Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY-NC 4.0
ID Serval
serval:BIB_F51E6AC4D4CF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation.
Périodique
Annals of neurology
Auteur⸱e⸱s
Meinel T.R., Branca M., De Marchis G.M., Nedeltchev K., Kahles T., Bonati L., Arnold M., Heldner M.R., Jung S., Carrera E., Dirren E., Michel P., Strambo D., Cereda C.W., Bianco G., Kägi G., Vehoff J., Katan M., Bolognese M., Backhaus R., Salmen S., Albert S., Medlin F., Berger C., Schelosky L., Renaud S., Niederhauser J., Bonvin C., Schaerer M., Mono M.L., Rodic B., Tarnutzer A.A., Mordasini P., Gralla J., Kaesmacher J., Engelter S., Fischer U., Seiffge D.J.
Collaborateur⸱rice⸱s
Investigators of the Swiss Stroke Registry
Contributeur⸱rice⸱s
Lyrer P., Peters N., Polymeris A., Thilemann S., Altersberger V., Blackham K., Dittrich T., El Mekabaty A., Fladt J., Fisch U., Gensicke H., Hert L., Manuzzi S., Psychogios M., Maurer M., Traenka C., Tsogkas I., Wagner B., Zietz A., Brehm A., Meya L., Sarikaya H., Goeldlin M., Vynckier J., Mamaari B., Siepen B., Mueller M., Eskandari A., Pantazou V., Wegener S., Mueller A., Schütz V., Pokorny T., Luft A., Albert S., Sturzenegger R., Humm A., Cuendet D., Accolla E., Annoni J.M., Foucras S., Minkner K.K., Olivier P., Kelemen P., Brodo G., Cordier M., Jurgutiene V., Sotomayor G.T., Fisch L.
ISSN
1531-8249 (Electronic)
ISSN-L
0364-5134
Statut éditorial
Publié
Date de publication
01/2021
Peer-reviewed
Oui
Volume
89
Numéro
1
Pages
42-53
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes.
This was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months.
Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15], p < 0.001; quantile regression: β -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51).
Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42-53.
Mots-clé
Anticoagulants, Anticoagulation, DOAC, Ischaemic Stroke, Thrombectomy, Thrombolysis
Pubmed
Web of science
Open Access
Oui
Création de la notice
02/10/2020 12:05
Dernière modification de la notice
20/06/2021 16:32
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