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

Circulation

From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne Hospital, Paris, France (G.T.); Department of Neurology, Frankfurt Höchst Hospital, Germany (B.I., T.S.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Department of Statistical Methods, Gutenberg University, Mainz, Germany (M.P.); Department of Neurology, University Hospital, Lille, France (N.D.-P., C.C.); Department of Neurology, Helsinki University Central Hospital, Finland (D.S., T.T.); Department of Neurology, University Hospital, Frankfurt am Main, Germany (W.P.); Stroke Unit, Department of Neuroscience, S'Agostino-Estense Hospital, AUSL Modena, Italy (A.Z.); Department of Neurology, Sorlandet Sykehus Kristiansand, Norway (A.T.); Department of Neurology and Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway (H.N.); Department of Neurology, University Hospital Lausanne, Switzerland (P.M.); Department of Neurology, University Hospital of Geneva and Medical School, Switzerland (R.S.); Department of Neurology, University Hospital Zurich, Switzerland (A.L.); Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom (A.C., D.J.W.); Department of Neurology, Municipal Hospital, Ludwigshafen, Germany (F.P.); Department of Neurology, University Hospital Freiburg, Germany (M.R., W.-D.N.); Department of Neurology, Tokyo Women's Medical University Hospital, Japan (T.N.); Department of Cli

Published: September 2015

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.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.115.015484	DOI Listing

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