Please use this identifier to cite or link to this item: https://doi.org/10.1002/ana.23924
Title: Safety of intravenous thrombolysis for ischemic stroke in patients treated with warfarin
Authors: Mazya, M.V.
Lees, K.R.
Markus, R.
Roine, R.O.
Seet, R.C.S. 
Wahlgren, N.
Ahmed, N.
Issue Date: Aug-2013
Source: Mazya, M.V., Lees, K.R., Markus, R., Roine, R.O., Seet, R.C.S., Wahlgren, N., Ahmed, N. (2013-08). Safety of intravenous thrombolysis for ischemic stroke in patients treated with warfarin. Annals of Neurology 74 (2) : 266-274. ScholarBank@NUS Repository. https://doi.org/10.1002/ana.23924
Abstract: Objective Controversy surrounds the safety of intravenous (IV) tissue plasminogen activator (tPA) in ischemic stroke patients treated with warfarin. The European tPA license precludes its use in anticoagulated patients altogether. American guidelines accept IV tPA use with an international normalized ratio (INR) ≤ 1.7. The influence of warfarin on symptomatic intracerebral hemorrhage (SICH), arterial recanalization, and long-term functional outcome in stroke thrombolysis remains unclear. Methods We analyzed data from 45,074 patients treated with IV tPA enrolled in the Safe Implementation of Thrombolysis in Stroke (SITS) International Stroke Thrombolysis Register. A total of 768 patients had baseline warfarin treatment with INR ≤ 1.7. Outcome measures were SICH, arterial recanalization, mortality, and functional independence at 3 months. Results Patients on warfarin with INR ≤ 1.7 were older, had more comorbidities, and had more severe strokes compared to patients without warfarin. There were no significant differences between patients with and without warfarin in SICH rates (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI] = 0.72-2.11 per SITS-MOST; aOR = 1.26, 95% CI = 0.82-1.70 per European Cooperative Acute Stroke Study II) after adjustment for age, stroke severity, and comorbidities. Neither did warfarin independently influence mortality (aOR = 1.05, 95% CI = 0.83-1.35) or functional independence at 3 months (aOR = 1.01, 95% CI = 0.81-1.24). Arterial recanalization by computed tomography/magnetic resonance angiography trended higher in warfarin patients (62% [37 of 59] vs 55% [776/1,475], p = 0.066). Recanalization approximated by disappearance at 22 to 36 hours of a baseline hyperdense middle cerebral artery sign was increased (63% [124 of 196] vs 55% [3,901 of 7,099], p = 0.022). Interpretation Warfarin treatment with INR ≤ 1.7 did not increase the risk for SICH or death, and had no impact on long-term functional outcome in patients treated with IV tPA for acute ischemic stroke. © 2013 American Neurological Association.
Source Title: Annals of Neurology
URI: http://scholarbank.nus.edu.sg/handle/10635/126851
ISSN: 03645134
DOI: 10.1002/ana.23924
Appears in Collections:Staff Publications

Show full item record
Files in This Item:
There are no files associated with this item.

SCOPUSTM   
Citations

29
checked on Jan 16, 2018

WEB OF SCIENCETM
Citations

24
checked on Nov 17, 2017

Page view(s)

13
checked on Jan 13, 2018

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.