Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation

被引：10

作者：

Giustozzi, Michela ^{[1
,2
]}

Acciarresi, Monica ^{[1
,2
]}

Agnelli, Giancarlo ^{[1
,2
]}

Caso, Valeria ^{[1
,2
]}

Bandini, Fabio ^{[3
]}

Tsivgoulis, Georgios ^{[4
,5
]}

Yaghi, Shadi ^{[6
]}

Furie, Karen L. ^{[6
]}

Tadi, Prasanna ^{[6
]}

Becattini, Cecilia ^{[1
,2
]}

Zedde, Marialuisa ^{[7
]}

Abdul-Rahim, Azmil H. ^{[8
]}

Lees, Kennedy R. ^{[9
]}

Alberti, Andrea ^{[1
,2
]}

Venti, Michele ^{[1
,2
]}

D'Amore, Cataldo ^{[1
,2
]}

Giulia Mosconi, Maria ^{[1
,2
]}

Anna Cimini, Ludovica ^{[1
,2
]}

Bovi, Paolo ^{[10
]}

Carletti, Monica ^{[10
]}

Rigatelli, Alberto ^{[11
]}

Cappellari, Manuel ^{[10
]}

Putaala, Jukka ^{[12
]}

Tomppo, Liisa ^{[12
]}

Tatlisumak, Turgut ^{[12
,13
,14
]}

Marcheselli, Simona ^{[15
]}

Pezzini, Alessandro ^{[16
]}

Poli, Loris ^{[16
]}

Padovani, Alessandro ^{[16
]}

Vannucchi, Vieri ^{[17
]}

Sohn, Sung-Il ^{[18
]}

Lorenzini, Gianni ^{[19
]}

Tassi, Rossana ^{[20
]}

Guideri, Francesca ^{[24
]}

Acampa, Maurizio

Martini, Giuseppe

Ntaios, George ^{[21
]}

Athanasakis, George ^{[21
]}

Makaritsis, Konstantinos ^{[21
]}

Karagkiozi, Efstathia ^{[21
]}

Vadikolias, Konstantinos ^{[22
]}

Liantinioti, Chrissoula ^{[5
]}

Theodorou, Aikaterini

Halvatsiotis, Panagiotis

Mumoli, Nicola ^{[23
]}

Galati, Franco

Sacco, Simona ^{[25
]}

Tiseo, Cindy ^{[25
]}

Corea, Francesco ^{[26
]}

Ageno, Walter ^{[27
]}

机构：

[1] Univ Perugia, Stroke Unit, Via G Dotior i,1, I-06129 Perugia, Italy

[2] Univ Perugia, Div Cardiovasc Med, Via G Dotior i,1, I-06129 Perugia, Italy

[3] Osped San Paolo, Dept Neurol, Savona, Italy

[4] Univ Tennessee, Ctr Hlth Sci, Dept Neurol, Memphis, TN 38163 USA

[5] Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Sch Med, Dept Neurol 2, Athens, Greece

[6] Brown Univ, Warren Alpert Med Sch, Dept Neurol, Div Stroke & Cerebrovasc Dis, Providence, RI 02912 USA

[7] Azienda Unites Sanitaria Locale IRCCS, Arcispedale Santa Maria Nuova, Neurol Unit, Stroke Unit, Reggio Emilia, Italy

[8] Univ Glasgow, Inst Neurosci & Psychol, Glasgow, Lanark, Scotland

[9] Univ Glasgow, Sch Med Dent & Nursing, Glasgow, Lanark, Scotland

[10] AQUI Verona, Stroke Unit, UO Neurol, DAI Neurosci, Verona, Italy

[11] AOUI Verona, Pronto Soccorso Osped Borgo Trento, DAI Emergenza & Accettaz, Verona, Italy

[12] Univ Helsinki, Dept Neurol, Cent Hosp, Helsinki, Finland

[13] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden

[14] Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden

[15] Ist Clin Humanitas, Neurol Urgenza & Stroke Unit, Milan, Italy

[16] Univ Brescia, Dept Clin & Expt Sci, Neurol Unit, Brescia, Italy

[17] Santa Maria Nuova Hosp, Internal Med, Florence, Italy

[18] Keimyung Univ, Dept Neurol, Sch Med, Daegu, South Korea

[19] Azienda USL Toscana Nordovest, Osped Lotti Pontdera, SC Med & Chirurg Accettaz & Urgenza, Pisa, Italy

[20] AOU Senese, Stroke Unit, Siena, Italy

[21] Univ Thessaly, Sch Hlth Sci, Fac Med, Dept Internal Med, Larisa, Greece

[22] Democritus Univ Thrace, Dept Neurol, Univ Hosp Alexandroupolis, Komotini, Greece

[23] Osped Civile Livorno, Dept Internal Med, Livorno, Italy

[24] Jazzolino Hosp, Stroke Unit, Vibo Valentia, Italy

[25] Univ Aquila, Avezzano Hosp, Dept Neurol, Laquila, Italy

[26] San Giovanni Battista Hosp, UO Gravi Cerebrolesioni, Foligno, Italy

[27] Insubria Univ, Dept Internal Med, Varese, Italy

[28] ASST Mantwa, SC Neurol & SS Stroke Unit, Mantua, Italy

[29] Univ Parma, Neurosci Dept, Stroke Unit, Parma, Italy

[30] Univ Parma, Dipartimento Geriatr Riabilitat, Stroke Unit, Parma, Italy

[31] Univ Pisa, Dept Clin & Expt Med, Neurol Inst, Pisa, Italy

[32] Osped Apuano, Neurol, Massa Carrara, Italy

[33] Santa Corona Hosp, Stroke Unit, Dept Neurol, Pietra Ligure, Savona, Italy

[34] Insubria Univ, Stroke Unit, Neurol, Varese, Italy

[35] Oberschwabenklin gGmbH, Abt Neurol, Ravensburg, Germany

[36] Osped Portogruaro, Stroke Unit, Venice, Italy

[37] Sapienza Univ Rome, Dept Human Neurosci, Rome, Italy

[38] Azienda USL Romagna, UO Neurol Presidio Osped Ravenna, Romagna, Italy

[39] MC Univ Clin Oberig Kyiv, Neurorehabil Unit, Kiev, Ukraine

[40] Metropolitan Hosp, Stroke Unit, Piraeus, Greece

[41] AHEPA Univ Hosp, Dept Neurol 2, Thessaloniki, Greece

[42] Osped Civ, Stroke Unit, Palermo, Italy

[43] Univ Debrecen, Stroke Unit, Debrecen, Hungary

[44] St Andrea Hosp, Dept Neurol, Stroke Unit, La Spezia, Italy

[45] Osped Galliera, Struttura Complessa Neurol, Genoa, Italy

[46] Osped Civile Piacenza, Dept Internal Med, Piacenza, Italy

[47] Novosibirsk State Med Univ, City Clin Hosp 1, Municipal Budgetary Healthcare Inst Novosibirsk, Novosibirsk, Russia

[48] Ctr Hop Univ Vaudois, Dept Neurosci Clin, Serv Neurol, Ctr Cerebrovasc, Lausanne, Switzerland

[49] Antwerp Univ Hosp, Born Bunge Inst, Dept Neurol, Antwerp, Belgium

[50] Dresden Univ, Dept Neurol, Stroke Ctr, Dresden, Germany

来源：

STROKE | 2020年 / 51卷 / 08期

关键词：

anticoagulants; atrial fibrillation; secondary prevention; thrombectomy; thrombolytic therapy; ORAL ANTICOAGULANTS; WARFARIN; RIVAROXABAN; ATTACK; THROMBOLYSIS; METAANALYSIS; DABIGATRAN; HEMORRHAGE; RISK;

D O I：

10.1161/STROKEAHA.120.030143

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. Results: A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]). Conclusions: Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant.

引用

页码：2347 / 2354

页数：8

共 23 条

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