Rivaroxaban plasma levels in acute ischemic stroke and intracerebral hemorrhage

被引：45

作者：

Seiffge, David J. ^{[1
,2
,3
]}

Kagi, Georg ^{[4
]}

Michel, Patrik ^{[5
]}

Fischer, Urs ^{[6
]}

Bejot, Yannick ^{[7
]}

Wegener, Susanne ^{[8
]}

Zedde, Marialuisa ^{[9
]}

Turc, Guillaume ^{[10
]}

Cordonnier, Charlotte ^{[11
]}

Sandor, Peter S. ^{[12
]}

Rodier, Gilles ^{[13
]}

Zini, Andrea ^{[14
]}

Cappellari, Manuel ^{[15
]}

Schadelin, Sabine ^{[16
]}

Polymeris, Alexandros A. ^{[1
,2
,3
]}

Werring, David ^{[17
,18
]}

Thilemann, Sebastian ^{[1
,2
,3
]}

Maestrini, Ilaria ^{[11
]}

Berge, Eivind ^{[19
,20
]}

Traenka, Christopher ^{[1
,2
,3
]}

Vehoff, Jochen ^{[4
]}

De Marchis, Gian Marco ^{[1
,2
,3
]}

Kapauer, Monika ^{[4
]}

Peters, Nils ^{[1
,2
,3
,21
]}

Sirimarco, Gaia ^{[5
]}

Bonati, Leo H. ^{[1
,2
,3
]}

Arnold, Marcel ^{[6
]}

Lyrer, Philippe A. ^{[1
,2
,3
]}

De Maistre, Emmanuel ^{[22
]}

Luft, Andreas ^{[8
]}

Tsakiris, Dimtrios A. ^{[23
]}

Engelter, Stefan T. ^{[1
,2
,3
,21
]}

机构：

[1] Univ Hosp Basel, Stroke Ctr, Petersgraben 4, CH-4031 Basel, Switzerland

[2] Univ Basel, Petersgraben 4, CH-4031 Basel, Switzerland

[3] Univ Hosp, Dept Clin Res, Dept Neurol, Basel, Switzerland

[4] St Gallen Cantonal Hosp, Dept Neurol, St Gallen, Switzerland

[5] Univ Hosp, Dept Neurol, Lausanne, Switzerland

[6] Inselspital Bern, Dept Neurol, Bern, Switzerland

[7] Univ Hosp, Dept Neurol, Dijon Stroke Registry, Dijon, France

[8] Univ Hosp Zurich, Dept Neurol, Zurich, Switzerland

[9] New Santa Maria Hosp, Inst Hospitalizat & Sci Care, Neurol Unit, Stroke Unit, Reggio Emilia, Italy

[10] St Anne Hosp, Natl Inst Hlth & Med Res, Dept Neurol, U894, Paris, France

[11] Univ Lille, Lille Univ Hosp Ctr, Natl Inst Hlth & Med Res, U1171,Degenerat & Vasc Cognit Disorders,Dept Neur, Lille, France

[12] Baden Cantonal Hosp, Dept Neurol, Baden, Switzerland

[13] Annecy Genevois Hosp Ctr, Dept Neurol, Epagny Metz Tessy, France

[14] Modena Univ Hosp, SAgostino Estense Hosp, Dept Neurosci, Stroke Unit, Modena, Italy

[15] Integrated Univ Hosp, USD Stroke Unit, DAI Neurosci, Verona, Italy

[16] Univ Hosp Basel, Clin Trial Unit, Basel, Switzerland

[17] UCL, Dept Brain Repair & Rehabil, Ctr Stroke Res, Inst Neurol, London, England

[18] Natl Hosp Neurol & Neurosurg, London, England

[19] Oslo Univ Hosp, Dept Internal Med, Oslo, Norway

[20] Oslo Univ Hosp, Dept Cardiol, Oslo, Norway

[21] Univ Basel, Univ Ctr Med Aging & Rehabil Basel, Felix Platter Hosp, Neurorehabil Unit, Basel, Switzerland

[22] Univ Hosp, Hematol Lab, Dijon, France

[23] Univ Hosp Basel, Diagnost Hematol, Basel, Switzerland

来源：

ANNALS OF NEUROLOGY | 2018年 / 83卷 / 03期

关键词：

HEALTH-CARE PROFESSIONALS; INTRAVENOUS THROMBOLYSIS; ORAL ANTICOAGULANTS; IV THROMBOLYSIS; FACTOR XA; MANAGEMENT; GUIDELINES; COMPLICATIONS; REVERSAL;

D O I：

10.1002/ana.25165

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

ObjectiveInformation about rivaroxaban plasma level (RivLev) may guide treatment decisions in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) taking rivaroxaban. MethodsIn a multicenter registry-based study (Novel Oral Anticoagulants in Stroke Patients collaboration; ClinicalTrials.gov: NCT02353585) of patients with stroke while taking rivaroxaban, we compared RivLev in patients with AIS and ICH. We determined how many AIS patients had RivLev100ng/ml, indicating possible eligibility for thrombolysis, and how many ICH patients had RivLev75ng/ml, making them possibly eligible for the use of specific reversal agents. We explored factors associated with RivLev (Spearman correlation, regression models) and studied the sensitivity and specificity of international normalized ratio (INR) thresholds to substitute RivLev using cross tables and receiver operating characteristic curves. ResultsAmong 241 patients (median age=80 years, interquartile range [IQR]=73-84; median time from onset to admission=2 hours, IQR=1-4.5 hours; median RivLev=89ng/ml, IQR=31-194), 190 had AIS and 51 had ICH. RivLev was similar in AIS patients (82ng/ml, IQR=30-202) and ICH patients (102ng/ml, IQR=51-165; p=0.24). Trough RivLev((137ng/ml)) occurred in 126/190 (66.3%) AIS and 34/51 (66.7%) ICH patients. Among AIS patients, 108/190 (56.8%) had RivLev100ng/ml. In ICH patients, 33/51 (64.7%) had RivLev75ng/ml. RivLev was associated with rivaroxaban dosage, and inversely with renal function and time since last intake (each p<0.05). INR1.0 had a specificity of 98.9% and a sensitivity of 25.7% to predict RivLev100ng/ml. INR1.4 had a sensitivity of 59.3% and specificity of 90.1% to predict RivLev75ng/ml. InterpretationRivLev did not differ between patients with AIS and ICH. Half of the patients with AIS under rivaroxaban had a RivLev low enough to consider thrombolysis. In ICH patients, two-thirds had a RivLev high enough to meet the eligibility for the use of a specific reversal agent. INR thresholds perform poorly to inform treatment decisions in individual patients. Ann Neurol 2018;83:451-459

引用

页码：451 / 459

页数：9

共 50 条

[41] Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke
Chen, Patrick M.
Lehmann, Brittney
Meyer, Brett C.
Rapp, Karen
Hemmen, Thomas
Modir, Royya
Agrawal, Kunal
Hailey, Lovella
Mortin, Melissa
Meyer, Dawn M.
NEUROLOGY-CLINICAL PRACTICE, 2019, 9 (04) : 304 - 308
[42] Predictors of Subarachnoid Hemorrhage in Acute Ischemic Stroke With Endovascular Therapy
Shi, Zhong-Song
Liebeskind, David S.
Loh, Yince
Saver, Jeffrey L.
Starkman, Sidney
Vespa, Paul M.
Gonzalez, Nestor R.
Tateshima, Satoshi
Jahan, Reza
Feng, Lei
Miller, Chad
Ali, Latisha K.
Ovbiagele, Bruce
Kim, Doojin
Duckwiler, Gary R.
Vinuela, Fernando
STROKE, 2010, 41 (12) : 2775 - 2781
[43] Choice and Timing of Antithrombotic after Ischemic Stroke, Intracerebral Hemorrhage or Cerebral Venous Thrombosis
Ryan, Dylan
Girotra, Tarun
Feng, Wuwei
CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS, 2024, 23 (02) : 135 - 152
[44] Gastrointestinal Hemorrhage is Associated with Mortality after Acute Ischemic Stroke
Zhou, Yongtao
Xu, Weihua
Wang, Wei
Yao, Shukun
Xiao, Bei
Wang, Yuping
Chen, Biao
CURRENT NEUROVASCULAR RESEARCH, 2019, 16 (02) : 135 - 141
[45] Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management
Mokin, Maxim
Kan, Peter
Kass-Hout, Tareq
Abla, Adib A.
Dumont, Travis M.
Snyder, Kenneth V.
Hopkins, L. Nelson
Siddiqui, Adnan H.
Levy, Elad I.
NEUROSURGICAL FOCUS, 2012, 32 (04)
[46] Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis Administration in an Acute Ischemic Stroke Patient with Chronic Pontine Microbleeds, a Case Report
Gutierrez, Samantha Anne S.
Co, Christian Oliver C.
Trias, Evita C.
Pineda-Franks, Maria Carissa C.
INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT, 2021, 23
[47] Effects of Candesartan in the Acute Phase of Intracerebral Hemorrhage
Jusufovic, Mirza
Berge, Trude Elisabeth
Guo, Rui
You, Shoujiang
Delcourt, Candice
Anderson, Craig
Bath, Philip M.
Karlson, Bjoern W.
Berge, Eivind
Sandset, Else Charlotte
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2019, 28 (08) : 2262 - 2267
[48] Novel Treatments for Transient Ischemic Attack and Acute Ischemic Stroke
Siket, Matthew S.
Cadena, Rhonda
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA, 2021, 39 (01) : 227 - 242
[49] Serum Magnesium Levels and Outcomes in Patients With Acute Spontaneous Intracerebral Hemorrhage
Goyal, Nitin
Tsivgoulis, Georgios
Malhotra, Konark
Houck, Alexander L.
Khorchid, Yasser M.
Pandhi, Abhi
Inoa, Violiza
Alsherbini, Khalid
Alexandrov, Andrei V.
Arthur, Adam S.
Elijovich, Lucas
Chang, Jason J.
JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2018, 7 (08):
[50] Acute treatment of intracerebral hemorrhage
Sembill, J. A.
Kuramatsu, J. B.
MEDIZINISCHE KLINIK-INTENSIVMEDIZIN UND NOTFALLMEDIZIN, 2019, 114 (07) : 613 - 619

← 1 2 3 4 5 →