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Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
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  7. Cardiovascular Medicine And Haematology
  9. Cardiovascular Medicine And Haematology Not Elsewhere Classified
  11. Thrombectomy Versus Combined Thrombolysis And Thrombectomy In Patients With Large Vessel Occlusion And Chronic Kidney Disease.
  1. Home
  3. Research Domains
  5. Biomedical And Clinical Sciences
  7. Cardiovascular Medicine And Haematology
  9. Cardiovascular Medicine And Haematology Not Elsewhere Classified
  11. Thrombectomy Versus Combined Thrombolysis And Thrombectomy In Patients With Large Vessel Occlusion And Chronic Kidney Disease.

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Thrombectomy versus combined thrombolysis and thrombectomy in patients with large vessel occlusion and chronic kidney disease.

Jiali Niu1, Kaixia Chen2, Jian Wu3

  • 1Department of Clinical Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China.

Heliyon
|February 26, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Bridging patients with large vessel occlusion (LVO) and chronic kidney disease (CKD) with intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) improved their long-term outcomes and reperfusion rates. This combined approach showed better functional recovery compared to direct mechanical thrombectomy alone.

Keywords:
Acute ischemic strokeChronic kidney diseaseIntravenous thrombolysisLarge vessel occlusion

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Area of Science:

  • Neurology
  • Nephrology
  • Interventional Cardiology

Background:

  • Uncertainty exists regarding the optimal treatment strategy for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) and chronic kidney disease (CKD).
  • The decision to administer intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) in this specific patient population requires further investigation.

Purpose of the Study:

  • To compare the efficacy and safety of bridging IVT followed by MT versus direct MT in AIS patients with LVO and CKD.
  • To evaluate long-term functional outcomes, reperfusion rates, and the incidence of symptomatic intracranial hemorrhage (sICH).

Main Methods:

  • Systematic enrollment of AIS patients with LVO and CKD who underwent MT between January 2015 and December 2022.
  • Categorization into two cohorts: direct MT and combined IVT + MT.
Mechanical thrombectomy
  • Propensity score matching (PSM) and binary logistic regression were used to adjust for confounders and assess outcomes.

    • Main Results:

    • After PSM, 170 patients were in each group, with well-balanced clinical characteristics.
    • The IVT + MT group demonstrated significantly better long-term functional outcomes (35.9% vs. 21.2%, P = 0.003) and higher rates of successful reperfusion (mTICI 2b-3: 94.1% vs. 87.6%, P = 0.038).
    • No significant difference in sICH was observed between the groups.

    Conclusions:

    • Bridging IVT before MT in LVO patients with CKD and IVT indications improves prognosis compared to direct MT.
    • The combined IVT + MT strategy offers superior clinical outcomes and reperfusion in this high-risk patient group.