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Bridging intravenous thrombolysis in patients with atrial fibrillation
BACKGROUND AND PURPOSE: 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral a...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9382124/ https://www.ncbi.nlm.nih.gov/pubmed/35989924 http://dx.doi.org/10.3389/fneur.2022.945338 |
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author | Mujanovic, Adnan Kurmann, Christoph C. Dobrocky, Tomas Olivé-Gadea, Marta Maegerlein, Christian Pierot, Laurent Mendes Pereira, Vitor Costalat, Vincent Psychogios, Marios Michel, Patrik Beyeler, Morin Piechowiak, Eike I. Seiffge, David J. Mordasini, Pasquale Arnold, Marcel Gralla, Jan Fischer, Urs Kaesmacher, Johannes Meinel, Thomas R. |
author_facet | Mujanovic, Adnan Kurmann, Christoph C. Dobrocky, Tomas Olivé-Gadea, Marta Maegerlein, Christian Pierot, Laurent Mendes Pereira, Vitor Costalat, Vincent Psychogios, Marios Michel, Patrik Beyeler, Morin Piechowiak, Eike I. Seiffge, David J. Mordasini, Pasquale Arnold, Marcel Gralla, Jan Fischer, Urs Kaesmacher, Johannes Meinel, Thomas R. |
author_sort | Mujanovic, Adnan |
collection | PubMed |
description | BACKGROUND AND PURPOSE: 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. MATERIALS AND METHODS: Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). RESULTS: In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). CONCLUSION: Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT. REGISTRATION: clinicaltrials.gov; Unique identifier: NCT03496064. |
format | Online Article Text |
id | pubmed-9382124 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93821242022-08-18 Bridging intravenous thrombolysis in patients with atrial fibrillation Mujanovic, Adnan Kurmann, Christoph C. Dobrocky, Tomas Olivé-Gadea, Marta Maegerlein, Christian Pierot, Laurent Mendes Pereira, Vitor Costalat, Vincent Psychogios, Marios Michel, Patrik Beyeler, Morin Piechowiak, Eike I. Seiffge, David J. Mordasini, Pasquale Arnold, Marcel Gralla, Jan Fischer, Urs Kaesmacher, Johannes Meinel, Thomas R. Front Neurol Neurology BACKGROUND AND PURPOSE: 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. MATERIALS AND METHODS: Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). RESULTS: In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). CONCLUSION: Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT. REGISTRATION: clinicaltrials.gov; Unique identifier: NCT03496064. Frontiers Media S.A. 2022-08-03 /pmc/articles/PMC9382124/ /pubmed/35989924 http://dx.doi.org/10.3389/fneur.2022.945338 Text en Copyright © 2022 Mujanovic, Kurmann, Dobrocky, Olivé-Gadea, Maegerlein, Pierot, Mendes Pereira, Costalat, Psychogios, Michel, Beyeler, Piechowiak, Seiffge, Mordasini, Arnold, Gralla, Fischer, Kaesmacher, Meinel and the BEYOND-SWIFT Investigators. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Mujanovic, Adnan Kurmann, Christoph C. Dobrocky, Tomas Olivé-Gadea, Marta Maegerlein, Christian Pierot, Laurent Mendes Pereira, Vitor Costalat, Vincent Psychogios, Marios Michel, Patrik Beyeler, Morin Piechowiak, Eike I. Seiffge, David J. Mordasini, Pasquale Arnold, Marcel Gralla, Jan Fischer, Urs Kaesmacher, Johannes Meinel, Thomas R. Bridging intravenous thrombolysis in patients with atrial fibrillation |
title | Bridging intravenous thrombolysis in patients with atrial fibrillation |
title_full | Bridging intravenous thrombolysis in patients with atrial fibrillation |
title_fullStr | Bridging intravenous thrombolysis in patients with atrial fibrillation |
title_full_unstemmed | Bridging intravenous thrombolysis in patients with atrial fibrillation |
title_short | Bridging intravenous thrombolysis in patients with atrial fibrillation |
title_sort | bridging intravenous thrombolysis in patients with atrial fibrillation |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9382124/ https://www.ncbi.nlm.nih.gov/pubmed/35989924 http://dx.doi.org/10.3389/fneur.2022.945338 |
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