Increased intracranial hemorrhage of mechanical thrombectomy in acute ischemic stroke patients with atrial fibrillation
- PDF / 1,336,841 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 78 Downloads / 212 Views
Increased intracranial hemorrhage of mechanical thrombectomy in acute ischemic stroke patients with atrial fibrillation Kangmo Huang1 · Mingming Zha2 · Jie Gao1 · Juan Du1 · Rui Liu1 · Xinfeng Liu1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The impact of atrial fibrillation (AF) on outcomes of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is controversial, and with a paucity of evidence base. This study aimed to investigate the potential association between AF and outcomes after MT in AIS patients. A post-hoc analysis of a multi-center prospective clinical trial was conducted. Before and after propensity score matching (PSM), the clinical features were compared between patients with and without AF. Multivariable logistic regression and mediation analyses were performed to assess the relationship between AF and ICH. Of the total 245 patients, 123 patients were included in the AF group. After PSM, the AF group showed more retrieval attempts (P = 0.004), comparable favorable outcome (P = 0.493), and mortality (P = 0.362) at 90 days. Multivariate analysis revealed that AF was significantly associated with increased risk for ICH (OR 2.198; 95%CI 1.099–4.395; P = 0.026). INR and retrieval attempts were found to act as partial mediations. In the subgroup with lower INR, AF still had a significant association with ICH (OR 2.496; 95%CI 1.331–4.679; P = 0.004). In AIS patients undergoing MT, AF was associated with more retrieval attempts and higher risk of any ICH. Of note, the effect of AF on the increased risk of ICH was partly attributable to the adjusted anticoagulation status and more retrieval attempts. It is crucial to elaborately prevent ICH after thrombectomy for stroke patients with AF. Keywords Atrial fibrillation · Ischemic stroke · Mechanical thrombectomy · Intracranial hemorrhage
Highlights • The study was a post hoc analysis of a prospective multi-
center thrombectomy device trial.
Kangmo Huang and Mingming Zha contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02269-3) contains supplementary material, which is available to authorized users. * Rui Liu [email protected] * Xinfeng Liu [email protected] 1
Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Xuanwu District, No. 305 Zhongshandong Road, Nanjing 210002, China
Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
2
• The study appropriately uses propensity score analyses
and mediation analysis to confirm the robust association between AF and ICH. • INR value and retrieval attempts act as partial mediations between AF and increased risk of ICH. • Our results emphasize the importance of elaborately preventing ICH after mechanical thrombectomy for stroke patients with AF.
Introduction Atrial fibrillation (AF) is a major risk factor for acute ischemic stroke (AIS) and is associated with about a five fold in
Data Loading...
