Department of Neurology, Nippon Medical School, Tokyo, Japan.
Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
J Neurol Sci. 2023 May 15;448:120639. doi: 10.1016/j.jns.2023.120639. Epub 2023 Mar 28.
The safety of intravenous recombinant tissue plasminogen activator (rtPA) and mechanical thrombectomy (MT) in patients treated with direct oral anticoagulants (DOACs) before stroke has not been fully investigated. Therefore, we aimed to investigate the safety of recanalization therapy in patients receiving DOACs.
We assessed data from a prospective multicenter registry of patients with stroke, including those with acute ischemic stroke (AIS) treated with rtPA and/or MT who were administered DOACs. We evaluated the safety of recanalization considering the DOACs dosage and interval between the last DOAC intake and recanalization.
The final analysis included 108 patients (women, n = 54; median age, 81 years; DOAC overdose, n = 7; appropriate dose, n = 74; and inappropriate low dose, n = 27). The rate of any ICH differed significantly among overdose-, appropriate dose-, and inappropriate-low dose DOACs groups (71.4, 23.0, and 33.3%, respectively; P = 0.0121), whereas no significant difference was observed in respect of symptomatic ICH (P = 0.6895). Multivariate analysis showed that the National Institutes of Health Stroke Scale score on admission (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01-1.11; P = 0.0267) and overdose-DOAC (OR: 8.40, 95% CI: 1.24-56.88; P = 0.0291) were independently associated with any ICH. No relationship was observed between the timing of the last DOAC intake and occurrence of ICH in patients treated with rtPA and/or MT (all P > 0.05).
Recanalization therapy during DOAC treatment may be safe in selected patients with AIS, if it is performed >4 h after the last DOAC intake and the patient is not overdosed with DOACs.
https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034958.
静脉注射重组组织纤溶酶原激活剂（rtPA）和机械取栓术（MT）在接受直接口服抗凝剂（DOAC）治疗的卒中患者中的安全性尚未得到充分研究。因此，我们旨在研究接受 DOAC 治疗的患者再通治疗的安全性。
我们评估了一项急性缺血性卒中（AIS）患者接受 rtPA 和/或 MT 治疗并接受 DOAC 治疗的前瞻性多中心登记研究的数据。我们根据 DOAC 剂量和最后一次 DOAC 摄入与再通之间的时间间隔评估再通治疗的安全性。
最终分析包括 108 例患者（女性，n=54；中位年龄 81 岁；DOAC 超量，n=7；合适剂量，n=74；不合适低剂量，n=27）。DOAC 超量、合适剂量和不合适低剂量组的任何 ICH 发生率差异显著（分别为 71.4%、23.0%和 33.3%；P=0.0121），但症状性 ICH 发生率无显著差异（P=0.6895）。多变量分析显示，入院时国立卫生研究院卒中量表评分（比值比 [OR]：1.06，95%置信区间 [CI]：1.01-1.11；P=0.0267）和 DOAC 超量（OR：8.40，95% CI：1.24-56.88；P=0.0291）与任何 ICH 独立相关。在接受 rtPA 和/或 MT 治疗的患者中，最后一次 DOAC 摄入时间与 ICH 发生之间无相关性（所有 P>0.05）。
在接受 DOAC 治疗的 AIS 患者中，如果最后一次 DOAC 摄入后>4 小时且未 DOAC 过量，再通治疗可能是安全的。
https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034958。
