Prior anticoagulation before reperfusion therapy for acute ischemic stroke was not associated with worse 90-day functional independence after propensity matching (pre-matching OR 0.48; 95% CI 0.33-0.70).
Cohort (n=866)
No
Does prior anticoagulation worsen 90-day functional outcomes and mortality in acute ischemic stroke patients undergoing reperfusion therapy?
Prior anticoagulation does not appear to worsen 90-day functional outcomes or mortality in selected acute ischemic stroke patients undergoing reperfusion therapy.
Effect estimate: OR 0.48 (95% CI 0.33-0.70)
Absolute Event Rate: 34.5% vs 52.1%
p-value: p=<0.001
Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact on functional recovery and mortality following intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains uncertain. Therefore, this study investigates the association between prior anticoagulation and 90-day outcomes in AIS patients undergoing reperfusion therapy. Methods: We conducted a retrospective cohort analysis using our institutional stroke registry, including AIS patients admitted to the Department of Neurology at our university between February 2023 and 2025. Anticoagulated patients were 1:1 propensity score-matched with non-anticoagulated controls (n = 126 per group) using Mahalanobis distance matching with a caliper, adjusting for age, sex, hypertension, diabetes, stroke severity (National Institutes of Health Stroke Scale NIHSS at admission and 72 h), and pre-stroke functional status (pre-morbid modified Rankin Scale pre-mRS). Primary endpoints at 90 days were functional independence (modified Rankin Scale mRS ≤ 2), mRS-shift, and mortality (mRS = 6). Predictors of outcome were assessed using multivariable logistic regression and generalized additive models (GAMs). Subgroup analyses evaluated the effects of anticoagulation type and treatment modality. Results: Among 866 AIS patients (DOAC n = 100, VKA n = 48, non-anticoagulated n = 718), 426 (49.2%) underwent reperfusion therapy (IVT n = 195, MT n = 163, IVT + MT n = 68). Before matching, anticoagulated patients were less likely to achieve functional independence (34.5% vs. 52.1%, odds ratio OR = 0.48, 95% confidence interval CI 0.33–0.70, p < 0.001), had a greater mRS-shift (2.53 vs. 1.79, p < 0.001), and higher mortality (30.4% vs. 14.5%, OR = 2.58, 95% CI 1.72–3.88, p < 0.001). However, after matching, these differences were no longer statistically significant. NIHSS, 72hNIHSS, and pre-mRS were the strongest independent predictors of outcome (p < 0.001), while anticoagulation status had no significant effect. Conclusions: Recanalization therapy was not associated with worse functional outcomes in selected anticoagulated AIS patients. These findings suggest that prior anticoagulation alone should not preclude reperfusion therapy in otherwise eligible patients, and underscore the importance of individualized, evidence-based decision-making in acute stroke care.
Seetge et al. (Mon,) conducted a cohort in Acute ischemic stroke (AIS) (n=866). Prior anticoagulation (DOACs or VKAs) vs. No prior anticoagulation was evaluated on Functional independence (mRS ≤ 2) at 90 days (pre-matching) (OR 0.48, 95% CI 0.33-0.70, p=<0.001). Prior anticoagulation before reperfusion therapy for acute ischemic stroke was not associated with worse 90-day functional independence after propensity matching (pre-matching OR 0.48; 95% CI 0.33-0.70).