MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists.

Meinel, Thomas Raphael; Kaesmacher, Johannes; Gralla, Jan; Seiffge, David J; Auer, Elias; Frey, Sebastién; El-Koussy, Marwan; Arnold, Marcel; Fischer, Urs; Göldlin, Martina; Jung, Simon; Hakim, Arsany (2020). MRI characteristics in acute ischemic stroke patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists. BMC neurology, 20(1), p. 86. BioMed Central 10.1186/s12883-020-01678-4

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BACKGROUND Despite the utility of neuroimaging in the diagnostic and therapeutic management of patients with acute ischemic stroke (AIS), imaging characteristics in patients with preceding direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) have hardly been described. We aimed to determine presence of large vessel occlusion (LVO), thrombus length, infarction diameter, and occurrence of hemorrhagic transformation in AIS patients with preceding DOAC as compared to VKA therapy. METHODS Using a prospectively collected cohort of AIS patients, we performed univariate and multivariable regression analyses regarding imaging outcomes. Additionally, we provide a sensitivity analysis for the subgroup of patients with confirmed therapeutic anticoagulation. RESULTS We included AIS in patients with preceding DOAC (N = 75) and VKA (N = 61) therapy, median age 79 (IQR 70-83), 39% female. Presence of any LVO between DOAC and VKA patients (29.3% versus 37.7%, P = 0.361), and target LVO for endovascular therapy (26.7% versus 27.9%, P = 1.0) was equal with a similar occlusion pattern. DOAC as compared to VKA were associated with a similar rate of target LVO for EVT (aOR 0.835, 95% CI 0.368-1.898). The presence of multiple lesions and characteristics of the thrombus were similar in DOAC and VKA patients. Acute ischemic lesion diameter in real world patients was equal in patients taking DOAC as compared to VKA. Lesion diameter in VKA patients (median 13 mm, IQR 6-26 versus median 20 mm, IQR 7-36, P = 0.001), but not DOAC patients was smaller in the setting of confirmed therapeutic VKA. The frequency of radiological hemorrhagic transformation and symptomatic intracranial hemorrhage in OAC patients was low. Sensitivity analysis considering only patients with confirmed therapeutic anticoagulation did not change any of the results. CONCLUSION Preceding DOAC treatment showed equal rates of LVO and infarct size as compared to VKA in AIS patients. This study adds to the knowledge of imaging findings in AIS patients with preceding anticoagulation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Meinel, Thomas Raphael; Kaesmacher, Johannes; Gralla, Jan; Seiffge, David Julian; El-Koussy, Marwan; Arnold, Marcel; Fischer, Urs; Göldlin, Martina Béatrice; Jung, Simon and Hakim, Arsany

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1471-2377

Publisher:

BioMed Central

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

06 Apr 2020 10:25

Last Modified:

06 Apr 2020 10:25

Publisher DOI:

10.1186/s12883-020-01678-4

PubMed ID:

32160909

Uncontrolled Keywords:

Acute ischemic stroke Anticoagulation DOAC Hemorrhagic transformation Infarction size Large vessel occlusion VKA

BORIS DOI:

10.7892/boris.141917

URI:

https://boris.unibe.ch/id/eprint/141917

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