Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Ramos-Araque, M.E. ; Chavarría-Miranda, A. ; Gómez-Vicente, B. ; López-Cancio Martínez, E. ; Castañón Apilánez, M. ; Castellanos, M. ; López Fernández, M. ; Tejada Meza, H. (Universidad de Zaragoza) ; Marta Moreno, J. (Universidad de Zaragoza) ; Tejada García, J. ; Beltrán Rodríguez, I. ; de la Riva, P. ; Díez, N. ; Arias Rivas, S. ; Santamaría Cadavid, M. ; Bravo Anguiano, Y. ; Bártulos Iglesias, M. ; Palacio Portilla, E.J. ; Revilla García, M. ; Timiraos Fernández, J.J. ; Arenaza Basterrechea, N. ; Maciñeiras Montero, J.L. ; Vicente Alba, P. ; Julián Villaverde, F.J. ; Pinedo Brochado, A. ; Azkune, I. ; Mar, F.M. ; Luna, A. ; Arenillas, J.F.

Resumen: 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.

Idioma: Inglés

DOI: 10.3389/fneur.2020.594251

Año: 2020

Publicado en: Frontiers in Neurology 11 (2020), 594251 [7 pp]
ISSN: 1664-2295

Factor impacto JCR: 4.003 (2020)

Categ. JCR: NEUROSCIENCES rank: 117 / 273 = 0.429 (2020) - Q2 - T2
Categ. JCR: CLINICAL NEUROLOGY rank: 72 / 208 = 0.346 (2020) - Q2 - T2

Factor impacto SCIMAGO: 1.23 - Neurology (clinical) (Q2) - Neurology (Q2)

Financiación: info:eu-repo/grantAgreement/ES/ISCIII/JR19-00020
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16-0019-0018
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16-0019-0019
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16-0019-0020
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD1670019-0004

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)