Key result
Direct oral anticoagulants significantly decreased symptomatic intracerebral hemorrhage compared with vitamin K antagonists after mechanical thrombectomy (OR 0.49; 95% CI 0.30-0.80; P=0.004).
Why the study?
Mechanical thrombectomy is safe for anticoagulated patients, but the safety and prognosis of DOACs compared with VKA have not been compared in this setting.
Do DOACs reduce symptomatic intracerebral hemorrhage and mortality compared to VKA in anticoagulated patients with acute ischemic stroke undergoing mechanical thrombectomy?
Meta-Analysis (n=3,571)
Do DOACs reduce symptomatic intracerebral hemorrhage and mortality compared to VKA in anticoagulated patients with acute ischemic stroke undergoing mechanical thrombectomy?
In anticoagulated patients with acute ischemic stroke undergoing mechanical thrombectomy, DOACs are associated with lower rates of symptomatic intracerebral hemorrhage and mortality compared to VKAs.
Supports preferring DOACs over VKA post-MT for lower sICH and mortality; extends comparative evidence in anticoagulated stroke patients.
BACKGROUND: According to a previous studies, mechanical thrombectomy(MT) is safe for anticoagulated patients. However, the safety and prognosis of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) have not been compared with those of MT.This meta-analysis aimed at determining the efficacy of DOACs or VKA for patients after MT. REVIEW SUMMARY: We searched PubMed, Embase, Web of Science databases, and Cochrane from their inception to Aug 2022. Revman 5.3 served for the meta-analysis. The meta-analysis included 12 studies that covered 3571 patients, finding that after MT treatment, DOACs significantly decreased the symptomatic intracerebral hemorrhage [odd ratio (OR)=0.49, 95% CI 0.30-0.80, P =0.004] and mortality (OR=0.63, 95% CI 0.48-0.83, P =0.001) compared with VKA. Meanwhile, no obvious differences were found between DOACs and VKA after MT treatment in terms of in any hemorrhagic transformation (OR=1.07, 95% CI 0.84-1.37, P =0.59), good functional outcome (OR=1.06, 95% CI 0.88-1.27, P =0.53), and successful arterial recanalization (OR=1.24, 95% CI 1.00-1.53, P =0.05). CONCLUSIONS: This meta-analysis demonstrates that the application of DOACs in MT treatment for anticoagulated patients with acute ischemic stroke is safer than that in the VKA group. However, further studies are necessary to confirm these results.
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Zhang et al. (2023) conducted a meta-analysis in Acute ischemic stroke (n=3,571). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKA) was evaluated on Symptomatic intracerebral hemorrhage (OR 0.49, 95% CI 0.30-0.80, p=0.004). Direct oral anticoagulants significantly decreased symptomatic intracerebral hemorrhage compared with vitamin K antagonists after mechanical thrombectomy (OR 0.49; 95% CI 0.30-0.80; P=0.004).
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