Editors' note: MT in anticoagulated patients: Direct oral anticoagulants versus vitamin K antagonists

Abstract

In “MT in anticoagulated patients: Direct oral anticoagulants versus vitamin K antagonists,” L'Allinec et al. compared procedural and clinical outcomes of mechanical thrombectomy (MT) in 115 patients on direct oral anticoagulants (DOACs) and 106 patients on vitamin K antagonists (VKAs) and found that reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b/3 or mTICI 2c/3), 90-day mortality, and excellent 90-day outcome (modified Rankin Scale [mRS] 0–1 or equal to prestroke mRS) were better in patients on DOACs. Frontera cautioned that this study does not clearly indicate that clot retrieval is easier in patients on DOACs because (1) up to 50% of VKA users may have had a subtherapeutic international normalized ratio (INR) (28% of patients had INR <2% and 24% did not have INR) and (2) data on the MT devices are not provided. Further study is warranted comparing patients on individual DOACs with patients on VKAs with therapeutic INRs who are treated with the latest MT techniques. However, these findings add to existing literature on the benefit of DOACs vs VKAs about the risk of ischemic and hemorrhagic events. In “MT in anticoagulated patients: Direct oral anticoagulants versus vitamin K antagonists,” L'Allinec et al. compared procedural and clinical outcomes of mechanical thrombectomy (MT) in 115 patients on direct oral anticoagulants (DOACs) and 106 patients on vitamin K antagonists (VKAs) and found that reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b/3 or mTICI 2c/3), 90-day mortality, and excellent 90-day outcome (modified Rankin Scale [mRS] 0–1 or equal to prestroke mRS) were better in patients on DOACs. Frontera cautioned that this study does not clearly indicate that clot retrieval is easier in patients on DOACs because (1) up to 50% of VKA users may have had a subtherapeutic international normalized ratio (INR) (28% of patients had INR <2% and 24% did not have INR) and (2) data on the MT devices are not provided. Further study is warranted comparing patients on individual DOACs with patients on VKAs with therapeutic INRs who are treated with the latest MT techniques. However, these findings add to existing literature on the benefit of DOACs vs VKAs about the risk of ischemic and hemorrhagic events.