title: Safety of endovascular treatment in acute stroke patients taking oral anticoagulants.
abstract: Background The endovascular treatment of acute cerebral ischemia has been proven beneficial without major safety concerns. To date, the role of endovascular treatment in patients treated with oral anticoagulants, which may be associated with periprocedural intracranial bleeding, remains uncertain. Aims The objective of the current analysis is to evaluate the safety of endovascular treatment in patients treated with oral anticoagulants. Methods The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria collecting pre-specified variables about endovascular stroke therapy. Results Data from 815 patients (median age 70 (interquartile range (IQR) 20), 57% male) undergoing endovascular treatment with known anticoagulation status were analyzed. A total of 85 (median age 76 (IQR 8), 52% male) patients (10.4%) took vitamin-K-antagonists prior to endovascular treatment. Anticoagulation status as measured with international normalized ratio was above 2.0 in 31 patients. Intracranial hemorrhage occurred in 11.8% of patients taking vitamin-K-antagonists compared to no-vitamin-K-antagonists (12.2%, p = 0.909). After adjustment for confounding factors which were unbalanced at univariate level such as NIHSS and age, anticoagulation status was not found to significantly influence clinical outcome (modified Rankin Scale 3-6) and occurrence of intracranial hemorrhage in a multivariate logistic regression analysis. Conclusion Prior use of vitamin-K-antagonists was not associated with a higher rate of periprocedural intracranial hemorrhage after endovascular treatment or worse outcome. Endovascular treatment should be considered as an important treatment option in patients taking vitamin-K-antagonists.
authors.affiliation: 1 Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Uphaus
authors.affiliation: 2 Department of Neurology, Goethe University Frankfurt/Main, Germany; Department of Neurology, HELIOS Dr Horst Schmidt Clinics Wiesbaden, Germany.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.affiliation: 3 Institute for Neuroradiology, Goethe University Frankfurt/Main, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.affiliation: 4 Department of Neurology, Charité Hospital, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.affiliation: 5 Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Hospital, Berlin, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Bohner
authors.affiliation: 6 Department of Neurology, Medical University Graz, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Niederkorn
authors.affiliation: 7 Department of Radiology, Clinical Division of Neuroradiology, Vascular and Interventional Radiology, Medical University Graz, Austria.
authors.forename: Hannes
authors.initials: H
authors.lastname: Deutschmann
authors.affiliation: 7 Department of Radiology, Clinical Division of Neuroradiology, Vascular and Interventional Radiology, Medical University Graz, Austria.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Haring
authors.affiliation: 9 Institute for Radiology, Wagner-Jauregg Hospital, Linz, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Trenkler
authors.affiliation: 10 Department of Neurology, Klinikum Fulda, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.affiliation: 11 Institute for Diagnostic and Interventional Neuroradiology, Klinikum Fulda, Germany.
authors.forename: Erich
authors.initials: E
authors.lastname: Hofmann
authors.affiliation: 12 Department of Neurology, Klinikum Altenburger Land, Altenburg, Germany.
authors.forename: Anett
authors.initials: A
authors.lastname: Stoll
authors.affiliation: 13 Institute for Radiology, Klinikum Altenburger Land, Altenburg, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Bormann
authors.affiliation: 14 Department of Neurology, Vest Klinikum, Recklinghausen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bussmeyer
authors.affiliation: 15 Institute for Radiology and Neuroradiology, Vest Klinikum, Recklinghausen, Germany.
authors.forename: Aanastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: 16 Department of Neurology, University Hospital Aachen, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Reich
authors.affiliation: 17 Institute for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.affiliation: 18 Department of Neurology and German Center for Neurodegenerative Disease (DZNE), University Hospital Bonn, Germany.
authors.forename: Gabor C
authors.initials: GC
authors.lastname: Petzold
authors.affiliation: 19 Institute for Radiology, University Hospital Bonn, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.affiliation: 20 Department of Neurology, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jander
authors.affiliation: 21 Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.affiliation: 22 Department of Neurology, University Hospital Essen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.affiliation: 23 Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schlamann
authors.affiliation: 24 Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: 1 Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Gröschel
authors.affiliation: 25 Institute of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Boor
authors.affiliation: 1 Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Gröschel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000188:drug therapy* / Q000601:surgery; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Ischaemic stroke; antithrombotic; intervention