scholarly journals MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

2020 ◽  
Author(s):  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Jan Gralla ◽  
David Julian Seiffge ◽  
Elias Auer ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Hemorrhagic Transformation ◽  
Ischemic Lesion ◽  
Lesion Diameter ◽  
Imaging Characteristics ◽  
Therapeutic Anticoagulation

Abstract 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.

scholarly journals MRI Characteristics in Acute Ischemic Stroke Patients with Preceding Direct Oral Anticoagulant Therapy as compared to Vitamin K Antagonists

2019 ◽  
Author(s):  
Thomas Meinel ◽  
Johannes Kaesmacher ◽  
Jan Gralla ◽  
David Julian Seiffge ◽  
Elias Auer ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Hemorrhagic Transformation ◽  
Ischemic Lesion ◽  
Lesion Diameter ◽  
Imaging Characteristics ◽  
Therapeutic Anticoagulation

Abstract 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.

scholarly journals Neutrophil-to-lymphocyte Ratio as a Risk Determinant of Hemorrhage Transformation in Acute Ischemic Stroke

2020 ◽  
pp. 8-16
Author(s):  
Shuang Ma ◽  
Bilal Muhammad ◽  
Shu Kan ◽  
Zhen-Ying Shang ◽  
Li Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Hemorrhagic Transformation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Optimal Cutoff ◽  
Ischemic Lesion ◽  
Lymphocyte Ratio ◽  
Independent Risk Factors

Objective: The purpose of this study was to investigate the clinical significance between neutrophil-to-lymphocyte ratio (NLR) and classification of non-thrombolytic hemorrhagic transformation (HT) in acute ischemic stroke (AIS), to unravel new diagnostic approach. Methods: We recruited and selected 636 patients who did not undergo thrombolytic therapy between May 2018 and April 2019 at the Affiliated Hospital of Xuzhou Medical University. The laboratory and clinical data were collected within 24 h after the onset of AIS. Based on the status of HT development during hospitalization, all participants were divided into three groups, namely, the non-HT (NHT) group, hemorrhagic infarction (HI) group, and parenchymal hematoma (PH) group. Results: Multivariate logistic regression analysis showed that NLR and the ischemic lesion diameter are independent risk factors of HI and PH, while the score of National Institutes of Health Stroke Scale (NIHSS) and cardioembolism are considered to be independent risk factors for PH only. Receiver operating characteristic (ROC) analysis determined that the optimal cutoff values of NLR in HI group and PH group were 3.75 and 3.97, respectively. The optimal cutoff value can be used as the critical value for the unfavorable outcome. Conclusion: NLR values were significantly increased and correlated with both HI and PH groups and NLR could be used as a predictor of both HI and PH.

scholarly journals Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis

2020 ◽  
Vol 33 (2) ◽  
pp. 118-133 ◽  
Author(s):  
Nada Elsaid ◽  
Wessam Mustafa ◽  
Ahmed Saied
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Treatment Plan ◽  
Hemorrhagic Transformation ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Blood Brain Barrier Disruption

Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.

Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke

2017 ◽  
Vol 10 (9) ◽  
pp. 834-838 ◽  
Author(s):  
Gustavo Zapata-Wainberg ◽  
Álvaro Ximénez-Carrillo ◽  
Santiago Trillo ◽  
Blanca Fuentes ◽  
Antonio Cruz-Culebras ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Mechanical Thrombectomy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Mortality Rates ◽  
Anticoagulated Patients

Background and purposeTo investigate the efficacy and safety of mechanical thrombectomy in patients with acute ischemic stroke according to the oral anticoagulation medication taken at the time of stroke onset.Materials and methodsA retrospective multicenter study of prospectively collected data based on data from the registry the Madrid Stroke Network was performed. We included consecutive patients with acute ischemic stroke treated with mechanical thrombectomy and compared the frequency of intracranial hemorrhage and the modified Rankin Scale (mRS) score at 3 months according to anticoagulation status.ResultsThe study population comprised 502 patients, of whom 389 (77.5%) were not anticoagulated, 104 (20.7%) were taking vitamin K antagonists, and 9 (1.8%) were taking direct oral anticoagulants. Intravenous thrombolysis had been performed in 59.8% and 15.0% of non-anticoagulated and anticoagulated patients, respectively. Rates of intracranial hemorrhage after treatment were similar between non-anticoagulated and anticoagulated patients, as were rates of recanalization. After 3 months of follow-up, the mRS score was ≤2 in 56.3% and 55.7% of non-anticoagulated and anticoagulated patients, respectively (P=NS). Mortality rates were similar in the two groups (13.1%and12.4%, respectively). Among anticoagulated patients, no differences were found for intracranial bleeding, mRS score, or mortality rates between patients taking vitamin K antagonists and those taking direct oral anticoagulants.ConclusionsMechanical thrombectomy is feasible in anticoagulated patients with acute ischemic stroke. The outcomes and safety profile are similar to those of patients with no prior anticoagulation therapy.

Acute Ischemic Stroke Outcome and Preceding Anticoagulation: Direct Oral Anticoagulants Versus Vitamin K Antagonists

2020 ◽  
Vol 29 (4) ◽  
pp. 104691 ◽  
Author(s):  
Sofia Felício Tavares ◽  
Inês Ferreira ◽  
Vanessa Chaves ◽  
Luis Flores ◽  
Cristina Correia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Stroke Outcome

Abstract W MP21: Contrast Staining on Ct After Endovascular Treatment for Acute Ischemic Stroke: Association With Worse Outcomes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Muhammad S Hussain ◽  
Gabor Toth ◽  
Nancy Obuchowski ◽  
Shumei Man ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Group Versus ◽  
Hemorrhagic Transformation ◽  
Chi Square ◽  
Vessel Occlusion ◽  
Post Procedure ◽  
Imaging Characteristics ◽  
Clinical Consequences ◽  
Brain Ct Scan

Introduction: Parenchymal contrast staining may appear on computerized tomography after intra-arterial therapy for acute ischemic stroke. This finding may not be associated with hemorrhagic transformation and has been reported to be transient. However, the incidence, associations and clinical consequences have not been well described. Methods: We reviewed a prospectively collected database of acute ischemic stroke patients admitted between January of 2012 and April of 2013. We included patients with acute ischemic stroke and large vessel occlusion who underwent endovascular therapy. Demographic, clinical and imaging characteristics were assessed. Post-procedure brain CTs were reviewed for contrast staining and ASPECTS score. Discharge and 30-day follow up data were compared using Wilcoxon two-sample tests and chi square tests. Results: 59 patients (34 (57.6%) female, mean age: 66.7 years;) were included in the analysis. Twenty two patients (37.3%) had contrast staining on post-procedure brain CT scan. Of this group, the initial median NIHSS was 16.5 and initial median ASPECTS score was 7 (compared to initial median NIHSS of 15 and median ASPECTS of 9 in those without contrast staining) (p=0.297 and 0.166, respectively). Recanalization rates were similar for both groups (82% vs. 83%, p=0.882). Upon discharge, the group of patients with post-procedure CT with contrast staining had significantly higher NIHSS (median of 15) and lower CT ASPECTS score (median of 6), (compared to NIHSS of 7 and CT ASPECTS of 8 in those without contrast staining) (p=0.025 and 0.017). Patients who had contrast staining tended to be more likely to have a hemorrhagic transformation of the ischemic infarct area (59.1% versus 36.1%, p=0.088) with rates of PH1 being 18.2% (versus 8.1%, p=0.407) and PH2 being 22.7% (versus 5.4%, p=0.090). The data also suggest a difference in the 30-day NIHSS (10 in the contrast staining group versus 4, p=0.092) and 30-day MRS (4 in the contrast staining group versus 3, p=0.107). Conclusion: The presence of contrast staining on CT obtained after intra-arterial therapy for acute ischemic stroke may be associated with worse imaging and clinical outcomes, including hemorrhagic transformation and worse neurologic deficits upon discharge and at 30 days.

scholarly journals Stress hyperglycemia as a prognostic factor in acute ischemic stroke patients: a prospective observational cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mahmoud A. Mohamed ◽  
Amr E. Abd-Elhamid ◽  
Mohammed A. Nosseir
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Diabetic Patients ◽  
Stroke Patients ◽  
Stress Hyperglycemia ◽  
Discrimination Power ◽  
Observational Cohort

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

scholarly journals Comparison of Left Atrial Appendage Occlusion versus Non-Vitamin-K Antagonist Oral Anticoagulation in High-Risk Atrial Fibrillation: An Update

2021 ◽  
Vol 8 (6) ◽  
pp. 69
Author(s):  
Shaojie Chen ◽  
K. R. Julian Chun ◽  
Zhiyu Ling ◽  
Shaowen Liu ◽  
Lin Zhu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Vitamin K ◽  
Major Bleeding ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Vitamin K Antagonists ◽  
Left Atrial Appendage Occlusion ◽  
The Mean

Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64–1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to “contemporary NOACs”. The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.

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