title: Safety of Endovascular Intervention for Stroke on Therapeutic Anticoagulation: Multicenter Cohort Study and Meta-Analysis.
abstract: BACKGROUND
  Intravenous (IV) tissue plasminogen activator (tPA) is contraindicated in therapeutically anti-coagulated patients. Such patients may be considered for endovascular intervention. However, there are limited data on its safety.
  
  
  METHODS
  We performed a multicenter retrospective study of patients undergoing endovascular intervention for acute ischemic stroke while on therapeutic anticoagulation. We compared the observed rate of National Institute of Neurological Disorders and Stroke defined symptomatic intracerebral hemorrhage (sICH) with risk-adjusted historical control rates of sICH after IV tPA using weighted averages of the hemorrhage after thrombolysis (HAT) and Multicenter Stroke Survey (MSS) prediction scores. We also performed a metaanalysis of studies assessing risk of sICH with endovascular intervention in patients on anticoagulation.
  
  
  CONCLUSIONS
  Of 94 cases, mean age was 73 years and median National Institutes of Health Stroke Scale was 19. Anticoagulation consisted of warfarin (n = 51), dabigatran (n = 6), rivaroxaban (n = 13), apixaban (n = 1), IV heparin (n = 19), low molecular weight heparin (n = 3), and combined warfarin and IV heparin (n = 3). sICH was seen in 7 patients (7%, 95% confidence interval 4-15), all on warfarin. Predicted sICH rates for the cohort based on HAT and MSS scoring were 12% and 7%, respectively. Meta-analysis of 6 studies showed no significant difference in sICH between patients undergoing endovascular intervention on anticoagulation and comparator groups.
  
  
  CONCLUSIONS
  Endovascular intervention in subjects on therapeutic anticoagulation appears reasonably safe, with a sICH rate similar to patients not on anticoagulation receiving IV tPA.
authors.affiliation: Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania. Electronic address: donna.kurowski@uphs.upenn.edu.
authors.forename: Donna
authors.initials: D
authors.lastname: Kurowski
authors.affiliation: Department of Neurology, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Karin
authors.initials: K
authors.lastname: Jonczak
authors.affiliation: Department of Neurology, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Qaisar
authors.initials: Q
authors.lastname: Shah
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: Department of Neurology, Columbia University, New York, New York.
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.affiliation: Department of Neurology, Robert Wood Johnson, New Brunswick, New Jersey.
authors.forename: Haroon
authors.initials: H
authors.lastname: Ahmad
authors.affiliation: Department of Neurology, New Hanover Regional Medical Center, Wilmington, North Carolina.
authors.forename: James
authors.initials: J
authors.lastname: McKinney
authors.affiliation: Department of Neurology, New York University, New York, New York.
authors.forename: Jose
authors.initials: J
authors.lastname: Torres
authors.affiliation: Department of Neurology, New York University, New York, New York.
authors.forename: Koto
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Brett
authors.initials: B
authors.lastname: Cucchiara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular treatment; anticoagulation; hemorrhage; ischemic stroke; meta-analysis; safety