Mechanical thrombectomy for stroke patients anticoagulated with direct oral anticoagulants versus warfarin

Abstract

Background Outcomes after mechanical thrombectomy (MT) for large vessel occlusion (LVO) were compared between stroke patients anticoagulated with direct oral anticoagulants (DOACs) and those anticoagulated with warfarin.

Materials and methods: From data for 2399 LVO stroke patients in a prospective, multicenter registry, patients with prior oral anticoagulation who underwent MT were analyzed. Angiographic outcomes included successful recanalization (modified Thrombolysis in Cerebral Infarction 2b/3). Clinical outcomes included modified Rankin Scale (mRS) score 0-2 at 3 months and symptomatic intracranial hemorrhage.

Results: A total of 235 patients (95 women, median age 78 [interquartile range, 72-84] years) were included. Prescribed anticoagulants were DOACs in 61 patients and warfarin in 174 patients. Of patients on warfarin, 135 (77.6%) had a non-therapeutic therapy (international normalized ration [INR] ≤1.7). Patients on therapeutic warfarin (INR >1.7) had younger age and shorter onset to hospital arrival time than those on non-therapeutic warfarin and DOACs. The achievement of successful recanalization in warfarin groups was similar to the DOACs group, with an adjusted odds ratio (aOR) for therapeutic warfarin versus DOACs of 1.14 (95% confidence interval [CI], 0.27-4.89) and non-therapeutic warfarin versus DOACs of 0.92 (95% CI, 0.39-2.20), respectively. The frequency of mRS score 0-2 at 3 months in the therapeutic (aOR, 2.63; 95% CI, 0.86-7.98) and non-therapeutic warfarin (aOR, 1.77; 95% CI, 0.76-4.09) groups were similar to those in the DOACs group. There was no significant difference in symptomatic intracranial hemorrhage between groups.

Conclusions: Angiographic and clinical outcomes after MT were similar between patients anticoagulated with DOACs and warfarin.

Keywords: Anticoagulation; Stroke; Thrombectomy; Thrombolysis.