Endovascular treatment in large vessel occlusion stroke patients treated with OAC

Endovascular treatment appears to be safe and efficacious in patients with large vessel occlusion stroke in patients using oral anticoagulation (OAC). This was suggested by the outcomes of a large-scale retrospective study analysing data from the German Stroke Registry-Endovascular Treatment [1].

Primary outcomes were successful recanalisation, defined as modified thrombolysis in cerebral infarction (mTICI 2b-3), good outcome at 3 months according to modified Rankin scale (mRS; 0-2 or back to baseline), and rates of intracranial haemorrhage (ICH) until hospital discharge.

The analysis included 2,521 stroke patients, of whom 442 (17.6%) were treated with OACs, 201 (8.0%) with vitamin-K antagonists (VKA), and 241 (9.6%) with non-vitamin-K antagonist oral anticoagulants (NOACs). OAC users were older, had more often a history of atrial fibrillation, and had a higher rate of arterial hypertension (see Table).

The rate of mTICI 2b-3 was similar among all 3 groups (82.7%, 85.5%, and 82.7%; P=1.00 and P=0.57). The other main results after 90 days:

• A favourable outcome was less frequent in OAC patients (28.4%, 31.1%, and 40.9%; P<0.005 and P<0.05);
• ICH rates were similar among the 3 groups (12.1%, 12.4%, and 10.4%; P=1.00 and P=0.86);
• OAC status had no influence on good outcome (OR 1.03; 95% CI 0.99-1.08);
• OAC status did not affect ICH risk (OR 1.03; 95% CI 0.94-1.05).

Table. Baseline patient, stroke, imaging, and treatment characteristics [1]

OAC, oral anticoagulation; VKA, vitamin-K antagonist; NOAC, non-vitamin-K oral anticoagulant; pmRS, premorbid modified Rankin Scale; NIHSS, National Institute of Health Stroke Scale; mTICI, modified thrombolysis in cerebral infarction; ICH, intracranial haemorrhage

1. Küpper C, et al. Abstract EPR2022, EAN 2020.

 

Posted on 9 September, 202023 February, 2021