Use of direct oral anticoagulants in patients with stroke transferred for thrombectomy

Abstract

Introduction and objectives: Regional telestroke networks offer several advantages, including upstream selection of thrombectomy candidates. However, it is unclear whether the network performance and the functional outcome of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy differ from those of non-hypocoagulated patients. To compare the time metrics and the functional status of patients with ischemic stroke treated with direct oral anticoagulants and transferred to thrombectomy with non-hypocoagulated patients.

Methods: This was a retrospective multicenter cohort study involving the eight hospitals involved a regional telestroke network. Clinical, imaging and time measures data were obtained from patients transferred for thrombectomy in the period between 01 January 2016 and 18 March 2021. Reperfusion was assumed for modified Thrombolysis in Cerebral Infarction scores 2b and 3. Functional status was assessed using the modified Rankin scale at 90 days.

Results: Of the 4341 patients evaluated in teleconsultation, 945 patients were transferred for thrombectomy and 15.98% had been previously treated with direct oral anticoagulants. There was no statistically significant difference between groups in the time interval, measured in minutes, between admission to the primary and tertiary hospital (231.59 versus 235.71, p=0.805) and, in patients undergoing thrombectomy, between admission to the tertiary hospital and reperfusion (100.45 versus 102.79, p=0.789). The reperfusion rate did not differ between groups (86.64% versus 83.57%, p=0.625). The functional outcome was not affected by direct oral anticoagulants intake (odds ratio 1.04 [95% confidence interval 0.69-1.55], p=0.857).

Conclusion(s): Treatment with direct oral anticoagulants did not have an impact on the performance or the functional outcome of ischemic stroke patients transferred for thrombectomy.

Keywords: Acidente vascular cerebral isquémico; Anticoagulantes orais diretos; Direct oral anticoagulants; Ischemic stroke; Rede telestroke; Telestroke network; Thrombectomy; Thrombolysis; Trombectomia; Trombólise.