Oral Anticoagulants – A Frequent Challenge for the Emergency Management of Acute Ischemic Stroke
| العنوان: | Oral Anticoagulants – A Frequent Challenge for the Emergency Management of Acute Ischemic Stroke |
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| المؤلفون: | Markus A Möhlenbruch, Roland Veltkamp, Werner Hacke, Marcia Spindler, Christoph Gumbinger, Peter A. Ringleb, Timolaos Rizos, Solveig Horstmann, Ekkehart Jenetzky |
| المصدر: | Cerebrovascular Diseases. 34:411-418 |
| بيانات النشر: | S. Karger AG, 2012. |
| سنة النشر: | 2012 |
| مصطلحات موضوعية: | Male, Emergency Medical Services, medicine.medical_specialty, Time Factors, MEDLINE, Administration, Oral, Hemorrhage, Tissue plasminogen activator, Brain Ischemia, Brain ischemia, 610 Medical sciences Medicine, Risk Factors, medicine, Emergency medical services, Humans, Prospective Studies, Prospective cohort study, Intensive care medicine, Acute ischemic stroke, Stroke, Aged, Aged, 80 and over, Emergency management, business.industry, Anticoagulants, Middle Aged, medicine.disease, Neurology, Tissue Plasminogen Activator, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, medicine.drug |
| الوصف: | Background: The emergency management of patients with acute ischemic stroke (IS) using oral anticoagulants (OAC) represents a great challenge. Effective anticoagulation predisposes to bleeding and represents a contraindication for systemic thrombolysis. However, patients on OAC can receive intravenous thrombolysis with recombinant tissue-type plasminogen activator if the international normalized ratio (INR) does not exceed 1.7, but data regarding the risk of hemorrhagic complications are highly controversial. Neurointerventional recanalization of intracranial artery occlusion represents an alternative option in OAC patients with acute IS. The proportion of OAC users among consecutive patients who suffer from acute IS or transient ichemic attacks (TIA) is unknown. Methods: A prospective observational study, consecutively enrolling all patients with IS or TIA admitted to our neurological emergency room (ER), was performed between August 2009 and February 2011. Basic demographic variables, present use of OAC, severity of stroke, cardiovascular risk factors, INR values and the symptom onset to presentation time were recorded. In IS patients on OAC presenting within 4.5 h after symptom onset, management was analyzed. In thrombolysed IS patients, bleeding events were documented. Outcome was assessed after 3 months. Results: During the study period, 12,237 patients were admitted to our neurological ER. IS or TIA were diagnosed in 2,074 (16.9%). Complete data were available for 1,914 of these subjects (92.3%); 53.8% were male (median age: 72 years). 69.7% suffered IS, 30.3% TIA. OAC were being used by 8.7% of all patients. OAC patients were older than non-OAC patients (78 vs. 72 years, p < 0.001). Subtherapeutic INR values (Conclusions: Oral anticoagulation represents a frequent challenge for the emergency manangement of IS. A considerable proportion of anticoagulated IS patients appears to be eligible for thrombolysis. Establishing standardized treatment procedures in these patients is warranted. |
| وصف الملف: | application/pdf |
| تدمد: | 1421-9786 1015-9770 |
| DOI: | 10.1159/000343655 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::82bc6f41d45c6899abc0beb14034e6a6 https://doi.org/10.1159/000343655 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....82bc6f41d45c6899abc0beb14034e6a6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14219786 10159770 |
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| DOI: | 10.1159/000343655 |