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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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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. |
format | Online Article Text |
id | pubmed-8124234 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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