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VKA Use and Intracranial Hemorrhage After Endovascular Thrombectomy

Among 32,715 patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke, recent use of vitamin K antagonists (VKAs) was not associated with significantly increased risk of symptomatic intracranial hemorrhage (sICH), researchers report. “However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants,” the authors conclude.

The study was based on the American Heart Association’s Get With the Guidelines–Stroke Program and used retrospective cohort analysis of data from 594 U.S. hospitals between Oct. 2015 and Mar. 2020. VKA use within 7 days before hospital arrival showed these effects on a primary endpoint of sICH: “Of 32,715 patients (median age, 72 years; 50.7% female), 3,087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29,628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211/3,087 patients [6.8%] taking a VKA compared with 1,904/29,628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, −0.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n = 1,585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, −0.79% to 3.04%]).…”

Source: JAMA