Key result
Prior anticoagulation in AF patients undergoing EVT is linked to ~68% better 90-day functional outcomes.
Why the study?
Studies validating bridging thrombolysis and endovascular thrombectomy in stroke with pre-existing AF and prior anticoagulation were limited to single-center reports.
Does prior anticoagulation or bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke?
Cohort (n=563)
Yes
Does prior anticoagulation or bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke?
In patients with atrial fibrillation undergoing endovascular thrombectomy for stroke, prior anticoagulation and bridging thrombolysis are associated with improved 90-day functional outcomes without increasing the risk of symptomatic intracerebral hemorrhage.
Answers are grounded in this paper and cite their sources.
May support anticoagulation before EVT in AF; hypothesis-generating, needs randomized confirmation.
BACKGROUND: Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports. METHODS: In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status: anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3). RESULTS: Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%). CONCLUSIONS: Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality.
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Lin et al. (2023) conducted a cohort in Atrial fibrillation with anterior circulation large vessel occlusion stroke undergoing EVT (n=563). Prior anticoagulation vs. No anticoagulation was evaluated on 90-day functional outcomes (modified Rankin Scale) (aOR 1.68, 95% CI 1.00 to 2.82). Prior anticoagulation in AF patients undergoing EVT for anterior circulation stroke was associated with improved 90-day functional outcomes (aOR 1.68; 95% CI 1.00-2.82).
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