Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Stroke. 2011 Nov;42(11):3061-6. doi: 10.1161/STROKEAHA.111.615476. Epub 2011 Oct 6.
Use of intravenous tissue-type plasminogen activator (IV tPA) for acute ischemic stroke is restricted to patients with an international normalized ratio (INR) less than 1.7. However, a recent study showed increased risk of symptomatic intracranial hemorrhage after IV tPA use in patients with oral anticoagulants (OAC) even with an INR less than 1.7. The present study assessed the risk of symptomatic intracranial hemorrhage, clinical outcome, and mortality after intra-arterial therapy (IAT) in patients with and without previous use of OAC.
Consecutive patients treated with IAT from December 1992 to October 2010 were included. Clinical outcome and mortality were assessed 90 days after stroke onset. Patients with and without previous use of OAC were compared.
Overall, 714 patients were treated with IAT. Twenty-eight patients (3.9%) were under OAC at time of symptom onset. Median INR in the OAC group was 1.79 (interquartile range [IQR], 1.41-2.3) and 1.01 (IQR, 1.0-1.09; P<0.0001) in the group without OAC. Patients treated with OAC at admission underwent more often mechanical-only IAT than did patients without OAC (46.4% versus 12.8%; P<0.0001). Comparing patients with and without previous use of OAC, we did not find any statistical difference in the rate of symptomatic intracranial hemorrhage (7.1% versus 6.0%; P=0.80), unfavorable outcome (modified Rankin Scale score, 3-6; 67.9% versus 50.9%; P=0.11), and mortality (17.9% versus 21.6%; P=0.58).
Previous use of OAC did not significantly increase the risk of symptomatic intracranial hemorrhage after IAT or the risk of unfavorable outcome and mortality 90 days after IAT.
对于急性缺血性脑卒中患者，静脉注射组织型纤溶酶原激活物（IV tPA）的使用仅限于国际标准化比值（INR）小于 1.7 的患者。然而，最近的一项研究表明，即使 INR 小于 1.7，接受口服抗凝剂（OAC）治疗的患者使用 IV tPA 后，症状性颅内出血的风险也会增加。本研究评估了有和无先前使用 OAC 的患者接受动脉内治疗（IAT）后的症状性颅内出血风险、临床结局和死亡率。
连续纳入 1992 年 12 月至 2010 年 10 月期间接受 IAT 治疗的患者。在卒中发作后 90 天评估临床结局和死亡率。比较有和无先前使用 OAC 的患者。
共有 714 例患者接受 IAT 治疗。28 例（3.9%）在症状发作时正在使用 OAC。OAC 组的 INR 中位数为 1.79（四分位距[IQR]，1.41-2.3），无 OAC 组为 1.01（IQR，1.0-1.09；P<0.0001）。入院时接受 OAC 治疗的患者比未接受 OAC 治疗的患者更常接受单纯机械性 IAT（46.4%比 12.8%；P<0.0001）。比较有和无先前使用 OAC 的患者，我们没有发现症状性颅内出血发生率（7.1%比 6.0%；P=0.80）、不良结局（改良 Rankin 量表评分，3-6 分；67.9%比 50.9%；P=0.11）和死亡率（17.9%比 21.6%；P=0.58）存在统计学差异。
IAT 前使用 OAC 不会显著增加 IAT 后症状性颅内出血的风险，也不会增加 IAT 后 90 天不良结局和死亡率的风险。
