Sistema de Salut de Catalunya
Institut Català de la Salut
[Mujanovic A] University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland. Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland. [Kurmann CC, Dobrocky T] University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland. [Olivé-Gadea M] Servei de Neurologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain. [Maegerlein C] Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. [Pierot L] Department of Neuroradiology, University Hospital Reims, Reims, France
Vall d'Hebron Barcelona Hospital Campus
2023-01-13T13:10:15Z
2023-01-13T13:10:15Z
2022-08-03
Atrial fibrillation; Intravenous thrombolysis; Oral anticoagulation
Fibrilación auricular; Trombólisis intravenosa; Anticoagulación oral
Fibril·lació auricular; Trombolisi intravenosa; Anticoagulació oral
Background and purpose: 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. Materials and Methods: Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). Results: In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). Conclusion: Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT.
This study was funded by the Bangerter-Rhyner Foundation and the Swiss Academy of Medical Sciences. Open access funding provided by University of Bern.
Article
Published version
English
Fibril·lació auricular - Tractament; Teràpia trombolítica; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Arrhythmias, Cardiac::Atrial Fibrillation; Other subheadings::Other subheadings::Other subheadings::/drug therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Thrombolytic Therapy; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::arritmias cardíacas::fibrilación atrial; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::tratamiento trombolítico
Frontiers Media
Frontiers in Neurology;13
https://doi.org/10.3389/fneur.2022.945338
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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