Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation

被引：87

作者：

Meinel, Thomas R. ^{[1
,2
]}

Branca, Mattia ^{[3
]}

De Marchis, Gian Marco ^{[4
,5
,6
]}

Nedeltchev, Krassen ^{[7
]}

Kahles, Timo ^{[7
]}

Bonati, Leo ^{[4
,5
,6
]}

Arnold, Marcel ^{[1
,2
]}

Heldner, Mirjam R. ^{[1
,2
]}

Jung, Simon ^{[1
,2
]}

Carrera, Emmanuel ^{[8
]}

Dirren, Elisabeth ^{[8
]}

Michel, Patrik ^{[9
]}

Strambo, Davide ^{[9
]}

Cereda, Carlo W. ^{[10
]}

Bianco, Giovanni ^{[10
]}

Kagi, Georg ^{[11
]}

Vehoff, Jochen ^{[11
]}

Katan, Mira ^{[12
]}

Bolognese, Manuel ^{[13
]}

Backhaus, Roland ^{[14
]}

Salmen, Stephan ^{[15
]}

Albert, Sylvan ^{[16
]}

Medlin, Friedrich ^{[17
]}

Berger, Christian ^{[18
]}

Schelosky, Ludwig ^{[19
]}

Renaud, Susanne ^{[20
]}

Niederhauser, Julien ^{[21
]}

Bonvin, Christophe ^{[22
]}

Schaerer, Michael ^{[23
]}

Mono, Marie-Luise ^{[24
]}

Rodic, Biljana ^{[25
]}

Tarnutzer, Alexander A. ^{[26
]}

Mordasini, Pasquale ^{[2
,27
]}

Gralla, Jan ^{[2
,27
]}

Kaesmacher, Johannes ^{[2
,28
]}

Engelter, Stefan ^{[4
,5
,6
,29
]}

Fischer, Urs ^{[1
,2
]}

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

机构：

[1] Bern Univ Hosp, Inselspital, Dept Neurol, Bern, Switzerland

[2] Univ Bern, Bern, Switzerland

[3] Univ Bern, Clinicial Trials Unit Bern, Bern, Switzerland

[4] Univ Hosp Basel, Dept Neurol, Basel, Switzerland

[5] Univ Hosp Basel, Stroke Ctr, Basel, Switzerland

[6] Univ Basel, Basel, Switzerland

[7] Kantonsspital Aarau, Dept Neurol, Aarau, Switzerland

[8] Hop Univ Geneve, Dept Neurol, Geneva, Switzerland

[9] Lausanne Univ Hosp, Stroke Ctr, Neurol Serv, Lausanne, Switzerland

[10] Neuroctr Southern Switzerland, Stroke Ctr, Lugano, Switzerland

[11] Kantonsspital St Gallen, Dept Neurol, St Gallen, Switzerland

[12] Univ Hosp Zurich, Dept Neurol, Basel, Switzerland

[13] Cantonal Hosp Lucerne, Neuroctr, Luzern, Switzerland

[14] Hirslanden Hosp Zurich, Glattpark, Switzerland

[15] Spitalzentrum Biel, Biel, Switzerland

[16] Cantonal Hosp Graubuenden, Chur, Switzerland

[17] Cantonal Hosp Fribourg, Stroke Unit, Fribourg, Switzerland

[18] Spital Sarganserland Grabs, Grabs, Switzerland

[19] Cantonal Hosp Munsterlingen, Neurol, Munsterlingen, Switzerland

[20] Cantonal Hosp Neuchatel, Neurol, Neuchatel, Switzerland

[21] Grp Hosp Ouest Leman, Stroke Unit, Nyon, Switzerland

[22] Hop Valais, Sion, Switzerland

[23] Burgerspital, Solothurn, Switzerland

[24] Stadtspital Waid & Triemli, Zurich, Switzerland

[25] Cantonal Hosp Winterthur, Winterthur, Switzerland

[26] Cantonal Hosp Baden, Baden, Switzerland

[27] Bern Univ Hosp, Inselspital, Inst Diagnost & Intervent Neuroradiol, Bern, Switzerland

[28] Bern Univ Hosp, Inselspital, Inst Diagnost & Intervent Neuroradiol, Inst Diagnost Intervent & Pediat Radiol,Dept Neur, Bern, Switzerland

[29] Univ Basel, Univ Dept Geriat Med Felix Platter, Neurol & Neurorehabil, Basel, Switzerland

来源：

ANNALS OF NEUROLOGY | 2021年 / 89卷 / 01期

关键词：

PRECEDING ANTITHROMBOTIC TREATMENT; ANTAGONIST ORAL ANTICOAGULANTS; INTRAVENOUS THROMBOLYSIS; PLASMA-LEVELS; EMERGENCY MANAGEMENT; REPERFUSION THERAPY; DABIGATRAN; SEVERITY; SAFETY; COMPLICATIONS;

D O I：

10.1002/ana.25917

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes. Methods This was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months. Results Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15],p < 0.001; quantile regression: beta -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51). Interpretation Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2020

引用

页码：42 / 53

页数：12

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