Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-08-07

AUTHORS

Shinichi Yoshimura, Kazutaka Uchida, Nobuyuki Sakai, Hirotoshi Imamura, Hiroshi Yamagami, Kanta Tanaka, Masayuki Ezura, Tadashi Nonaka, Yasushi Matsumoto, Masunari Shibata, Hajime Ohta, Masafumi Morimoto, Norihito Fukawa, Taketo Hatano, Yukiko Enomoto, Masataka Takeuchi, Takahiro Ota, Fuminori Shimizu, Naoto Kimura, Yuki Kamiya, Norito Shimamura, Takeshi Morimoto

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) More... »

PAGES

266-274

Journal

TITLE

Translational Stroke Research

ISSUE

2

VOLUME

12

Author Affiliations

  • Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
  • Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, 663-8501, Nishinomiya, Hyogo, Japan
  • Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
  • Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
  • Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
  • Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
  • Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Japan
  • Department of Neuroendovascular Therapy, Kohnan Hospital, Miyagi, Japan
  • Department of Neurology, Tenri Yorozu Hospital, Nara, Japan
  • Department of Neurosurgery, Division of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan
  • Department of Neurosurgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
  • Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
  • Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
  • Department of Neurosurgery, Seishou Hospital, Odawara, Japan
  • Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
  • Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
  • Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
  • Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
  • Department of Neurosurgery, Hirosaki University Hospital, Hirosaki, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s12975-020-00839-4

    DOI

    http://dx.doi.org/10.1007/s12975-020-00839-4

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1129926530

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/32766953


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