What question did this study set out to answer?

To investigate the efficacy and safety of mechanical thrombectomy in patients presenting with acute ischemic stroke according to their oral anticoagulation status at stroke onset.

December 23, 2017Journal of NeuroInterventional Surgery

Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

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Why the study?

Does mechanical thrombectomy have similar efficacy and safety in acute ischemic stroke patients taking oral anticoagulants compared to those not taking anticoagulants?

Key Points

To investigate the efficacy and safety of mechanical thrombectomy in patients presenting with acute ischemic stroke according to their oral anticoagulation status at stroke onset.
Retrospective multicenter study utilizing prospectively collected registry data from the Madrid Stroke Network.
Included 502 consecutive patients with acute ischemic stroke treated with mechanical thrombectomy: 389 (77.5%) non-anticoagulated, 104 (20.7%) on vitamin K antagonists, and 9 (1.8%) on direct oral anticoagulants.
Evaluated post-treatment intracranial hemorrhage, recanalization, and 3-month functional independence (modified Rankin Scale ≤2) and mortality.
Favorable functional outcome (mRS ≤2) at 3 months was achieved in 56.3% of non-anticoagulated and 55.7% of anticoagulated patients (P=NS), with corresponding mortality rates of 13.1% and 12.4%.
Rates of intracranial hemorrhage and recanalization were similar across groups, despite intravenous thrombolysis being administered to only 15.0% of anticoagulated versus 59.8% of non-anticoagulated patients.
Outcomes among anticoagulated patients, including intracranial bleeding, mRS score, and mortality, did not differ significantly between those taking vitamin K antagonists and direct oral anticoagulants.

Structured PICO

Does mechanical thrombectomy have similar efficacy and safety in acute ischemic stroke patients taking oral anticoagulants compared to those not taking anticoagulants?

Population

502 consecutive patients with acute ischemic stroke treated with mechanical thrombectomy

Intervention

Mechanical thrombectomy in patients taking oral anticoagulants at the time of stroke onset (n=113; 104 on vitamin K antagonists, 9 on direct oral anticoagulants)

Comparator

Mechanical thrombectomy in patients not taking oral anticoagulants (n=389)

Outcome

Frequency of intracranial hemorrhage and modified Rankin Scale (mRS) score at 3 monthshard clinical

Mechanical thrombectomy is feasible and safe in acute ischemic stroke patients on oral anticoagulation, with outcomes comparable to non-anticoagulated patients.

Discussion

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Implication

Supports thrombectomy feasibility in anticoagulated stroke patients; leaves open need for randomized confirmation.

Cite This Study

Zapata-Wainberg et al. (2017) studied this question.

synapsesocial.com/papers/6a80d3e4176d2ce03165dd67 https://doi.org/10.1136/neurintsurg-2017-013504

Topics

Anticoagulation in AF

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Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider