Safety of Endovascular Thrombectomy in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulants.

Abstract

BACKGROUND AND PURPOSE:

Prospective data on the safety of endovascular thrombectomy in acute stroke patients on non-vitamin K antagonist oral anticoagulants are lacking.

METHODS:

Prospective multicenter observational study. Patients with ischemic stroke undergoing thrombectomy with or without preceding thrombolysis were enrolled into the Registry of Acute Ischemic Stroke Under New Oral Anticoagulants. Baseline characteristics and functional outcome at 3 months were assessed. Hemorrhagic transformation and symptomatic intracranial hemorrhage were analyzed. Reperfusion was graded using the modified Thrombolysis in Cerebral Infarction score.

RESULTS:

Of 28 patients treated with thrombectomy, 5 had received also systemic thrombolysis (18%). Intracranial hemorrhage was observed in 46%, but symptomatic intracranial hemorrhage occurred only in 1 patient. Successful reperfusion (Thrombolysis in Cerebral Infarction score, 2b-3) was achieved in 59%. At 3 months, 19% had a modified Rankin Scale score of 0 to 2, and mortality was 26%.

CONCLUSIONS:

Thrombectomy in non-vitamin K antagonist oral anticoagulant patients seems safe although a comparatively high rate of asymptomatic hemorrhagic transformation was noted. Confirmation in larger prospective controlled cohorts is necessary.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01850797.

• Authors: Jan C Purrucker, Marcel Wolf, Kirsten Haas, Timolaos Rizos, Shujah Khan, Rainer Dziewas, Christoph Kleinschnitz, Andreas Binder, Klaus Gröschel, Michael G Hennerici, Kyriakos Lobotesis, Sven Poli, Günter Seidel, Tobias Neumann-Haefelin, Peter A Ringleb, Peter U Heuschmann, Roland Veltkamp
• Journal: Stroke (Stroke) Vol. 47 Issue 4 Pg. 1127-30 (Apr 2016) ISSN: 1524-4628 [Electronic] United States
• PMID: 26931156 (Publication Type: Journal Article)
• Copyright: © 2016 American Heart Association, Inc.

Chemical References

• Anticoagulants

Topics

• Aged
• Anticoagulants (therapeutic use)
• Brain Ischemia (drug therapy, therapy)
• Endovascular Procedures (adverse effects, methods)
• Female
• Humans
• Intracranial Hemorrhages (etiology)
• Male
• Prospective Studies
• Stroke (drug therapy, therapy)
• Thrombectomy (adverse effects, methods)
• Thrombolytic Therapy
• Treatment Outcome