Pfeilschifter Waltraud, Farahmand Dana, Niemann Daniela, Ikenberg Benno, Hohmann Carina, Abruscato Mario, Thonke Sven, Strzelczyk Adam, Hedtmann Günther, Neumann-Haefelin Tobias, Kollmar Rainer, Singer Oliver C, Ferbert Andreas, Steiner Thorsten, Steinmetz Helmuth, Reihs Anke, Misselwitz Björn, Foerch Christian
Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.
Cerebrovasc Dis. 2016;42(5-6):415-420. doi: 10.1159/000447952. Epub 2016 Jul 21.
The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit.
We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units.
Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate.
Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
非维生素K拮抗剂口服抗凝药（NOAC）的首个特异性解毒剂最近已获批准。NOAC解毒剂将能够对两个迄今为止存在问题的患者群体进行特异性治疗：接受口服抗凝治疗（OAT）并发生脑出血（ICH）的患者，以及可能正在接受口服抗凝治疗（OAT）的溶栓候选患者。我们旨在估计这些事件的发生频率，从而确定卒中单元对抗解毒剂剂量的定量需求。
我们从一个全州范围的前瞻性卒中住院患者登记处提取了2012 - 2015年急性缺血性卒中和症状发作后<24小时的脑出血患者的数据。我们选择了8个卒中单元，并确定了2012 - 2013年入院时的OAT模式。2015年，OAT模式成为住院患者登记的必填项目。根据抗凝患者数量和NOAC的占比，我们估计了卒中单元当前和未来对NOAC解毒剂剂量的需求。
症状发作6小时内或症状发作时间不明的脑出血患者中有18%正在接受OAT治疗。假设入院时NOAC的占比为40%，那么所有脑出血患者中约7%可能符合NOAC逆转治疗的条件。4小时内入院的缺血性卒中患者中有13%正在接受抗凝治疗。如果有合适的解毒剂，NOAC占比50%可能会使溶栓率提高6.1%。
服务于具有相似人口结构人群的卒中单元应准备好使用NOAC解毒剂治疗所有急性缺血性卒中患者的1%以及所有急性脑出血患者的7%。随着房颤患病率的上升和NOAC使用的增加，这些数字可能会上升。
