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. 2021 May;268(5):1762-1769.
doi: 10.1007/s00415-020-10369-6. Epub 2020 Dec 29.

Endovascular stroke treatment in orally anticoagulated patients: an analysis from the German Stroke Registry-Endovascular Treatment

Clemens Küpper  1 , Katharina Feil  1   2   3 , Frank Arne Wollenweber  4 , Steffen Tiedt  5 , Moriz Herzberg  6 , Franziska Dorn  6   7 , Thomas Liebig  6 , Marianne Dieterich  1   2   8 , Lars Kellert  9 ; GSR investigators
Affiliations

Endovascular stroke treatment in orally anticoagulated patients: an analysis from the German Stroke Registry-Endovascular Treatment

Clemens Küpper et al. J Neurol. 2021 May.

Abstract

Background: Endovascular treatment (ET) in orally anticoagulated (OAC) patients has not been evaluated in randomized clinical trials and data regarding this issue are sparse.

Methods: We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET; NCT03356392, date of registration: 22 Nov 2017). The primary outcomes were successful reperfusion defined as modified thrombolysis in cerebral infarction (mTICI 2b-3), good outcome at 3 months (modified Rankin scale [mRS] 0-2 or back to baseline), and intracranial hemorrhage (ICH) on follow-up imaging at 24 h analyzed by unadjusted univariate and adjusted binary logistic regression analysis. Additionally, we analyzed mortality at 3 months with adjusted binary logistic regression analysis.

Results: Out of 6173 patients, there were 1306 (21.2%) OAC patients, 479 (7.8%) with vitamin K antagonists (VKA) and 827 (13.4%) with non-vitamin K antagonist oral anticoagulation (NOAC). The control group consisted of 4867 (78.8%) non-OAC patients. ET efficacy with the rates of mTICI 2b-3 was similar among the three groups (85.6%, 85.3% vs 84.3%, p = 0.93 and 1). On day 90, good outcome was less frequent in OAC patients (27.8%, 27.9% vs 39.5%, p < 0.005 and < 0.005). OAC status was not associated with ICH at 24 h (NOAC: odd's ratio [OR] 0.89, 95% confidence interval [CI] 0.67-1.20; VKA: OR 1.04, CI 0.75-1.46). Binary logistic regression analysis revealed no influence of OAC status on good outcome at 3 months (NOAC: OR 1.25, CI 0.99-1.59; VKA: OR 1.18, CI 0.89-1.56) and mortality at 3 months (NOAC: OR 1.03, CI 0.81-1.30; VKA: OR 1.04, CI 0.78-1.1.37).

Conclusions: ET can be performed safely and successfully in LVO stroke patients treated with OAC. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov . Unique identifier: NCT03356392.

Keywords: Endovascular treatment; Ischemic stroke; Large vessel occlusion; Oral anticoagulation.

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Conflict of interest statement

CK, KF, ST, MH, FD, and MD have nothing to disclose. FAW reports personal fees from Bayer, Pfizer-BMS, Portola, and Boehringer Ingelheim outside of this study. TL consults for Stryker Neurovascular GmbH and has received speaker honoraria by Pfizer, Covidien, Phenox, and Microvention outside this study. LK has received funding for travel or speaker honoraria from Bayer Vital, Boehringer Ingelheim, Bristol-Meyer-Squibb, Daiichi Sankyo, and Pfizer outside of this study.

Figures

Fig. 1
Fig. 1
Binary logistic regression analysis for good outcome (mRS 0–2 or back to baseline) at d90. mRS modified Rankin scale, IVT intravenous thrombolysis, NIHSS National Institute of Health Stroke Scale, pmRS premorbid modified Rankin scale, VKA vitamin K antagonist, NOAC non-vitamin K oral anticoagulation anticoagulant
Fig. 2
Fig. 2
Binary logistic regression analysis for mortality at d90. IVT intravenous thrombolysis, NIHSS National Institute of Health Stroke Scale, pmRS premorbid modified Rankin scale, VKA vitamin K antagonist, NOAC non-vitamin K oral anticoagulant
Fig. 3
Fig. 3
Binary logistic regression analysis for ICH at 24 h. ICH intracranial hemorrhage, IVT intravenous thrombolysis, NIHSS National Institute of Health Stroke Scale, pmRS premorbid modified Rankin scale, VKA vitamin K antagonist, NOAC non-vitamin K oral anticoagulant
See this image and copyright information in PMC

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