH or unfavorable outcome. These results were replicated in a sensitivity analysis introducing an error of the INR of ±5%. They were also confirmed using other sICH definitions (Safe Implementation of Thrombolysis in Stroke (SITS), National Institute of neurological Disorders and Stroke (NINDS), Heidelberg bleeding classification). CONCLUSIONS: Endovascular therapy in patients with an elevated INR is safe and efficient. Patients with an INR of 1.2-1.7 may be treated with combined IV thrombolysis and endovascular therapy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
INTRODUCTION: Endovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials. OBJECTIVE: To analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values. METHODS: Retrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy. Patients with anticoagulation other than vitamin K antagonists were excluded. The primary safety endpoint was defined as symptomatic intracranial hemorrhage (sICH; ECASS II definition). The efficacy endpoint was the modified Rankin scale (mRS) score after 3 months, dichotomized into favorable outcome (mRS 0-2) and unfavorable outcome (mRS 3-6). RESULTS: 435 patients were included. 90% were treated with stent retriever. 27 (6.2%) patients with an INR of 1.2-1.7 and 21 (4.8%) with an INR >1.7. 33 (7.6%) had sICH and 149 patients (34.3%) had a favorable outcome. Patients with an elevated INR did not have an increased risk for sICH or unfavorable outcome in multivariable analysis. The additional use of IV thrombolysis in patients with an INR of 1.2-1.7 did not increase the risk of sICH or unfavorable outcome. These results were replicated in a sensitivity analysis introducing an error of the INR of ±5%. They were also confirmed using other sICH definitions (Safe Implementation of Thrombolysis in Stroke (SITS), National Institute of neurological Disorders and Stroke (NINDS), Heidelberg bleeding classification). CONCLUSIONS: Endovascular therapy in patients with an elevated INR is safe and efficient. Patients with an INR of 1.2-1.7 may be treated with combined IV thrombolysis and endovascular therapy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: 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 Journal: Front Neurol Date: 2020-11-26 Impact factor: 4.003