Thrombolysis after dabigatran reversal: A nation-wide Italian multicentre study, systematic review and meta-analysis-Reference-Cited by-同舟云学术

Thrombolysis after dabigatran reversal: A nation-wide Italian multicentre study, systematic review and meta-analysis

Published:2022-10-29 Issue:1 Volume:8 Page:117-124
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Romoli Michele¹^ORCID,Matteo Eleonora²,Migliaccio Ludovica³,Gentile Mauro³,Mosconi Maria Giulia⁴,Scura Giuseppe Maria⁴,Naccarato Marcello⁵,Colangeli Enrico⁶,Candelaresi Paolo⁷,Andreone Vincenzo⁷,Giammello Fabrizio⁸^ORCID,Fortunata Musolino Rosa⁸,Dell’Aera Cristina⁸,Sepe Federica Nicoletta⁹,Pronello Edoardo⁹,Barbarini Leonardo¹⁰,Caggiula Marcella¹⁰,Rizzo Federica¹¹,Petruzzellis Marco¹¹,Giorli Elisa¹²,Zedde Maria Luisa¹³^ORCID,Anticoli Sabrina¹⁴,Mangiardi Marilena¹⁴,Muto Mario¹⁵,Diana Francesco¹⁶,De Angelis Maria Vittoria¹⁷,Digiovanni Anna¹⁷,Concari Letizia¹⁸,La Gioia Sara¹⁹,Sessa Maria¹⁹,Biguzzi Sara¹,Cordici Francesco¹,Longoni Marco¹,Ruggiero Maria²⁰^ORCID,Cenciarelli Silvia²¹,Eusebi Paolo²²,Sacco Simona⁶^ORCID,Caso Valeria⁴,Paciaroni Maurizio⁴,Ricci Stefano²,Zini Andrea³,Toni Danilo²³,Giannandrea David²¹^ORCID

Affiliation:

1. Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy

2. Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy

3. IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Bologna, Italy

4. Medicina Vascolare e d’Urgenza, Stroke Unit, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Perugia, Italy

5. Neurology and Stroke Unit, Department of Medical, Surgical and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy

6. University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences, L’Aquila, Italy

7. UOC Neurologia e Stroke Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy

8. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

9. Stroke Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

10. UOC Neurologia- PO Vito Fazzi, Lecce, Italy

11. UOC Neurologia e Stroke Unit “F. Puca” AOU Consorziale Policlinico Bari, Bari, Italy

12. SC Neurologia, Ospedale S. Andrea, La Spezia, Italy

13. S.C Neurologia, Stroke Unit, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy

14. Stroke Unit, Head, Neck and Neuroscience Department, San Camillo Forlanini Hospital, Rome, Italy

15. UOC Neuroradiologia diagnostica ed interventistica, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy

16. Neuroradioly, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy

17. Department of Neurology, SS Annunziata Hospital, Chieti, Italy

18. SC Neurologia, Azienda Ospedaliera Universitaria di Parma, Parma, Italy

19. UOC Neurologia, Stroke Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

20. Neuroradiologia, Ospedale Bufalini, Cesena, Italy

21. Neurologia e Stroke Unit, Ospedale di Gubbio e Città di Castello, USL Umbria 1, Perugia, Italy

22. Umbria Regional Health Authority, Perugia, Italy

23. Stroke Unit, Emergency Department, Sapienza University of Rome, Roma, Italy

Abstract

Introduction: Recent anticoagulant intake represents a contraindication for thrombolysis in acute ischemic stroke. Idarucizumab reverses the anticoagulant effect of dabigatran, potentially allowing for thrombolysis. This nation-wide observational cohort study, systematic review, and meta-analysis evaluated the efficacy and safety of thrombolysis preceded by dabigatran-reversal in people with acute ischemic stroke. Patients and methods: We recruited people undergoing thrombolysis following dabigatran-reversal at 17 stroke centers in Italy (reversal-group), people on dabigatran treated with thrombolysis without reversal (no-reversal group), and age, sex, hypertension, stroke severity, and reperfusion treatment-matched controls in 1:7 ratio (control-group). We compared groups for symptomatic intracranial hemorrhage (sICH, main outcome), any brain hemorrhage, good functional outcome (mRS 0–2 at 3 months), and death. The systematic review followed a predefined protocol (CRD42017060274), and odds ratio (OR) meta-analysis was implemented to compare groups. Results: Thirty-nine patients in dabigatran-reversal group and 300 matched controls were included. Reversal was associated with a non-significant increase in sICH (10.3% vs 6%, aOR = 1.32, 95% CI = 0.39–4.52), death (17.9% vs 10%, aOR = 0.77, 95% CI = 0.12–4.93) and good functional outcome (64.1% vs 52.8%, aOR = 1.41, 95% CI = 0.63–3.19). No hemorrhagic events or deaths were registered in no-reversal group (n = 12). Pooling data from 3 studies after systematic review (n = 1879), reversal carried a non-significant trend for sICH (OR = 1.53, 95% CI = 0.67–3.50), death (OR = 1.53, 95% CI = 0.73–3.24) and good functional outcome (OR = 2.46, 95% CI = 0.85–7.16). Discussion and conclusion: People treated with reperfusion strategies after dabigatran reversal with idarucizumab seem to have a marginal increase in the risk of sICH but comparable functional recovery to matched patients with stroke. Further studies are needed to define treatment cost-effectiveness and potential thresholds in plasma dabigatran concentration for reversal.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/23969873221131635

Reference23 articles.

1. Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation

2. Idarucizumab for Dabigatran Reversal — Full Cohort Analysis

3. Intravenous thrombolysis in stroke after dabigatran reversal with idarucizumab: case series and systematic review

4. Stroke reperfusion therapy following dabigatran reversal with idarucizumab in a national cohort

5. Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany—Updated series of 120 cases

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