Clinical neuroradiology · 2025
Association Between Direct Oral Anticoagulants and the Risk of Internal Carotid Artery Occlusion in Patients Eligible for Thrombectomy.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Hanai Sho, Sato Masayuki, Hayakawa Mikito, Hosoo Hisayuki, Ikeda Go, Ito Yoshiro, Marushima Aiki, Takigawa Tomoji, Tsuruta Wataro, Kato Noriyuki, Uemura Kazuya, Suzuki Kensuke, Komatsu Yoji, Yamagami Hiroshi, Ishikawa Eiichi, Matsumaru Yuji
Аннотация
PURPOSE: Direct oral anticoagulants (DOACs) have equivalent efficacy and fewer complications than vitamin K antagonists (VKAs) and are widely used for atrial fibrillation. However, data on how DOACs affect mechanical thrombectomy (MT) and influence the occlusion site are limited. This study aimed to investigate the efficacy and safety of MT before DOAC administration and how DOAC influences the occlusion site eligible for MT.
METHODS: The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0-3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).
RESULT: Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195-0.943; p = 0.035).
CONCLUSION: Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did not lead to mRS improvement at discharge and did not increase PH after MT.
METHODS: The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0-3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).
RESULT: Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195-0.943; p = 0.035).
CONCLUSION: Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did not lead to mRS improvement at discharge and did not increase PH after MT.