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Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke
  1. Gustavo Zapata-Wainberg1,2,3,
  2. Álvaro Ximénez-Carrillo1,2,3,
  3. Santiago Trillo1,2,3,
  4. Blanca Fuentes2,4,
  5. Antonio Cruz-Culebras5,6,
  6. Clara Aguirre1,2,3,
  7. María Alonso de Leciñana2,4,
  8. Rocío Vera5,6,
  9. Eduardo Bárcena1,2,
  10. Andrés Fernández-Prieto2,4,
  11. José Carlos Méndez-Cendón5,6,
  12. Jose Luis Caniego1,2,
  13. Exuperio Díez-Tejedor2,4,
  14. Jaime Masjuan5,6,
  15. José Vivancos1,2,3
  16. the Madrid Stroke Network
  1. 1Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain
  2. 2Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
  3. 3Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
  4. 4Neurology Department, Hospital Universitario La Paz, Madrid, Spain
  5. 5Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
  6. 6Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain
  1. Correspondence to Dr Gustavo Zapata-Wainberg, Neurology Department, Hospital Universitario de la Princesa, Madrid, Spain ; gzapatawainberg{at}gmail.com

Abstract

Background and purpose To investigate the efficacy and safety of mechanical thrombectomy in patients with acute ischemic stroke according to the oral anticoagulation medication taken at the time of stroke onset.

Materials and methods A retrospective multicenter study of prospectively collected data based on data from the registry the Madrid Stroke Network was performed. We included consecutive patients with acute ischemic stroke treated with mechanical thrombectomy and compared the frequency of intracranial hemorrhage and the modified Rankin Scale (mRS) score at 3 months according to anticoagulation status.

Results The study population comprised 502 patients, of whom 389 (77.5%) were not anticoagulated, 104 (20.7%) were taking vitamin K antagonists, and 9 (1.8%) were taking direct oral anticoagulants. Intravenous thrombolysis had been performed in 59.8% and 15.0% of non-anticoagulated and anticoagulated patients, respectively. Rates of intracranial hemorrhage after treatment were similar between non-anticoagulated and anticoagulated patients, as were rates of recanalization. After 3 months of follow-up, the mRS score was ≤2 in 56.3% and 55.7% of non-anticoagulated and anticoagulated patients, respectively (P=NS). Mortality rates were similar in the two groups (13.1%and12.4%, respectively). Among anticoagulated patients, no differences were found for intracranial bleeding, mRS score, or mortality rates between patients taking vitamin K antagonists and those taking direct oral anticoagulants.

Conclusions Mechanical thrombectomy is feasible in anticoagulated patients with acute ischemic stroke. The outcomes and safety profile are similar to those of patients with no prior anticoagulation therapy.

  • thrombectomy

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Footnotes

  • Contributors All authors contributed extensively to the work presented in this paper. All authors have contributed to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; drafted the work and revised it critically; approved the final version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Madrid Stroke Network.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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