London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 285 17 Acute stroke: current treatment Reperfusion therapy in acute stroke patients treated with vitamin K antagonists (VKA). Is it safe? S. Rudilosso1, A. Cervera2, L. Llull3, X. Urra4, S. Amaro5, V. Obach6, A. Chamorro7 Comprehensive Stroke Center, Hospital Clinic, Barcelona, SPAIN1, Comprehensive Stroke Cen-ter, Hospital Clinic, Barcelona, SPAIN2, Comprehensive Stroke Center, Hospital Clinic, Barcelona, SPAIN3, Comprehensive Stroke Center, Hospital Clinic, Barcelona, SPAIN4, Comprehensive Stroke Center, Hospital Clinic, Barcelona, SPAIN5, Comprehensive Stroke Center, Hospital Clinic, Barce-lona, SPAIN6, Comprehensive Stroke Center, Hospital Clinic, Barcelona, SPAIN7 Background: The appropriate treatment for acute ischemic stroke patients under VKA is not clear. It has been proposed that off-label use of IV tPA (IVt) is safe if the INR is ≤1.7. However, in some series this is associated with an increased symptomatic intracranial hemorrhage (sICH) rate. Other authors propose mechanical thrombectomy (MT) if the INR is higher. The objective of our study was to evaluate the safety and efficacy of reperfusion therapies in patients taking VKA. Methods: We analyzed 494 consecutive patients treated with reperfusion therapies at our Stroke Unit. Patients taking VKA were treated with IVt if INR was≤ 1.7, and rescue MT if there was a persistent arterial occlusion in CT angiography. If INR was >1.7 and <3 or there were for-mal contraindications to IVt, patients were treated with elective MT. Main outcomes variables were sICH and mRS at 90 days, that were analyzed in a regression model adjusting for baseline variables. Good outcome was defined as mRS 0 to 2. Results: Forty-one (8.3%) patients were taking VKA at stroke onset. Their INR was higher than pa-tients without VKA treatment (1.66 vs. 1.04, p<0.01). Patients taking VKA had less frequent good outcome (39% vs 56.5%, p=0.031), higher mortality (29.3% vs. 15.9%, p= 0.029) and higher sICH (12.8% vs. 6.2%, p=0.17) compared with patients not taking VKA. However, VKA treatment was not independently associated to these variables in the multivariate analysis. In patients taking VKA, INR at admission was not associated to outcome or sICH. Treatment modality was not significant-ly associated to outcome, although patients receiving IVt plus rescue MT had a tendency for worse outcome in comparison with elective MT or isolated IVt. Moreover, sICH was more frequent in this group. Discussion: Reperfusion therapy is safe in patients taking VKA. Outcome and hemorrhage is not related to baseline INR. MT is a good treatment choice in patients taking VKA that have a proximal arterial occlusion.
Karger_ESC London_2013
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