John W P Wong1, Leonid Churilov2, Richard Dowling3, Peter Mitchell3, Steven Bush3, Lasheta Kanesan4, Bernard Yan5,6. 1. Royal Melbourne Hospital, Melbourne, Victoria, Australia. 2. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia. 3. Department of Radiology, Neurointervention Service, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia. 4. Department of Medicine, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia. 5. Department of Radiology, Neurointervention Service, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia, Bernard.yan@mh.org.au. 6. Department of Medicine, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia, Bernard.yan@mh.org.au.
Abstract
BACKGROUND/AIM: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis. METHODS: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic stroke patients undergoing mechanical thrombectomy from January 2008 to June 2017. Patients receiving any dose of intravenous or intra-arterial thrombolysis were excluded. Patients taking oral anticoagulants (VKAs or DOACs) were compared with non-anticoagulated patients. Outcomes compared between groups included the rate of intracerebral haemorrhage (ICH) on follow-up imaging (ICHany), symptomatic ICH, functional independence at 90 days (modified Rankin scale score, 0-2), mortality, and post-treatment recanalization (Thrombolysis in Cerebral Infarction score ≥2b). RESULTS: In all, 102 patients undergoing mechanical thrombectomy without prior thrombolysis were included in the study. Sixty-six (64.7%) patients were not anticoagulated, 23 (22.5%) patients were taking VKAs, and 13 (12.7%) patients were taking DOACs. There were no significant differences in the rate of ICHany (11.1 vs. 13.6%, p = 0.93) or sICH (2.8 vs. 1.5%, p = 0.14) in anticoagulated patients compared to non-anticoagulated patients. No cases of sICH were observed among patients taking DOACs. After 90 days of follow-up, the rates of functional independence (50.0 vs. 43.1%) and mortality (27.8 vs. 25.8%) were also similar between the anticoagulation and the non-anticoagulation groups. CONCLUSION: Mechanical thrombectomy appears to be safe and effective in anticoagulated patients ineligible for thrombolysis, with observed haemorrhage rates similar to those of patients not on anticoagulant therapy. However, further multicentre prospective studies are needed, due to the rising number of patients on warfarin and DOACs worldwide.
BACKGROUND/AIM: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis. METHODS: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic strokepatients undergoing mechanical thrombectomy from January 2008 to June 2017. Patients receiving any dose of intravenous or intra-arterial thrombolysis were excluded. Patients taking oral anticoagulants (VKAs or DOACs) were compared with non-anticoagulated patients. Outcomes compared between groups included the rate of intracerebral haemorrhage (ICH) on follow-up imaging (ICHany), symptomatic ICH, functional independence at 90 days (modified Rankin scale score, 0-2), mortality, and post-treatment recanalization (Thrombolysis in Cerebral Infarction score ≥2b). RESULTS: In all, 102 patients undergoing mechanical thrombectomy without prior thrombolysis were included in the study. Sixty-six (64.7%) patients were not anticoagulated, 23 (22.5%) patients were taking VKAs, and 13 (12.7%) patients were taking DOACs. There were no significant differences in the rate of ICHany (11.1 vs. 13.6%, p = 0.93) or sICH (2.8 vs. 1.5%, p = 0.14) in anticoagulated patients compared to non-anticoagulated patients. No cases of sICH were observed among patients taking DOACs. After 90 days of follow-up, the rates of functional independence (50.0 vs. 43.1%) and mortality (27.8 vs. 25.8%) were also similar between the anticoagulation and the non-anticoagulation groups. CONCLUSION: Mechanical thrombectomy appears to be safe and effective in anticoagulated patients ineligible for thrombolysis, with observed haemorrhage rates similar to those of patients not on anticoagulant therapy. However, further multicentre prospective studies are needed, due to the rising number of patients on warfarin and DOACs worldwide.
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
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