Key result
Prior treatment with direct oral anticoagulants compared to vitamin K antagonists was associated with higher odds of successful reperfusion (OR 3.27; 95% CI 1.40-7.65) and lower 90-day mortality.
Why the study?
The use of direct oral anticoagulants has increased relative to vitamin K antagonists, but procedural and clinical outcomes of mechanical thrombectomy needed comparison between these anticoagulation groups.
Does prior treatment with DOA compared to VKA improve angiographic and clinical outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy?
Cohort (n=221)
Yes
Does prior treatment with DOA compared to VKA improve angiographic and clinical outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy?
Prior treatment with direct oral anticoagulants is associated with better reperfusion rates and lower 90-day mortality compared to vitamin K antagonists in patients undergoing mechanical thrombectomy for acute ischemic stroke.
Mechanical thrombectomy (MT) is one of the main treatments for acute ischemic stroke (AIS) in patients on effective anticoagulation. The use of direct oral anticoagulants (DOA) has increased, given their efficacy and safety profile compared to vitamin K antagonists (VKA). We compared procedural and clinical outcomes of MT in patients on DOA and VKA treatment before stroke onset. We analyzed 2 groups from the Endovascular Treatment in Ischemic Stroke prospective registry: patients on DOA and patients on VKA treated by MT without thrombolysis. Generalized linear mixed models including center as random effect were used to compare angiographic (rates of reperfusion at end of procedure, number of passes >2, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to anticoagulation subgroups. Comparisons were adjusted for prespecified confounders (age, admission NIH Stroke Scale score) as well as for meaningful baseline between-group differences. Among 221 patients included, more DOA-treated patients (n = 115, 52%) achieved successful (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b/3) or near complete (mTICI 2c/3) reperfusion at the procedure end than did VKA-treated patients, with an adjusted odds ratio (OR) for DOA vs VKA of 3.27 (95% confidence interval [CI], 1.40-7.65) and 2.00 (95% CI, 1.08-3.73), respectively. DOA-treated patients had a lower 90-day mortality risk with an adjusted OR of 0.47 (95% CI, 0.24-0.89) and a better excellent outcome OR of 2.40 (1.10-5.27). There was no significant between-group difference in hemorrhagic or procedural complications. The study highlights the benefits of DOA compared to VKA. Regarding mortality, excellent outcomes, and recanalization rate, DOA appears to provide a favorable setting for MT treatment in AIS.
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L’Allinec et al. (2020) conducted a cohort in Acute ischemic stroke (n=221). Direct oral anticoagulants (DOA) vs. Vitamin K antagonists (VKA) was evaluated on Successful reperfusion (mTICI 2b/3) at procedure end (OR 3.27, 95% CI 1.40-7.65). Prior treatment with direct oral anticoagulants compared to vitamin K antagonists was associated with higher odds of successful reperfusion (OR 3.27; 95% CI 1.40-7.65) and lower 90-day mortality.
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