Data_Sheet_1_Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry.PDF

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy.Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants.Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01–3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months.Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months.

引言：本研究旨在评估既往口服抗凝治疗（OAC）及其类型是否增加了急性缺血性卒中（AIS）患者在接受机械取栓术后发生症状性出血性转化的风险。材料与方法：本研究纳入了来自2017年1月至2019年12月期间西班牙北部三级卒中中心网络NORDICTUS前瞻性再灌注登记处的连续性AIS患者。记录了既往口服抗凝药物的使用情况、基线变量以及入院时的国际标准化比值（INR）。症状性颅内出血（sICH）为首要的结局指标。次要结局指标为INR与sICH之间的关系，并通过改良Rankin量表评估了3个月时的死亡率及功能预后。我们比较了既往接受过OAC治疗的患者与未接受过OAC治疗的患者，并考虑了口服抗凝药物的类型。结果：约1,455名AIS患者被纳入研究，其中274名（19%）正在接受OAC治疗，其中193名（70%）接受维生素K拮抗剂（VKA）治疗，81名（30%）接受直接口服抗凝剂（DOACs）治疗。接受抗凝治疗的患者年龄更大，合并症更多。81名（5.6%）患者发生了sICH，其中VKA组更为常见，而DOAC组则不然。在多变量回归模型中，OAC与VKA的使用成为sICH的预测因子（OR，1.89 [95% CI，1.01–3.51]，p = 0.04），并且与入院时的INR水平无关。既往VKA的使用与多变量回归模型中的不良预后或3个月时的死亡率无相关性。结论：与DOACs不同，OAC与VKA的使用是机械取栓术后sICH的独立预测因子。这种额外的风险既与手术时INR值无关，也与3个月时的更差功能预后或死亡率无关。