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Recanalization Therapies in Acute Ischemic Stroke Patients

2015; Lippincott Williams & Wilkins; Volume: 132; Issue: 13 Linguagem: Inglês

10.1161/circulationaha.115.015484

1524-4539

David Seiffge, Robbert‐Jan Van Hooff, Christian H. Nolte, Yannick Béjot, Guillaume Turc, Benno Ikenberg, Eivind Berge, Malte Persike, Nelly Dequatre‐Ponchelle, Daniel Strbian, Waltraud Pfeilschifter, Andrea Zini, Arnstein Tveiten, Halvor Næss, Patrik Michel, Roman Sztajzel, Andreas R. Luft, Henrik Gensicke, Christopher Traenka, Lisa Hert, Jan F. Scheitz, Gian Marco De Marchis, Leo H. Bonati, Nils Peters, Andreas Charidimou, David J. Werring, Frederick Palm, Matthias Reinhard, Wolf‐Dirk Niesen, Takehiko Nagao, Alessandro Pezzini, Valeria Caso, Paul J. Nederkoorn, Georg Kägi, Alexander von Hessling, Višnja Padjen, Charlotte Cordonnier, Hebun Erdur, Philippe Lyrer, Raf Brouns, Thorsten Steiner, Turgut Tatlisumak, Stefan T. Engelter,

Venous Thromboembolism Diagnosis and Management

We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC).This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8-22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1-1.6). ICHany was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICHECASS-II and sICHNINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences.IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.