对于接受血管内血栓切除术治疗前循环卒中的房颤患者，预先抗凝和桥接溶栓可改善预后。

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

机构信息

South-Western Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.

Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.

出版信息

J Neurointerv Surg. 2023 Dec 21;15(e3):e433-e437. doi: 10.1136/jnis-2022-019560.

DOI:10.1136/jnis-2022-019560

PMID:36944493

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.

摘要

背景

在伴有先前存在的心房颤动 (AF) 的情况下发生中风的情况下，验证桥接溶栓治疗以及在先前抗凝的情况下使用血管内血栓切除术 (EVT) 的安全性和有效性的研究仅限于单中心报告。

方法

在回顾性分析中，研究了在 2016 年至 2019 年期间在一个前瞻性维护的国际多中心数据库（国际中风灌注成像登记处（INSPIRE））中接受 EVT 治疗前循环大血管闭塞性中风的 AF 患者。根据抗凝状态对患者进行分类：抗凝（华法林/非维生素 K 口服抗凝剂）与未抗凝。未抗凝的患者进一步分为静脉溶栓与无溶栓。组间比较的结果包括 90 天改良 Rankin 量表、90 天死亡率、症状性颅内出血 (sICH) 发生率和良好再灌注（改良脑梗死溶栓 (mTICI) 2b-3）。

结果

在 563 名 AF 患者中，有 118 名（21%）正在接受抗凝治疗。接受抗凝治疗的 AF 患者 90 天功能结局得到改善（调整后的优势比（aOR）1.68，95%置信区间（95%CI）为 1.00 至 2.82）。死亡率（26.3% 比 23.8%）、sICH（4.5% 比 3.9%）和良好再灌注率（91.3% 比 88.0%）在抗凝组和未抗凝组之间相似。AF 患者 EVT 前溶栓与 90 天功能结局改善相关（aOR 1.81，95%CI 1.18 至 2.79）和死亡率降低（aOR 0.51，95%CI 0.31 至 0.84），sICH 发生率相似（3.4% 比 4.5%）。