Kentaro Suzuki1, Junya Aoki2, Yuki Sakamoto2, Arata Abe2, Satoshi Suda2, Seiji Okubo2, Takehiko Nagao3, Kazumi Kimura2. 1. Department of Neurological Science, Nippon Medical School Hospital, Tokyo, Japan. Electronic address: kentarow@nms.ac.jp. 2. Department of Neurological Science, Nippon Medical School Hospital, Tokyo, Japan. 3. Department of Neurological Science, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
Abstract
BACKGROUND: The safety of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients treated with DOAC is unclear. We investigated whether recanalization therapy in patients treated with DOAC is safe. METHODS: A nationwide, multicenter, retrospective cohort questionnaire survey was conducted to investigate the: (1) frequency of intracerebral hemorrhage (ICH) after recanalization therapy in patients treated with DOAC; (2) independent factors related to ICH; (3) relationship between last intake time of DOAC and ICH; and (4) comparison of ICH frequency between patients treated with DOAC, vitamin K antagonist (VKA), and no-anticoagulation (no-ACT) (control). RESULTS: One hundred eighteen stroke centers returned the questionnaire and 100 patients (56 IVT alone, 29 EVT alone, and 15 both IVT and EVT) on DOAC were registered. The frequency of asymptomatic and symptomatic (≥4-point NIHSS score increase) ICH within 24h in DOAC patients were 18% and 2%, and were not different compared with the VKA and no-ACT groups (p=0.728; and p=0.626). On multivariate analysis, systolic blood pressure (OR, 1.04; p<0.001) and blood glucose (OR, 1.02; p=0.019) were independent factors for ICH. Among the 52 patients with a known last intake time of DOAC, the rate of ICH was higher in patients ≤4h from last intake than those >4h (38% vs. 10%, p=0.033). CONCLUSIONS: Risk of ICH after reperfusion therapy in patients treated with DOAC should be low. Systolic blood pressure, glucose level, and DOAC intake time appear to be factors for ICH.
BACKGROUND: The safety of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients treated with DOAC is unclear. We investigated whether recanalization therapy in patients treated with DOAC is safe. METHODS: A nationwide, multicenter, retrospective cohort questionnaire survey was conducted to investigate the: (1) frequency of intracerebral hemorrhage (ICH) after recanalization therapy in patients treated with DOAC; (2) independent factors related to ICH; (3) relationship between last intake time of DOAC and ICH; and (4) comparison of ICH frequency between patients treated with DOAC, vitamin K antagonist (VKA), and no-anticoagulation (no-ACT) (control). RESULTS: One hundred eighteen stroke centers returned the questionnaire and 100 patients (56 IVT alone, 29 EVT alone, and 15 both IVT and EVT) on DOAC were registered. The frequency of asymptomatic and symptomatic (≥4-point NIHSS score increase) ICH within 24h in DOACpatients were 18% and 2%, and were not different compared with the VKA and no-ACT groups (p=0.728; and p=0.626). On multivariate analysis, systolic blood pressure (OR, 1.04; p<0.001) and blood glucose (OR, 1.02; p=0.019) were independent factors for ICH. Among the 52 patients with a known last intake time of DOAC, the rate of ICH was higher in patients ≤4h from last intake than those >4h (38% vs. 10%, p=0.033). CONCLUSIONS: Risk of ICH after reperfusion therapy in patients treated with DOAC should be low. Systolic blood pressure, glucose level, and DOAC intake time appear to be factors for ICH.
Authors: Duncan Wilson; Teddy Y Wu; David J Seiffge; Thomas Meinel; Jan Christoph Purrucker; Johannes Kaesmacher; Urs Fischer Journal: J Neurol Neurosurg Psychiatry Date: 2021-02-04 Impact factor: 10.154