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Multicenter Study
. 2023 Dec 21;15(e3):e433-e437.
doi: 10.1136/jnis-2022-019560.

Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke

Longting Lin  1   2 , Christopher Blair  1   2 , James Fu  1 , Dennis Cordato  1   2   3 , Cecilia Cappelen-Smith  1   2   3 , Andrew Cheung  1   4   5   6 , Nathan W Manning  1   4   5   6 , Jason Wenderoth  1   4   5   6 , Chushuang Chen  7 , Andrew Bivard  2   8 , Kenneth Butcher  5 , Timothy J Kleinig  9 , Philip Choi  10 , Christopher R Levi  7 , Mark Parsons  11   2   3 ; INSPIRE study group
Collaborators, Affiliations
Multicenter Study

Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke

Longting Lin et al. J Neurointerv Surg. .

Abstract

Background: Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports.

Methods: In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status: anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3).

Results: Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%).

Conclusions: Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality.

Keywords: Stroke; Thrombectomy; Thrombolysis.

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Conflict of interest statement

Competing interests: None declared.

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