Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants
Authors: Goldhoorn Robert-Jan B. , van de Graaf Rob A. , van Rees Jan M. , Lingsma Hester F. , Dippel Diederik W.J. , Hinsenveld Wouter H. , Postma Alida , van den Wijngaard Ido , van Zwam Wim H. , van Oostenbrugge Robert J. , Roozenbeek Bob ,   on behalf of the MR CLEAN Registry Investigators†, van der Lugt Aad , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , Boiten Jelis , Albert Vos Jan , Brouwer Josje , den Hartog Sanne J. , Kappelhof Manon , Compagne Kars C.J. , Mulder Maxim J.H.L. , Jansen Ivo G.H. , van der Lugt Aad , van Es Adriaan C.G.M. , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Vos Jan Albert , Wermer Marieke J.H. , van Walderveen Marianne A.A. , Staals Julie , Hofmeijer Jeannette , Martens Jasper M. , Lycklama à Nijeholt Geert J. , Boiten Jelis , de Bruijn Sebastiaan F. , van Dijk Lukas C. , van der Worp H. Bart , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , de Vries J , de Kort Paul L.M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S.P. , van Hasselt Boudewijn A.A.M. , Aerden Leo A.M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Bokkers Reinoud P.H. , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Keizer Koos , Yo Lonneke S.F. , den Hertog Heleen M. , Sturm Emiel J.C. , Brouwers Paul , Majoie Charles B.L.M. , van der Lugt Aad , Lycklama à Nijeholt Geert J. , van Walderveen Marianne A.A. , Sprengers Marieke E.S. , Jenniskens Sjoerd F.M. , van den Berg René , Yoo Albert J. , Beenen Ludo F.M. , Roosendaal Stefan D. , van der Kallen Bas F.W. , van Es Adriaan C.G.M , Emmer Bart J. , Martens Jasper M , Yo Lonneke S.F. , Albert Vos Jan , Bot Joost , van Doormaal Pieter-Jan , Meijer Anton , Ghariq Elyas , Bokkers Reinoud P.H. , van Proosdij Marc P. , Krietemeijer G. Menno , Peluso Jo P. , Boogaarts Hieronymus D. , Lo Rob , Gerrits Dick , Dinkelaar Wouter , Appelman Auke P.A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , van der Lugt Aad , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , Lycklama à Nijeholt Geert J. , Boiten Jelis , Albert Vos Jan , Schonewille Wouter J. , Hofmeijer Jeannette , Martens Jasper M. , van der Worp H. Bart , Lo Rob H. , Hofmeijer Jeannette , Zwenneke Flach H. , el Ghannouti Naziha , Sterrenberg Martin , Puppels Corina , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , van Rijswijk Cathelijn , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Elfrink Marjan , Aaldering Nicoline , Zweedijk Berber , Khalilzada Mostafa , Vervoort Jocova , Droste Hanneke , Nicolaij Nynke , Simons Michelle , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Bos Erna , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R.M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M.M. , Huguet J. , Groot P.F.C. , Mens Marieke A. , van Kranendonk Katinka R. , Treurniet Kilian M. , Jansen Ivo G.H , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J.H.F. , Schupp Lieve M. , Collette Sabine , Groot Adrien E.D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte-Terreros Nerea , Ramos Lucas A. 
Published: May 2020

Background and Purpose—
The use of oral anticoagulants (OAC) is considered a contra-indication for intravenous thrombolytics as acute treatment of ischemic stroke. However, little is known about the risks and benefits of endovascular treatment in patients on prior OAC. We aim to compare outcomes after endovascular treatment between patients with and without prior use of OAC.

Methods—
Data of patients with acute ischemic stroke caused by an intracranial anterior circulation occlusion, included in the nationwide, prospective, MR CLEAN Registry between March 2014 and November 2017, were analyzed. Outcomes of interest included symptomatic intracranial hemorrhage and functional outcome at 90 days (modified Rankin Scale score). Outcomes between groups were compared with (ordinal) logistic regression analyses, adjusted for prognostic factors.

Results—
Three thousand one hundred sixty-two patients were included in this study, of whom 502 (16%) used OAC. There was no significant difference in the occurrence of symptomatic intracranial hemorrhage between patients with and without prior OACs (5% versus 6%; adjusted odds ratio, 0.63 [95% CI, 0.38–1.06]). Patients on OACs had worse functional outcomes than patients without OACs (common odds ratio, 0.57 [95% CI, 0.47–0.66]). However, this observed difference in functional outcome disappeared after adjustment for prognostic factors (adjusted common odds ratio, 0.91 [95% CI, 0.74–1.13]).

Conclusions—
Prior OAC use in patients treated with endovascular treatment for ischemic stroke is not associated with an increased risk of symptomatic intracranial hemorrhage or worse functional outcome compared with no prior OAC use. Therefore, prior OAC use should not be a contra-indication for endovascular treatment.