Recanalization therapies in acute ischemic stroke patients: impact of prior treatment with novel oral anticoagulants on bleeding complications and outcome.

Détails

ID Serval
serval:BIB_52425E1B7CE2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Recanalization therapies in acute ischemic stroke patients: impact of prior treatment with novel oral anticoagulants on bleeding complications and outcome.
Périodique
Circulation
Auteur(s)
Seiffge D.J., Hooff R.J., Nolte C.H., Béjot Y., Turc G., Ikenberg B., Berge E., Persike M., Dequatre-Ponchelle N., Strbian D., Pfeilschifter W., Zini A., Tveiten A., Næss H., Michel P., Sztajzel R., Luft A., Gensicke H., Traenka C., Hert L., Scheitz J.F., De Marchis G.M., Bonati L.H., Peters N., Charidimou A., Werring D.J., Palm F., Reinhard M., Niesen W.D., Nagao T., Pezzini A., Caso V., Nederkoorn P.J., Kägi G., von Hessling A., Padjen V., Cordonnier C., Erdur H., Lyrer P.A., Brouns R., Steiner T., Tatlisumak T., Engelter S.T.
Collaborateur(s)
NOACISP Study Group*
ISSN
1524-4539 (Electronic)
ISSN-L
0009-7322
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
132
Numéro
13
Pages
1261-1269
Langue
anglais
Résumé
BACKGROUND: 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).
METHODS AND RESULTS: 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.
CONCLUSIONS: 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.
Mots-clé
Acute Disease, Administration, Oral, Aged, Aged, 80 and over, Anticoagulants/administration & dosage, Anticoagulants/adverse effects, Antithrombins/administration & dosage, Antithrombins/adverse effects, Atrial Fibrillation/complications, Brain Ischemia/blood, Brain Ischemia/drug therapy, Cerebral Hemorrhage/chemically induced, Cerebral Hemorrhage/epidemiology, Cohort Studies, Factor Xa Inhibitors/administration & dosage, Factor Xa Inhibitors/adverse effects, Female, Fibrinolytic Agents/therapeutic use, Humans, Incidence, Male, Middle Aged, Pilot Projects, Thrombolytic Therapy, Treatment Outcome, Vitamin K/antagonists & inhibitors
Pubmed
Web of science
Open Access
Oui
Création de la notice
01/03/2016 19:45
Dernière modification de la notice
08/05/2019 18:37
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