AUTHOR=Ramos-Araque María E. , Chavarría-Miranda Alba , Gómez-Vicente Beatriz , López-Cancio Martínez Elena , Castañón Apilánez María , Castellanos Mar , López Fernández María , Tejada Meza Herbert , Marta Moreno Javier , Tejada García Javier , Beltrán Rodríguez Iria , de la Riva Patricia , Díez Noemi , Arias Rivas Susana , Santamaría Cadavid María , Bravo Anguiano Yolanda , Bártulos Iglesias Mónica , Palacio Portilla Enrique Jesús , Revilla García Marian , Timiraos Fernández Juan José , Arenaza Basterrechea Naroa , Maciñeiras Montero José Luis , Vicente Alba Pablo , Julián Villaverde Francisco José , Pinedo Brochado Ana , Azkune Itxaso , Mar Freijo M. , Luna Alain , Arenillas Juan F.
TITLE=Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry
JOURNAL=Frontiers in Neurology
VOLUME=11
YEAR=2020
URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.594251
DOI=10.3389/fneur.2020.594251
ISSN=1664-2295
ABSTRACT=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.