TY - JOUR
T1 - Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes
AU - Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators
AU - Akbik, Feras
AU - Alawieh, Ali
AU - Dimisko, Laurie
AU - Howard, Brian M.
AU - Cawley, C. Michael
AU - Tong, Frank C.
AU - Nahab, Fadi
AU - Samuels, Owen B.
AU - Maier, Ilko
AU - Feng, Wuwei
AU - Goyal, Nitin
AU - Starke, Robert M.
AU - Rai, Ansaar
AU - Fargen, Kyle M.
AU - Psychogios, Marios N.
AU - Jabbour, Pascal
AU - De Leacy, Reade
AU - Keyrouz, Saleh G.
AU - Dumont, Travis M.
AU - Kan, Peter
AU - Liman, Jan
AU - Arthur, Adam S.
AU - Wolfe, Stacey Q.
AU - Mocco, J.
AU - Crosa, Roberto Javier
AU - Fox, W. Christopher
AU - Gory, Benjamin
AU - Spiotta, Alejandro M.
AU - Grossberg, Jonathan A.
AU - Richard, Sébastien
AU - Hoh, Brian
AU - Polifka, Adam
AU - Park, Min
AU - Kicielinski, Kimberly
AU - Al Kasab, Sami
AU - Almallouhi, Eyad
AU - Allen, Michelle
AU - Lena, Jonathan
AU - Hoit, Daniel A.
AU - Elijovich, Lucas
AU - Inoa, Violiza
AU - Nickele, Christopher
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022.
PY - 2022/10
Y1 - 2022/10
N2 - Background Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT. Methods This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared. Results 6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis. Conclusion In this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers.
AB - Background Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT. Methods This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared. Results 6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis. Conclusion In this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers.
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U2 - 10.1136/neurintsurg-2021-017954
DO - 10.1136/neurintsurg-2021-017954
M3 - Article
C2 - 34819345
AN - SCOPUS:85138445154
SN - 1759-8478
VL - 14
SP - 979
EP - 984
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 10
ER -