- Title
- Comparison of functional outcomes after endovascular thrombectomy in patients with and without atrial fibrillation
- Creator
- Fu, James; Cappelen-Smith, Cecilia; Edwards, Leon; Cheung, Andrew; Manning, Nathan; Wenderoth, Jason; Parsons, Mark; Cordato, Dennis
- Relation
- Vessel Plus Vol. 5, no. 33
- Publisher Link
- http://dx.doi.org/10.20517/2574-1209.2021.36
- Publisher
- OAE Publishing
- Resource Type
- journal article
- Date
- 2021
- Description
- Aim: Patients with atrial fibrillation (AF) are over-represented in endovascular thrombectomy (EVT) populations, due to a high prevalence of large vessel occlusions (LVO) and contraindication to intravenous thrombolysis. This study aimed to: (1) compare 90-day functional outcomes [modified Rankin Score (mRS) 0-2] and mortality in AF vs. non-AF patients receiving EVT; (2) compare 90-day functional outcomes and mortality in AF patients on therapeutic vs. non-therapeutic anticoagulation receiving EVT; and (3) identify factors influencing outcomes in AF patients receiving EVT. Methods: A retrospective analysis of 394 consecutive patients who received EVT for anterior cerebral circulation LVO at an Australian comprehensive stroke center was performed. The main outcome measures [90-day dichotomized mRS (0-2 good; 3-6 poor functional outcome) and mortality] were compared between AF and non-AF patients, as well as between therapeutic and non-therapeutic anticoagulation cohorts. Results: In total, 171 (49%) EVT patients had AF. Patients with AF were older, had higher NIHSS, and had lower rates of thrombolysis administration. AF patients showed improved 90-day mRS on multivariate analysis [aOR 1.988 (1.167-3.387)], with similar symptomatic intracranial hemorrhage (sICH) [aOR 0.364 (0.064-2.086)] and mortality [aOR 1.454 (0.785-2.696)]. There was no difference in 90-day mRS [aOR 1.402 (0.625-3.145)], successful reperfusion rates [aOR 3.761 (0.661-21.410)], or mortality [aOR 1.077 (0.429-2.705)] between AF patients on therapeutic vs. non-therapeutic anticoagulation. In patients with AF, advancing age and higher NIHSS were independent predictors of worse 90-day functional outcome (OR = 1.045, P = 0.020; OR = 1.086, P = 0.001) and mortality (OR = 1.138, P < 0.001; OR = 1.107, P = 0.002). On multivariate analysis, thrombolysis administration improved mortality (OR = 0.215, P = 0.016) but not functional outcomes. Conclusion: Patients with AF showed improved 90-day functional outcome, with similar mortality and sICH, after EVT. Therapeutic anticoagulation did not adversely influence EVT outcomes.
- Subject
- endovascular thrombectomy; atrial fibrillation; anticoagulation; functional outcomes; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1442512
- Identifier
- uon:41708
- Identifier
- ISSN:2574-1209
- Language
- eng
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