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Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine

Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = 1500) of...

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Autores principales: Kühne Escolà, Jordi, Nagel, Simon, Panitz, Verena, Reiff, Tilman, Gutschalk, Alexander, Gumbinger, Christoph, Purrucker, Jan Christoph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124234/
https://www.ncbi.nlm.nih.gov/pubmed/34063203
http://dx.doi.org/10.3390/jcm10091956
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author Kühne Escolà, Jordi
Nagel, Simon
Panitz, Verena
Reiff, Tilman
Gutschalk, Alexander
Gumbinger, Christoph
Purrucker, Jan Christoph
author_facet Kühne Escolà, Jordi
Nagel, Simon
Panitz, Verena
Reiff, Tilman
Gutschalk, Alexander
Gumbinger, Christoph
Purrucker, Jan Christoph
author_sort Kühne Escolà, Jordi
collection PubMed
description Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017. Management of patients suffering AIS with and without prior oral anticoagulation treatment was characterized, including potential vs. actual treatment with intravenous thrombolysis (IVT) and reasons for withholding it. Results: n = 359 patients had suffered an AIS, of whom 63 (17.5%) were under treatment with oral anticoagulants (VKA, n = 24; NOAC, n = 39). Administration of IVT was more common in patients who had not received prior oral anticoagulation treatment (20.3% vs. 3.2%, p < 0.001). NOAC intake was the primary reason for withholding IVT in 37% of orally anticoagulated patients who were found potentially eligible for IVT. Furthermore, patients under oral anticoagulation tended to be transported to the comprehensive stroke center more often (23.8% vs. 13.9%, p = 0.056). Conclusions: AIS in patients on oral anticoagulation treatment is a frequent reason for telestroke consultation, and NOAC intake constitutes an important barrier to administering IVT.
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spelling pubmed-81242342021-05-17 Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine Kühne Escolà, Jordi Nagel, Simon Panitz, Verena Reiff, Tilman Gutschalk, Alexander Gumbinger, Christoph Purrucker, Jan Christoph J Clin Med Article Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017. Management of patients suffering AIS with and without prior oral anticoagulation treatment was characterized, including potential vs. actual treatment with intravenous thrombolysis (IVT) and reasons for withholding it. Results: n = 359 patients had suffered an AIS, of whom 63 (17.5%) were under treatment with oral anticoagulants (VKA, n = 24; NOAC, n = 39). Administration of IVT was more common in patients who had not received prior oral anticoagulation treatment (20.3% vs. 3.2%, p < 0.001). NOAC intake was the primary reason for withholding IVT in 37% of orally anticoagulated patients who were found potentially eligible for IVT. Furthermore, patients under oral anticoagulation tended to be transported to the comprehensive stroke center more often (23.8% vs. 13.9%, p = 0.056). Conclusions: AIS in patients on oral anticoagulation treatment is a frequent reason for telestroke consultation, and NOAC intake constitutes an important barrier to administering IVT. MDPI 2021-05-02 /pmc/articles/PMC8124234/ /pubmed/34063203 http://dx.doi.org/10.3390/jcm10091956 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kühne Escolà, Jordi
Nagel, Simon
Panitz, Verena
Reiff, Tilman
Gutschalk, Alexander
Gumbinger, Christoph
Purrucker, Jan Christoph
Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title_full Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title_fullStr Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title_full_unstemmed Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title_short Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine
title_sort challenges of acute ischemic stroke treatment in orally anticoagulated patients via telemedicine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124234/
https://www.ncbi.nlm.nih.gov/pubmed/34063203
http://dx.doi.org/10.3390/jcm10091956
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