Abstract
Background: Endovascular therapy (EVT ) is the only available reperfusion treatment in acute ischemic patients on prior oral anticoagulants (OACs). We evaluated the practice patterns, safety, and outcomes of EVT in patients on OAC therapy. Methods: From 2010 to 2019, 84,346 ischemic stroke patients presenting within 24 hours of symptoms across 107hospitals were enrolled in the Florida Stroke Registry, of which 5,702 received EVT. We collected data on demographics, past history, medications, NIHSS, symptomatic intracranial hemorrhage (sICH), discharge destination and hospital characteristics and used multivariable-adjusted logistic regression models to identify differences in outcome based on anticoagulation status. Results: Among all EVT patients (mean age 71±15 years, 48% women), 969 (17%) were treated with OAC. Compared to those not on OACs, anticoagulated patients were older (mean age 75.5±12.8 vs 70.0 ±14.9 years), more women (56% vs 50%), Hispanics (25% vs 20%), Medicare patients (44% vs 34%) and more likely to have atrial fibrillation (78.5% vs 27%), present earlier to the hospital (101 min vs 122 min) with similar clinical severity (median NIHSS 16 vs 15). There was no significant difference in length of stay 0-6 days (OAC 45.7% vs 46.8%), mRS 0-2 (OAC 23.9% vs 30.9%), independent ambulation (OAC 31.1% vs 38.3%), sICH (OAC 6.1% vs 5.4%), life-threatening or serious hemorrhage (OAC 0.4% vs 0.8%) or mortality (OAC 9.8% vs 9.8%) between the two groups. After multivariate adjustment, EVT patients on OACs were less likely to be discharged home compared to patients not on OACs (OR 0.18, 95% CI 0.05-0.31). Conclusion: In this large, multi-center study, EVT for patients with acute ischemic stroke on oral anticoagulation therapy did not result in higher rates of sICH, life threatening hemorrhage or death, though these patients are less likely to be discharged directly home.
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