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 (2022). Bridging intravenous thrombolysis in patients with atrial fibrillation. Frontiers in neurology, 13, p. 945338. Frontiers Media S.A. 10.3389/fneur.2022.945338

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Mujanović, Adnan; Kurmann, Christoph Carmelino; Dobrocky, Tomas; Beyeler, Morin; Piechowiak, Eike Immo; Seiffge, David Julian; Mordasini, Pasquale; Arnold, Marcel; Gralla, Jan; Fischer, Urs; Kaesmacher, Johannes and Meinel, Thomas Raphael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1664-2295

Publisher:

Frontiers Media S.A.

Language:

English

Submitter:

Pubmed Import

Date Deposited:

23 Aug 2022 10:28

Last Modified:

28 Aug 2022 02:12

Publisher DOI:

10.3389/fneur.2022.945338

PubMed ID:

35989924

Uncontrolled Keywords:

atrial fibrillation intravenous thrombolysis ischemic stroke mechanical thrombectomy oral anticoagulation

BORIS DOI:

10.48350/172272

URI:

https://boris.unibe.ch/id/eprint/172272

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