Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke
dc.contributor.author | Mac Grory, Brian | |
dc.contributor.author | Holmes, DaJuanicia N. | |
dc.contributor.author | Matsouaka, Roland A. | |
dc.contributor.author | Shah, Shreyansh | |
dc.contributor.author | Chang, Cherylee W. J. | |
dc.contributor.author | Rison, Richard | |
dc.contributor.author | Jindal, Jenelle | |
dc.contributor.author | Holmstedt, Christine | |
dc.contributor.author | Logan, William R. | |
dc.contributor.author | Corral, Candy | |
dc.contributor.author | Mackey, Jason S. | |
dc.contributor.author | Gee, Joey R. | |
dc.contributor.author | Bonovich, David | |
dc.contributor.author | Walker, James | |
dc.contributor.author | Gropen, Toby | |
dc.contributor.author | Benesch, Curtis | |
dc.contributor.author | Dissin, Jonathan | |
dc.contributor.author | Pandey, Hemant | |
dc.contributor.author | Wang, David | |
dc.contributor.author | Unverdorben, Martin | |
dc.contributor.author | Hernandez, Adrian F. | |
dc.contributor.author | Reeves, Mathew | |
dc.contributor.author | Smith, Eric E. | |
dc.contributor.author | Schwamm, Lee H. | |
dc.contributor.author | Bhatt, Deepak L. | |
dc.contributor.author | Saver, Jeffrey L. | |
dc.contributor.author | Fonarow, Gregg C. | |
dc.contributor.author | Peterson, Eric D. | |
dc.contributor.author | Xian, Ying | |
dc.contributor.department | Neurology, School of Medicine | |
dc.date.accessioned | 2024-05-14T10:03:05Z | |
dc.date.available | 2024-05-14T10:03:05Z | |
dc.date.issued | 2023 | |
dc.description.abstract | Importance: Use of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications. Objective: To determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice. Design, setting, and participants: Retrospective, observational cohort study based on the American Heart Association's Get With the Guidelines-Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included. Exposure: VKA use within the 7 days prior to hospital arrival. Main outcome and measures: The primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion therapy, in-hospital mortality, and in-hospital mortality or discharge to hospice. Results: Of 32 715 patients (median age, 72 years; 50.7% female), 3087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29 628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211/3087 patients [6.8%] taking a VKA compared with 1904/29 628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, -0.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n = 1585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, -0.79% to 3.04%]). Of 5 prespecified secondary end points, none showed a significant difference across VKA-exposed vs VKA-unexposed groups. Conclusions and relevance: Among patients with acute ischemic stroke selected to receive EVT, VKA use within the preceding 7 days was not associated with a significantly increased risk of sICH overall. However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants. | |
dc.identifier.citation | Mac Grory B, Holmes DN, Matsouaka RA, et al. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA. 2023;329(23):2038-2049. doi:10.1001/jama.2023.8073 | |
dc.identifier.uri | https://hdl.handle.net/1805/40704 | |
dc.language.iso | en_US | |
dc.publisher | American Medical Association | |
dc.relation.isversionof | 10.1001/jama.2023.8073 | |
dc.relation.journal | JAMA | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Anticoagulants | |
dc.subject | Brain ischemia | |
dc.subject | Fibrinolytic agents | |
dc.subject | Endovascular procedures | |
dc.subject | Intracranial hemorrhages | |
dc.subject | Thrombectomy | |
dc.title | Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke | |
dc.type | Article | |
ul.alternative.fulltext | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10282891/ |