IV Thrombolysis for Acute Ischemic Stroke with Unknown Onset in Patients on Oral Anticoagulation.

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-08-23 DOI:10.1159/000540552

Kosmas Macha, Jochen A Sembill, Iris Muehlen, Tobias Engelhorn, Arnd Doerfler, Stefan Schwab, Bernd Kallmünzer

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引用次数: 0

Abstract

Introduction: IV thrombolysis (IVT) is established in the unknown or extended time window based on multimodal imaging. Further, increasing evidence exists regarding IVT in patients on oral anticoagulation including direct oral anticoagulants (DOACs). However, data on IVT in ischemic stroke patients on oral anticoagulation with unknown time of stroke onset are sparse.

Methods: This study bases on the longitudinal cohort study Stroke Research Consortium in Northern Bavaria (STAMINA; ClinicalTrials.gov Identifier: NCT04357899). Acute ischemic stroke patients treated with IVT in the unknown or extended time window from January 2015 to December 2019 were included. Patient selection was based on multimodal CT or MRI. Patients on oral anticoagulation (vitamin-K antagonist [VKA] or DOAC within 48 h) were eligible for IVT based on INR measurement (VKA) or plasma levels (DOAC) according to an institutional protocol. Primary outcomes were the incidence of any and symptomatic intracranial hemorrhage.

Results: Of 170 ischemic stroke patients treated with IVT in the unknown or extended time window, 151 had no oral anticoagulation at stroke onset and 19 were on oral anticoagulation (6 on VKA and 13 on DOAC). The risk of symptomatic ICH according to ECASS II criteria was similar between the patients with and without oral anticoagulation (1 [5.3%] vs. 4 [2.7%], p = 0.453). After adjustment for confounding factors, pre-medication with oral anticoagulation was not associated with symptomatic ICH (aOR 1.02 [0.09-11.02], p = 0.988).

Conclusion: IVT for ischemic stroke with unknown onset appeared safe in selected patients on oral anticoagulation with both DOAC and VKA.

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静脉溶栓治疗口服抗凝药患者发病不明的急性缺血性脑卒中。

导言根据多模态成像，静脉溶栓可在未知时间窗或延长时间窗内进行。此外，越来越多的证据表明，静脉溶栓适用于口服抗凝药（包括直接口服抗凝药（DOAC））的患者。然而，对于卒中发病时间不明的口服抗凝药缺血性卒中患者进行静脉溶栓的数据却很少。方法本研究以纵向队列研究北巴伐利亚卒中研究联合会（STAMINA；ClinicalTrials.gov Identifier：NCT04357899）为基础。研究纳入了在2015年1月至2019年12月的未知时间窗或延长时间窗内接受静脉溶栓（IVT）治疗的急性缺血性脑卒中患者。根据多模态 CT 或 MRI 选择患者。根据机构协议，口服抗凝药（维生素 K 拮抗剂 (VKA) 或 DOAC，48 小时内）的患者有资格根据 INR 测量（VKA）或血浆水平（DOAC）进行静脉溶栓治疗。主要结果是任何颅内出血和无症状颅内出血的发生率。结果在未知时间窗或延长时间窗内接受静脉溶栓治疗的 170 例缺血性脑卒中患者中，151 例在脑卒中发病时未服用口服抗凝药，19 例服用了口服抗凝药（6 例服用维生素 K 拮抗剂 (VKA)，13 例服用直接口服抗凝药 (DOAC)）。根据 ECASS II 标准，有口服抗凝药和没有口服抗凝药的患者发生症状性 ICH 的风险相似（1 (5.3%) vs. 4 (2.7%); p=0.453）。调整混杂因素后，口服抗凝药物治疗前与症状性 ICH 无关（aOR 1.02 (0.09 - 11.02)；p=0.988）。结论对于口服 DOAC 和 VKA 抗凝药的特定患者，静脉溶栓治疗起病不明的缺血性卒中似乎是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.