Shindo Koichiro, Ogino Tatsuya, Kamiyama Kenji, Fukuda Mamoru, Okamura Naoyasu, Fuchizaki Tomoki, Ishizuka Tomoaki, Ishikawa Kohei, Yamaguchi Yohei, Muraki Takeshi, Tatsuta Yasuyuki, Sakurai Suguru, Endo Hideki, Ookuma Masahiro, Osato Toshiaki, Nakamura Hirohiko
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
Center for Endovascular Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
J Neuroendovasc Ther. 2020;14(11):481-487. doi: 10.5797/jnet.oa.2019-0118. Epub 2020 Aug 18.
The usage of oral anticoagulants (OACs) in the acute phase of cerebral infarction has increased, but the optimal timing for starting OACs after mechanical thrombectomy (MT) is unclear. We report the usage of OACs after MT at our hospital and evaluated the outcomes.
OACs were selected as secondary preventive drugs for 64 patients who underwent MT for anterior circulatory embolism between July 2016 and January 2019. Of the 64 patients, 28 and 36 received direct oral anticoagulants (DOACs) and warfarin (Wf), respectively. We compared the frequency of intracranial hemorrhage in the acute phase and that of recurrent cerebral infarction within 30 days.
The median diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Scores + white matter (DWI-ASPECTS + W) score at admission was 7.5 (IQR 6-9)/8 (IQR, 6-9) in the DOACs group/Wf group. The rate of recanalization with modified thrombolysis in cerebral infarction (TICI) ≥2B by MT was 89.3/80.6%. In patients with subarachnoid hemorrhage (SAH) associated with MT and patients with hemorrhagic transformation (HT) on MRI the next day, administration was started after hemostasis. The median timing of the first anticoagulant administration was 3 (IQR, 2-4)/2 (IQR, 1-4) days. In the case of no HT the next day, the rate of new HT after 1 week was 7.1%/29.1%. In the case of HT the next day, the rate of HT deterioration the next day was 7.1%/16.6%. The percentage of symptomatic bleeding was 0%/2.8%. The percentage of recurrent cerebral infarction within 30 days was 0%/2.8%.
OACs in the acute phase after MT can be safely used and are expected to be effective at preventing recurrence.
脑梗死急性期口服抗凝剂（OACs）的使用有所增加，但机械取栓术（MT）后开始使用OACs的最佳时机尚不清楚。我们报告了我院MT术后OACs的使用情况并评估了结果。
选择OACs作为2016年7月至2019年1月间因前循环栓塞接受MT的64例患者的二级预防药物。64例患者中，分别有28例和36例接受了直接口服抗凝剂（DOACs）和华法林（Wf）治疗。我们比较了急性期颅内出血的发生率以及30天内复发性脑梗死的发生率。
DOACs组/华法林组入院时的扩散加权成像-阿尔伯塔卒中项目早期计算机断层扫描评分+白质（DWI-ASPECTS+W）评分中位数分别为7.5（四分位间距6-9）/8（四分位间距，6-9）。MT后改良脑梗死溶栓（TICI）≥2B级的再通率为89.3%/80.6%。对于MT相关的蛛网膜下腔出血（SAH）患者和次日MRI显示有出血转化（HT）的患者，在止血后开始给药。首次抗凝剂给药的中位时间为3（四分位间距，2-4）/2（四分位间距，1-4）天。次日无HT的情况下，1周后新发生HT的发生率为7.1%/29.1%。次日有HT的情况下，次日HT恶化的发生率为7.1%/16.6%。症状性出血的百分比为0%/2.8%。30天内复发性脑梗死的百分比为0%/2.8%。
MT术后急性期的OACs可以安全使用，并有望有效预防复发。
