Safety of Anticoagulation in Patients Treated With Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation.

Aged Aged, 80 and over Anticoagulants / administration & dosage Atrial Fibrillation / diagnosis Blood Coagulation / drug effects Brain Ischemia / diagnosis Female Hemorrhage / chemically induced Humans Male Middle Aged Prospective Studies Reperfusion / adverse effects Stroke / diagnosis Thrombectomy / methods Thrombolytic Therapy / methods Treatment Outcome
anticoagulants atrial fibrillation secondary prevention thrombectomy thrombolytic therapy

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
08 2020
Historique:
pubmed: 11 7 2020
medline: 5 11 2020
entrez: 11 7 2020
Statut: ppublish

Résumé

The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]). Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant.

Sections du résumé

BACKGROUND AND PURPOSE
The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention.
METHODS
We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features.
RESULTS
A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]).
CONCLUSIONS
Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant.

Identifiants

DOI: 10.1161/STROKEAHA.120.030143 PMID: 32646335
pubmed: 32646335
doi: 10.1161/STROKEAHA.120.030143
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

2347-2354

Auteurs

Michela Giustozzi (M)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Monica Acciarresi (M)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Giancarlo Agnelli (G)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Valeria Caso (V)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Fabio Bandini (F)

Department of Neurology, Ospedale San Paolo, Savona, Italy (F.B.).

Georgios Tsivgoulis (G)

Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.).
Second Department of Neurology, "Attikon" University Hospital, National & KapodistrianUniversity of Athens, School of Medicine, Greece (G.T., C.L.).

Shadi Yaghi (S)

Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F., P.T.).

Karen L Furie (KL)

Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F., P.T.).

Prasanna Tadi (P)

Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F., P.T.).

Cecilia Becattini (C)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Marialuisa Zedde (M)

Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy (M.Z.).

Azmil H Abdul-Rahim (AH)

Institute of Neuroscience and Psychology, University of Glasgow (A.H.A.-R.).

Kennedy R Lees (KR)

School of Medicine, Dentistry and Nursing, University of Glasgow (K.R.S.).

Andrea Alberti (A)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Michele Venti (M)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Cataldo D'Amore (C)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Maria Giulia Mosconi (M)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Ludovica Anna Cimini (L)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Paolo Bovi (P)

SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy (P.B., M. Carletti, M. Cappellari).

Monica Carletti (M)

SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy (P.B., M. Carletti, M. Cappellari).

Alberto Rigatelli (A)

Pronto Soccorso - Ospedale Borgo Trento, DAI emergenza e accettazione, AOUI Verona (A.R.).

Manuel Cappellari (M)

SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy (P.B., M. Carletti, M. Cappellari).

Jukka Putaala (J)

Department of Neurology, Helsinki University Central Hospital, Finland (J.P., L.T., T. Tatlisumak).

Liisa Tomppo (L)

Department of Neurology, Helsinki University Central Hospital, Finland (J.P., L.T., T. Tatlisumak).

Turgut Tatlisumak (T)

Department of Neurology, Helsinki University Central Hospital, Finland (J.P., L.T., T. Tatlisumak).
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T. Tatlisumak).
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T. Tatlisumak).

Simona Marcheselli (S)

Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy (S. Marcheselli).

Alessandro Pezzini (A)

Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy (A. Pezzini, L. Poli, A. Padovani).

Loris Poli (L)

Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy (A. Pezzini, L. Poli, A. Padovani).

Alessandro Padovani (A)

Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy (A. Pezzini, L. Poli, A. Padovani).

Vieri Vannucchi (V)

Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy (V. Vannucchi, L.M.).

Sung-Il Sohn (SI)

Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (S.-I.).

Gianni Lorenzini (G)

SC Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Lotti Pontedera, Azienda USL Toscana Nordovest (G.L.).

Rossana Tassi (R)

Stroke Unit, AOU Senese, Siena, Italy (R.T.).

Francesca Guideri (F)

Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy (F. Galati).

Maurizio Acampa (M)

Giuseppe Martini (G)

George Ntaios (G)

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., G.A., K.M., E.K.).

George Athanasakis (G)

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., G.A., K.M., E.K.).

Konstantinos Makaritsis (K)

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., G.A., K.M., E.K.).

Efstathia Karagkiozi (E)

Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., G.A., K.M., E.K.).

Konstantinos Vadikolias (K)

Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece (K.V.).

Chrissoula Liantinioti (C)

Second Department of Neurology, "Attikon" University Hospital, National & KapodistrianUniversity of Athens, School of Medicine, Greece (G.T., C.L.).

Aikaterini Theodorou (A)

Panagiotis Halvatsiotis (P)

Nicola Mumoli (N)

Department of Internal Medicine, Ospedale Civile di Livorno, Italy (N.M.).

Franco Galati (F)

Simona Sacco (S)

Department of Neurology, University of L'Aquila, Avezzano Hospital, Italy (S.S., C.T.).

Cindy Tiseo (C)

Department of Neurology, University of L'Aquila, Avezzano Hospital, Italy (S.S., C.T.).

Francesco Corea (F)

UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno (F.C.).

Walter Ageno (W)

Department of Internal Medicine, Insubria University, Varese, Italy (W.A., M.B.).

Marta Bellesini (M)

Department of Internal Medicine, Insubria University, Varese, Italy (W.A., M.B.).

Giorgio Silvestrelli (G)

S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy (G.S., A. Ciccone, A.L.).

Alfonso Ciccone (A)

S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy (G.S., A. Ciccone, A.L.).

Alessia Lanari (A)

S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy (G.S., A. Ciccone, A.L.).

Umberto Scoditti (U)

Stroke Unit, Neuroscience Department, University of Parma, Italy (U.S.).

Licia Denti (L)

Stroke Unit - Dipartimento Geriatrico Riabilitativo - University of Parma, Italy (L.D.).

Michelangelo Mancuso (M)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).

Elena Ferrari (E)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).

Leonardo Ulivi (L)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).

Giovanni Orlandi (G)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).
Neurologia, Ospedale Apuano, Massa Carrara, Italy (G.O., M. Giuntini).

Nicola Giannini (N)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).

Tiziana Tassinari (T)

Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Li-gure (Savona), Italy (T. Tassinari).

Maria Luisa De Lodovici (M)

Stroke Unit, Neurology, Insubria University, Varese, Italy (M.L.D.L.).

Christina Rueckert (C)

Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany (C.R.).

Antonio Baldi (A)

Stroke Unit, Ospedale di Portogruaro, Portogruaro (Venice), Italy (A.B.).

Danilo Toni (D)

Department of Human Neurosciences,, Sapienza University of Rome, Italy (D.T., F.L., A. Pieroni).

Federica Letteri (F)

Department of Human Neurosciences,, Sapienza University of Rome, Italy (D.T., F.L., A. Pieroni).

Martina Giuntini (M)

Enrico Maria Lotti (E)

U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L.).

Yuriy Flomin (Y)

Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig' Kyiv, Ukraine (Y.F.).

Alessio Pieroni (A)

Department of Human Neurosciences,, Sapienza University of Rome, Italy (D.T., F.L., A. Pieroni).

Odysseas Kargiotis (O)

Stroke Unit, Metropolitan Hospital, Piraeus, Greece (O.K.).

Theodore Karapanayiotides (T)

2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece (T.K.).

Serena Monaco (S)

Stroke Unit, Ospedale Civico, Palermo, Italy (S. Monaco).

Mario Maimone Baronello (M)

Stroke Unit, University of Debrecen, Hungary (M.M.B., L.C., L.S.).

Laszló Csiba (L)

Stroke Unit, University of Debrecen, Hungary (M.M.B., L.C., L.S.).

Lilla Szabó (L)

Stroke Unit, University of Debrecen, Hungary (M.M.B., L.C., L.S.).

Alberto Chiti (A)

Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M.M., E.F., L.U., G.O., N.G., A. Chiti).
Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy (A. Chiti, E.G.).

Elisa Giorli (E)

Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy (A. Chiti, E.G.).

Massimo Del Sette (M)

Struttura Complessa di Neurologia, Ospedale Galliera, Genoa, Italy (M.D.S.).

Davide Imberti (D)

Department of Internal Medicine, Ospedale Civile di Piacenza, Italy (D.I., D.Z.).

Dorjan Zabzuni (D)

Department of Internal Medicine, Ospedale Civile di Piacenza, Italy (D.I., D.Z.).

Boris Doronin (B)

Municipal Budgetary Healthcare Institution of Novosibirsk. City Clinical Hospital # 1. Novosibirsk (Russia) at the Novosibirsk State Medical University (Russia) (B.D., V. Volodina).

Vera Volodina (V)

Municipal Budgetary Healthcare Institution of Novosibirsk. City Clinical Hospital # 1. Novosibirsk (Russia) at the Novosibirsk State Medical University (Russia) (B.D., V. Volodina).

Patrik Michel (P)

Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne (Switzerland) (P.M.).

Peter Vanacker (P)

Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium (P.V.).

Kristian Barlinn (K)

Department of Neurology, Dresden University Stroke Center, Germany (K.B., J.B.).

Jessica Barlinn (J)

Department of Neurology, Dresden University Stroke Center, Germany (K.B., J.B.).

Dirk Deleu (D)

Department of Neurology, Hamad Medical Corporation, Doha, Qatar (D.D.).

Vanessa Gourbali (V)

Department of Neurology, Evangelismos Hospital, Athens (V.G.).

Maurizio Paciaroni (M)

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M. Giustozzi, M. Acciarresi, G.A., V.C., C.B., A.A., M.V., C.D., M.G.M., L.A.C., M.P.).

Luca Masotti (L)

Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy (V. Vannucchi, L.M.).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Fibrillation auriculaire › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiogiques du sang › Hémostase › Coagulation sanguine › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Techniques d'investigation › Perfusion › Reperfusion › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement thrombolytique › Safety of Anticoagulation in Patients Treated...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Safety of Anticoagulation in Patients Treated...