Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion
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ORIGINAL ARTICLE
Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion Shinichi Yoshimura 1 & Kazutaka Uchida 1,2 & Nobuyuki Sakai 3 & Hirotoshi Imamura 3 & Hiroshi Yamagami 4,5 & Kanta Tanaka 4 & Masayuki Ezura 6 & Tadashi Nonaka 7 & Yasushi Matsumoto 8 & Masunari Shibata 9 & Hajime Ohta 10 & Masafumi Morimoto 11 & Norihito Fukawa 12 & Taketo Hatano 13 & Yukiko Enomoto 14 & Masataka Takeuchi 15 & Takahiro Ota 16 & Fuminori Shimizu 17 & Naoto Kimura 18 & Yuki Kamiya 19 & Norito Shimamura 20 & Takeshi Morimoto 2 Received: 19 May 2020 / Revised: 29 July 2020 / Accepted: 31 July 2020 # The Author(s) 2020
Abstract Early administration of direct oral anticoagulants in patients with acute large vessel occlusion (LVO) and nonvalvular atrial fibrillation (NVAF) is a concern, as endovascular therapy (EVT) became highly utilized. We conducted a historical and prospective multicenter registry at 38 centers in Japan from July 2016 to February 2018. Patients aged ≥ 20 years with NVAF and acute LVO or stenosis who received apixaban within 14 days from onset were included. We compared patients who received apixaban < 48 h (Early group) and ≥ 48 h (Late group) after onset in terms of the primary outcome (a composite of ischemic events, major bleeding events, and all-cause deaths). The secondary outcomes were each component of the primary outcome. Among the 686 patients, the median time from onset to administration was 2.5 days (range, 0–14; Early 263, Late 423). The Alberta Stroke Program Early CT Score (ASPECTS) and diffusion-weighted imaging (DWI)-ASPECTS) were significantly higher in the Early group than in the Late group. Recombinant tissue plasminogen activator (rt-PA) and EVT were more utilized in the Early group (rt-PA 46% vs. 35%, p = 0.003; EVT 62% vs. 46%, p < 0.0001). The cumulative incidence of primary outcome was similar between groups (ischemic events: Early 1.9% vs. Late 0.5% at 30 days; 3.5% vs. 0.7% at 90 days, major bleeding 3.4% vs. 2.9% at 30 days; 5.0% vs. 3.4% at 90 days). Early administration of apixaban (< 48 h), after onset of acute LVO in patients with NVAF, was generally safe compared with those who received it Late (≥ 48 h). http://www.clinicaltrials.gov. Unique identifier: NCT02818868 (June 30, 2016) Keywords Acute large vessel occlusion . Apixaban . Bleeding . Stroke
Introduction Observational studies have evaluated the efficacy of several direct oral anticoagulants (DOACs) in patients with acute ischemic stroke caused by nonvalvular atrial fibrillation (NVAF). However, the optimal timing to start anticoagulants for such patients remains unclear [1–3]. Particularly, this issue is more important for patients with acute stroke due to large vessel occlusion (LVO), a more severe form, having a higher Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12975-020-00839-4) contains supplementary material, which is available to authorized users. * Takeshi Morimoto [email protected] Extended author i
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