Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry

Robert-Jan B. Goldhoorn; Rob A. van de Graaf; Jan M. van Rees; Hester F. Lingsma; Diederik W. J. Dippel; Wouter H. Hinsenveld; Alida Postma; Ido van den Wijngaard; Wim H. van Zwam; Robert J. van Oostenbrugge; Bob Roozenbeek; MR CLEAN Registry Investigators

doi:10.1161/STROKEAHA.119.028675

Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry

Robert-Jan B. Goldhoorn^*, Rob A. van de Graaf, Jan M. van Rees, Hester F. Lingsma, Diederik W. J. Dippel, Wouter H. Hinsenveld, Alida Postma, Ido van den Wijngaard, Wim H. van Zwam, Robert J. van Oostenbrugge, Bob Roozenbeek, MR CLEAN Registry Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and Purpose-

The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC.

Methods-

Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors.

Results-

Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38-1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47-0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74-1.13]).

Conclusions-

Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.

Original language	English
Pages (from-to)	1781-1789
Number of pages	9
Journal	Stroke
Volume	51
Issue number	6
DOIs	https://doi.org/10.1161/STROKEAHA.119.028675
Publication status	Published - Jun 2020

Keywords

anticoagulants
intracranial hemorrhage
outcome
stroke
thrombectomy
MECHANICAL THROMBECTOMY
SAFETY
THERAPY
EFFICACY
OUTCOMES
COHORT
SCORE

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Goldhoorn, R.-J. B., van de Graaf, R. A., van Rees, J. M., Lingsma, H. F., Dippel, D. W. J., Hinsenveld, W. H., Postma, A., van den Wijngaard, I., van Zwam, W. H., van Oostenbrugge, R. J., Roozenbeek, B., & MR CLEAN Registry Investigators (2020). Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry. Stroke, 51(6), 1781-1789. https://doi.org/10.1161/STROKEAHA.119.028675

@article{7df900aa2eba4595be7dcb72bae13f09,

title = "Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry",

abstract = "Background and Purpose-The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC.Methods-Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors.Results-Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38-1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47-0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74-1.13]).Conclusions-Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.",

keywords = "anticoagulants, intracranial hemorrhage, outcome, stroke, thrombectomy, MECHANICAL THROMBECTOMY, SAFETY, THERAPY, EFFICACY, OUTCOMES, COHORT, SCORE",

author = "Goldhoorn, {Robert-Jan B.} and {van de Graaf}, {Rob A.} and {van Rees}, {Jan M.} and Lingsma, {Hester F.} and Dippel, {Diederik W. J.} and Hinsenveld, {Wouter H.} and Alida Postma and {van den Wijngaard}, Ido and {van Zwam}, {Wim H.} and {van Oostenbrugge}, {Robert J.} and Bob Roozenbeek and {MR CLEAN Registry Investigators}",

year = "2020",

month = jun,

doi = "10.1161/STROKEAHA.119.028675",

language = "English",

volume = "51",

pages = "1781--1789",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

}

Goldhoorn, R-JB, van de Graaf, RA, van Rees, JM, Lingsma, HF, Dippel, DWJ, Hinsenveld, WH , Postma, A, van den Wijngaard, I, van Zwam, WH , van Oostenbrugge, RJ, Roozenbeek, B & MR CLEAN Registry Investigators 2020, 'Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry', Stroke, vol. 51, no. 6, pp. 1781-1789. https://doi.org/10.1161/STROKEAHA.119.028675

TY - JOUR

T1 - Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants

T2 - Results From the MR CLEAN Registry

AU - Goldhoorn, Robert-Jan B.

AU - van de Graaf, Rob A.

AU - van Rees, Jan M.

AU - Lingsma, Hester F.

AU - Dippel, Diederik W. J.

AU - Hinsenveld, Wouter H.

AU - Postma, Alida

AU - van den Wijngaard, Ido

AU - van Zwam, Wim H.

AU - van Oostenbrugge, Robert J.

AU - Roozenbeek, Bob

AU - MR CLEAN Registry Investigators

PY - 2020/6

Y1 - 2020/6

N2 - Background and Purpose-The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC.Methods-Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors.Results-Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38-1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47-0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74-1.13]).Conclusions-Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.

AB - Background and Purpose-The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC.Methods-Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors.Results-Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38-1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47-0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74-1.13]).Conclusions-Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.

KW - anticoagulants

KW - intracranial hemorrhage

KW - outcome

KW - stroke

KW - thrombectomy

KW - MECHANICAL THROMBECTOMY

KW - SAFETY

KW - THERAPY

KW - EFFICACY

KW - OUTCOMES

KW - COHORT

KW - SCORE

U2 - 10.1161/STROKEAHA.119.028675

DO - 10.1161/STROKEAHA.119.028675

M3 - Article

C2 - 32390550

SN - 0039-2499

VL - 51

SP - 1781

EP - 1789

JO - Stroke

JF - Stroke

IS - 6

ER -

Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants: Results From the MR CLEAN Registry

Abstract

Keywords

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